温针灸对恢复期脑梗死患者脑血流灌注情况及血清ICAM-1、IGF-1的影响
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摘要
目的观察温针灸对恢复期脑梗死患者脑血流CT灌注情况及细胞间黏附分子-1(ICAM-1)、胰岛素样生长因子-1(IGF-1)水平的影响。方法将80例恢复期脑梗死患者随机分为治疗组和对照组,每组40例。对照组采用常规药物治疗及康复训练,治疗组在对照组基础上采用温针灸治疗。治疗8周后,观察两组治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、Fugl-Meyer运动功能评分法评分、脑CT灌注成像各项指标[局部脑血流量(rCBF)、局部脑血容积(rCBV)、平均通过时间(MTT)]及血清ICAM-1、IGF-1水平的变化情况。结果两组治疗后NIHSS评分、FMA评分、脑CT灌注成像各项指标及血清ICAM-1、IGF-1水平与同组治疗前比较,差异均具有统计学意义(P<0.01,P<0.05)。治疗组治疗后NIHSS评分、FMA评分、脑CT灌注成像各项指标及血清ICAM-1、IGF-1水平与对照组比较,差异均具有统计学意义(P<0.01,P<0.05)。结论温针灸可降低恢复期脑梗死患者血清ICAM-1水平,提高IGF-1水平,有效改善脑血流灌注水平,从而有助于神经功能恢复。
Objective To investigate the effect of warm needling moxibustion on cerebral blood perfusion by CT scan and the levels of serum intercellular adhesion molecule-1 (ICAM-1) and insulin-like growth factor 1 (IGF-1) in patients with cerebral infarction in the convalescent stage. Method Eighty patients with cerebral infarction in the convalescent stage were randomized into treatment and control groups, with 40 cases in each group. The control group was intervened by conventional medication plus rehabilitation training, while the treatment group was additionally given warm needling moxibustion. Before and after 8-week treatment, the national institute of health stroke scale (NIHSS) score, Fugl-Meyer assessment (FMA) of motor function score, CT indicators of cerebral blood perfusion [regional cerebral blood flow (rCBF), region cerebral blood volume (rCBV) and mean transit time (MTT)] and the levels of serum ICAM-1 and IGF-1 in the two groups were observed. Result NIHSS score, FMA score, CT indicators of cerebral blood perfusion and the levels of serum ICAM-1 and IGF-1 all showed a significant change after the treatment in the two groups (P<0.01, P<0.05). After the treatment, NIHSS score, FMA score, CT indicators of cerebral blood perfusion and the levels of serum ICAM-1 and IGF-1 in the treatment group were significantly different from those in the control group (P<0.01, P<0.05). Conclusion Warm needling moxibustion can down-regulate serum ICAM-1 level and up-regulate serum IGF-1 level in patients with cerebral infarction in the convalescent stage, and it can also effectively improve the level of cerebral blood perfusion in the patients, which helps to recover the nerve function.
Objective To investigate the effect of warm needling moxibustion on cerebral blood perfusion by CT scan and the levels of serum intercellular adhesion molecule-1 (ICAM-1) and insulin-like growth factor 1 (IGF-1) in patients with cerebral infarction in the convalescent stage. Method Eighty patients with cerebral infarction in the convalescent stage were randomized into treatment and control groups, with 40 cases in each group. The control group was intervened by conventional medication plus rehabilitation training, while the treatment group was additionally given warm needling moxibustion. Before and after 8-week treatment, the national institute of health stroke scale (NIHSS) score, Fugl-Meyer assessment (FMA) of motor function score, CT indicators of cerebral blood perfusion [regional cerebral blood flow (rCBF), region cerebral blood volume (rCBV) and mean transit time (MTT)] and the levels of serum ICAM-1 and IGF-1 in the two groups were observed. Result NIHSS score, FMA score, CT indicators of cerebral blood perfusion and the levels of serum ICAM-1 and IGF-1 all showed a significant change after the treatment in the two groups (P<0.01, P<0.05). After the treatment, NIHSS score, FMA score, CT indicators of cerebral blood perfusion and the levels of serum ICAM-1 and IGF-1 in the treatment group were significantly different from those in the control group (P<0.01, P<0.05). Conclusion Warm needling moxibustion can down-regulate serum ICAM-1 level and up-regulate serum IGF-1 level in patients with cerebral infarction in the convalescent stage, and it can also effectively improve the level of cerebral blood perfusion in the patients, which helps to recover the nerve function.
引文
[1]范军铭,乔珊,刘鹏,等.倾向评分法评价针灸治疗脑梗死疗效回顾性分析[J].中国针灸,2015,35(1):72-76.
[2]王玉莲.背俞穴温针灸对急性脑梗死患者肿瘤坏死因子-?的影响[J].光明中医,2015,30(1):114-115.
[3]尹变利.盐酸法舒地尔对急性脑梗死老年患者血清中血管细胞间黏附分子-1、细胞间黏附分子-1、内皮素-1和一氧化氮水平的影响[J].中国老年学杂志,2015,35(6):1573-1575.
[4]Kawamura T,Umemura T,Kanai A,et al.Soluble adhesion molecules and C-reactive protein in the progression of silent cerebral infarction in patients with type 2 diabetes mellitus[J].Metabolism,2006,55(4):461-466.
[5]王杰华,李国前,杨小霞,等.尤瑞克林对脑缺血再灌注大鼠脑组织中IGF-1和IGF-1R表达水平的影响及其机制[J].吉林大学学报(医学版),2015,41(2):338-342.
[6]王瑶瑶.急性脑梗死合并睡眠呼吸暂停综合征血清IGF-1水平与临床预后相关性分析[J].中国临床神经外科杂志,2016,21(10):589-592.
[7]戢运建,况娥.老年2型糖尿病合并急性脑梗死患者血清IGF-1水平与神经功能及颈动脉斑块的关系[J].卒中与神经疾病,2016,23(5):322-325.
[8]中华神经科学会,中华神经外科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[9]王赟芝.温针灸对缺血性中风患者血液流变学的影响和疗效观察[J].上海针灸杂志,2014,33(4):309-311.
[10]Zhao QS,Li W,Li D,et al.Clinical treatment efficiency of mechanical thrombectomy combined with rhPro-UKthrombolysis for acute moderate/severe cerebral infarction[J].Eur Rev Med Pharmacol Sci,2018,22(17):5740-5746.
[11]Wang K,Zhang D,Wu J,et al.A comparative study of Danhong injection and Salvia miltiorrhiza injection in the treatment of cerebral infarction:A systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(22):e7079.
[12]Meng ZY,Song WQ.Low frequency repetitive transcranial magnetic stimulation improves motor dysfunction after cerebral infarction[J].Neural Regen Res,2017,12(4):610-613.
[13]Pan N,Lu LY,Li M,et al.Xyloketal B alleviates cerebral infarction and neurologic deficits in a mouse stroke model by suppressing the ROS/TLR4/NF-κB inflamematory signaling pathway[J].Acta Pharmacol Sin,2017,38(9):1236-1247.
[14]Meloni BP,Milani D,Cross JL,et al.Assessment of the neuroprotective effects of arginine-Rich protamine peptides,poly-arginine peptides(R12-Cyclic,R22)and arginine-tryptophan-containing peptides following in vitro excitotoxicity and/or permanent middle cerebral artery occlusion in rats[J].Neuromolecular Med,2017,19(2-3):271-285.
[15]Saito Y,Aizawa Y,Monno K,et al.Small,smooth,nonmobile cardiac myxoma detected by transesophageal echocardiography following recurrent cerebral infarction:a case report[J].J Med Case Rep,2017,11(1):131.
[16]Ma LL,Song L,Yu XD,et al.The clinical study on the treatment for acute cerebral infarction by intra-arterial thrombolysis combined with mild hypothermia[J].Eur Rev Med Pharmacol Sci,2017,21(8):1999-2006.
[17]李德奎,刘跃,朱清红,等.脑梗死患者同型半胱氨酸、凝血功能、血小板参数和血液流变学指标检测的临床意义[J].国际检验学杂志,2014,35(10):1275-1276,1279.
[18]陈水金,洪昆达,龚德贵,等.温针灸配合委中穴拍打放血治疗腰椎间盘突出症43例临床观察[J].中医杂志,2015,56(12):1034-1037.
[19]宋明霞,沈友虎,胡长顺.温针灸治疗腰椎间盘突出症临床疗效观察[J].中国中医急症,2016,25(2):326-328.
[20]应海舟,黄芳,应海芬.温针灸与电针对膝关节骨性关节炎的治疗效果分析[J].浙江中医药大学学报,2015,39(2):150-152.
[21]Bo A,Si L,Wang Y,et al.Mechanism of Mongolian medical warm acupuncture in treating insomnia by regulating miR-101a in rats with insomnia[J].Exp Ther Med,2017,14(1):289-297.
[22]刘杰.温针灸联合中药复方干预恢复期脑梗死上肢功能障碍的临床观察[J].中国实用医药,2016,11(17):164-165.
[23]刘志文,费英俊,郜时华,等.温针灸结合运动疗法治疗脑卒中后肩手综合征的疗效观察[J].中国疗养医学,2013,22(2):139-140.
[24]王莉娜,冯晓东,刘承梅,等.温针灸对脑卒中后认知障碍的疗效[J].中国康复理论与实践,2015,21(2):199-201.
[25]袁艳辉.温针灸治疗缺血性脑卒中后肩手综合征临床观察[J].中国中医药信息杂志,2014,21(4):100-101.
[26]Shi L,Cao HM,Li Y,et al.Electroacupuncture improves neurovascular unit reconstruction by promoting collateral circulation and angiogenesis[J].Neural Regen Res,2017,12(12):2000-2006.
[27]范崇桂,张保朝,闪海霞,等.电针治疗对缺血性脑卒中患者功能恢复及侧支循环建立的影响[J].中华物理医学与康复杂志,2015,37(3):189-191.
[28]安娟娟.温针灸治疗脑卒中后肩手综合征疗效的系统评价与Meta分析[J].实用医药杂志,2017,34(1):22-26.
[29]薛忠文,董天崴,张琦,等.参芍口服液对冠状动脉粥样硬化大鼠主动脉IL-8、VCAM-1和ICAM-1表达的影响[J].中成药,2012,34(11):2077-2081.
[30]张丽慧,魏尔清.ICAM-1、VCAM-1在脑缺血损伤炎症机制中的作用及调控[J].中国药理学通报,2005,21(11):1281-1285.
[31]林群锋,应芝英.D-二聚体、IGF-1、IGFBP-3和SAA在急性脑梗死检测中的意义[J].现代中西医结合杂志,2015,24(34):3785-3787.
[32]刘红彬,周国胜.急性脑梗死患者IGF-1和同型半胱氨酸的水平探讨[J].中国医药指南,2015,13(21):121.
[2]王玉莲.背俞穴温针灸对急性脑梗死患者肿瘤坏死因子-?的影响[J].光明中医,2015,30(1):114-115.
[3]尹变利.盐酸法舒地尔对急性脑梗死老年患者血清中血管细胞间黏附分子-1、细胞间黏附分子-1、内皮素-1和一氧化氮水平的影响[J].中国老年学杂志,2015,35(6):1573-1575.
[4]Kawamura T,Umemura T,Kanai A,et al.Soluble adhesion molecules and C-reactive protein in the progression of silent cerebral infarction in patients with type 2 diabetes mellitus[J].Metabolism,2006,55(4):461-466.
[5]王杰华,李国前,杨小霞,等.尤瑞克林对脑缺血再灌注大鼠脑组织中IGF-1和IGF-1R表达水平的影响及其机制[J].吉林大学学报(医学版),2015,41(2):338-342.
[6]王瑶瑶.急性脑梗死合并睡眠呼吸暂停综合征血清IGF-1水平与临床预后相关性分析[J].中国临床神经外科杂志,2016,21(10):589-592.
[7]戢运建,况娥.老年2型糖尿病合并急性脑梗死患者血清IGF-1水平与神经功能及颈动脉斑块的关系[J].卒中与神经疾病,2016,23(5):322-325.
[8]中华神经科学会,中华神经外科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[9]王赟芝.温针灸对缺血性中风患者血液流变学的影响和疗效观察[J].上海针灸杂志,2014,33(4):309-311.
[10]Zhao QS,Li W,Li D,et al.Clinical treatment efficiency of mechanical thrombectomy combined with rhPro-UKthrombolysis for acute moderate/severe cerebral infarction[J].Eur Rev Med Pharmacol Sci,2018,22(17):5740-5746.
[11]Wang K,Zhang D,Wu J,et al.A comparative study of Danhong injection and Salvia miltiorrhiza injection in the treatment of cerebral infarction:A systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(22):e7079.
[12]Meng ZY,Song WQ.Low frequency repetitive transcranial magnetic stimulation improves motor dysfunction after cerebral infarction[J].Neural Regen Res,2017,12(4):610-613.
[13]Pan N,Lu LY,Li M,et al.Xyloketal B alleviates cerebral infarction and neurologic deficits in a mouse stroke model by suppressing the ROS/TLR4/NF-κB inflamematory signaling pathway[J].Acta Pharmacol Sin,2017,38(9):1236-1247.
[14]Meloni BP,Milani D,Cross JL,et al.Assessment of the neuroprotective effects of arginine-Rich protamine peptides,poly-arginine peptides(R12-Cyclic,R22)and arginine-tryptophan-containing peptides following in vitro excitotoxicity and/or permanent middle cerebral artery occlusion in rats[J].Neuromolecular Med,2017,19(2-3):271-285.
[15]Saito Y,Aizawa Y,Monno K,et al.Small,smooth,nonmobile cardiac myxoma detected by transesophageal echocardiography following recurrent cerebral infarction:a case report[J].J Med Case Rep,2017,11(1):131.
[16]Ma LL,Song L,Yu XD,et al.The clinical study on the treatment for acute cerebral infarction by intra-arterial thrombolysis combined with mild hypothermia[J].Eur Rev Med Pharmacol Sci,2017,21(8):1999-2006.
[17]李德奎,刘跃,朱清红,等.脑梗死患者同型半胱氨酸、凝血功能、血小板参数和血液流变学指标检测的临床意义[J].国际检验学杂志,2014,35(10):1275-1276,1279.
[18]陈水金,洪昆达,龚德贵,等.温针灸配合委中穴拍打放血治疗腰椎间盘突出症43例临床观察[J].中医杂志,2015,56(12):1034-1037.
[19]宋明霞,沈友虎,胡长顺.温针灸治疗腰椎间盘突出症临床疗效观察[J].中国中医急症,2016,25(2):326-328.
[20]应海舟,黄芳,应海芬.温针灸与电针对膝关节骨性关节炎的治疗效果分析[J].浙江中医药大学学报,2015,39(2):150-152.
[21]Bo A,Si L,Wang Y,et al.Mechanism of Mongolian medical warm acupuncture in treating insomnia by regulating miR-101a in rats with insomnia[J].Exp Ther Med,2017,14(1):289-297.
[22]刘杰.温针灸联合中药复方干预恢复期脑梗死上肢功能障碍的临床观察[J].中国实用医药,2016,11(17):164-165.
[23]刘志文,费英俊,郜时华,等.温针灸结合运动疗法治疗脑卒中后肩手综合征的疗效观察[J].中国疗养医学,2013,22(2):139-140.
[24]王莉娜,冯晓东,刘承梅,等.温针灸对脑卒中后认知障碍的疗效[J].中国康复理论与实践,2015,21(2):199-201.
[25]袁艳辉.温针灸治疗缺血性脑卒中后肩手综合征临床观察[J].中国中医药信息杂志,2014,21(4):100-101.
[26]Shi L,Cao HM,Li Y,et al.Electroacupuncture improves neurovascular unit reconstruction by promoting collateral circulation and angiogenesis[J].Neural Regen Res,2017,12(12):2000-2006.
[27]范崇桂,张保朝,闪海霞,等.电针治疗对缺血性脑卒中患者功能恢复及侧支循环建立的影响[J].中华物理医学与康复杂志,2015,37(3):189-191.
[28]安娟娟.温针灸治疗脑卒中后肩手综合征疗效的系统评价与Meta分析[J].实用医药杂志,2017,34(1):22-26.
[29]薛忠文,董天崴,张琦,等.参芍口服液对冠状动脉粥样硬化大鼠主动脉IL-8、VCAM-1和ICAM-1表达的影响[J].中成药,2012,34(11):2077-2081.
[30]张丽慧,魏尔清.ICAM-1、VCAM-1在脑缺血损伤炎症机制中的作用及调控[J].中国药理学通报,2005,21(11):1281-1285.
[31]林群锋,应芝英.D-二聚体、IGF-1、IGFBP-3和SAA在急性脑梗死检测中的意义[J].现代中西医结合杂志,2015,24(34):3785-3787.
[32]刘红彬,周国胜.急性脑梗死患者IGF-1和同型半胱氨酸的水平探讨[J].中国医药指南,2015,13(21):121.