“通督调神针法”治疗急性脑梗死临床疗效观察及其对自噬的影响
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摘要
目的:观察"通督调神针法"与常规针刺治疗急性脑梗死患者的临床疗效差异及其与自噬的关系。方法:将60例急性脑梗死患者分为观察组(30例,2例脱落)与对照组(30例,3例脱落)。两组均采用常规药物治疗。观察组穴取大椎、风池、强间、百会、神庭、印堂、水沟、曲池(患侧)、合谷(患侧)、足三里(患侧),将百会和印堂连接电针仪,30 min后去除电针及非督脉穴位针,继续留督脉穴位针20 min,每隔5 min捻转1次,每次1 min。对照组穴取百会、印堂、曲池(患侧)、外关(患侧)、手三里(患侧)、合谷、足三里、三阴交(患侧)、太溪(患侧)、太冲(患侧),足三里、合谷加电针仪,每次留针30 min。每天治疗1次,连续治疗10 d。观察两组患者治疗前后美国国立卫生院神经功能缺损评分量表(National Institute of Health stroke scale,NIHSS)、简易智能精神状态检查量表(mini-mental state examimation,MMSE)、改良Barthel指数(modified Barthel index,MBI)评分,并评定外周血清中微管相关蛋白1轻链3-Ⅱ(LC3-Ⅱ)和自噬相关蛋白Beclin1表达量的变化及临床疗效。结果:治疗后两组NIHSS评分均低于治疗前,MBI评分、MMSE评分均高于治疗前(均P<0.01),且观察组均优于对照组(均P<0.05)。治疗后两组患者LC3-Ⅱ、Beclin1表达量均高于治疗前(均P<0.01),且观察组均高于对照组(均P<0.05)。治疗后观察组总有效率为92.9%(26/28),优于对照组的70.4%(19/27,P<0.05)。结论:"通督调神针法"减轻急性脑梗死患者临床症状优于常规针刺,可能与自噬体数量增加、自噬活性增强有关。
Objective To observe the difference of clinical efficacy between "Tongdu Tiaoshen needles therapy" and conventional acupuncture in patients with acute cerebral infarction(ACI) and its relationship with autophagy. Methods Sixty patients with ACI were randomly divided into an observation group(30 cases and 2 dropping) and a control group(30 cases and 3 dropping). Conventional drugs were applied in the two groups. In the observation group, acupuncture was applied at Dazhui(GV 14), Fengchi(GB 20), Qiangjian(GV 18), Baihui(GV 20), Shenting(GV 24), Yintang(GV 29), Shuigou(GV 26), Quchi(LI 11, affected side), Hegu(LI 4, affected side), Zusanli(ST 36, affected side), and EA was connected at Baihui(GV 20) and Yintang(GV 29). After 30 min, the EA and non-governor vessel acupoints were removed, and the governor vessel points were continued for 20 min. Twirling was used twice every 5 min, 1 min a time. In the control group, acupuncture was applied at Baihui(GV 20), Yintang(GV 29), Quchi(LI 11, affected side), Waiguan(TE 5, affected side), Shousanli(LI 10, affected side), Hegu(LI 4), Zusanli(ST 36), Sanyinjiao(SP 6, affected side), Taixi(KI 3, affected side), Taichong(LR 3, affected side). EA was connected at Zusanli(ST 36) and Hegu(LI 4). The treatment was given for 10 days,once every day with needle retained for 30 min. National Institute of Health stroke scale(NIHSS), mini-mental state examination(MMSE), modified Barthel index(MBI) scores were observed before and after treatment in the two groups. The clinical efficacy, the changes of contents of LC3-Ⅱ and Beclin1 in peripheral serum were judged. Results After treatment, NIHSS score was lower than that before treatment, and MMSE score and MBI score were higher than those before treatment(all P<0.01), and the result in the observation group was better than that in the control group(all P<0.05). Contents of LC3-Ⅱ and Beclin1 in peripheral serum were higher than those before treatment in the two groups(both P<0.01), and the result in the observation group was better than that in the control group(both P<0.05). The total effective rate in the observation group was 92.9%(26/28), which was better than 70.4%(19/27) in the control group(both P<0.05). Conclusion "Tiaoshen Tongdu needles therapy" have better effect to relieve the clinical symptoms of patients with acute cerebral infarction than conventional acupuncture, which may be related to the increasing number of autophagic bodies and autophagy activity.
Objective To observe the difference of clinical efficacy between "Tongdu Tiaoshen needles therapy" and conventional acupuncture in patients with acute cerebral infarction(ACI) and its relationship with autophagy. Methods Sixty patients with ACI were randomly divided into an observation group(30 cases and 2 dropping) and a control group(30 cases and 3 dropping). Conventional drugs were applied in the two groups. In the observation group, acupuncture was applied at Dazhui(GV 14), Fengchi(GB 20), Qiangjian(GV 18), Baihui(GV 20), Shenting(GV 24), Yintang(GV 29), Shuigou(GV 26), Quchi(LI 11, affected side), Hegu(LI 4, affected side), Zusanli(ST 36, affected side), and EA was connected at Baihui(GV 20) and Yintang(GV 29). After 30 min, the EA and non-governor vessel acupoints were removed, and the governor vessel points were continued for 20 min. Twirling was used twice every 5 min, 1 min a time. In the control group, acupuncture was applied at Baihui(GV 20), Yintang(GV 29), Quchi(LI 11, affected side), Waiguan(TE 5, affected side), Shousanli(LI 10, affected side), Hegu(LI 4), Zusanli(ST 36), Sanyinjiao(SP 6, affected side), Taixi(KI 3, affected side), Taichong(LR 3, affected side). EA was connected at Zusanli(ST 36) and Hegu(LI 4). The treatment was given for 10 days,once every day with needle retained for 30 min. National Institute of Health stroke scale(NIHSS), mini-mental state examination(MMSE), modified Barthel index(MBI) scores were observed before and after treatment in the two groups. The clinical efficacy, the changes of contents of LC3-Ⅱ and Beclin1 in peripheral serum were judged. Results After treatment, NIHSS score was lower than that before treatment, and MMSE score and MBI score were higher than those before treatment(all P<0.01), and the result in the observation group was better than that in the control group(all P<0.05). Contents of LC3-Ⅱ and Beclin1 in peripheral serum were higher than those before treatment in the two groups(both P<0.01), and the result in the observation group was better than that in the control group(both P<0.05). The total effective rate in the observation group was 92.9%(26/28), which was better than 70.4%(19/27) in the control group(both P<0.05). Conclusion "Tiaoshen Tongdu needles therapy" have better effect to relieve the clinical symptoms of patients with acute cerebral infarction than conventional acupuncture, which may be related to the increasing number of autophagic bodies and autophagy activity.
引文
[1]曹树刚,徐文安,王嵘峰,等.急性双侧对称性脑梗死的发病机制探讨[J].卒中与神经疾病,2014,21(3):148-153.
[2]Kang J,Park TH,Lee KB,et al.Symptomatic steno-oc-clusion in patients with acute cerebral infarction:prevalence,Distribution,and functional outcome[J].JOS,2014,6(1):36-43.
[3]张秋月.急性脑梗死治疗的研究进展[J].数理医药学杂志,2015,28(6):742-743.
[4]甘伟,王海英.电针结合康复治疗对早期急性脑梗死患者白细胞黏附分子CD11b、CD18和肿瘤坏死因子-α表达水平的影响[J].中国老年学杂志,2013,33(6):1439-1440.
[5]刘奕蕾,谢宗亮.通督调神针法对中风后轻度认知障碍临床疗效观察[J].中医药临床杂志,2017,29(4):495-497.
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[7]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
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[10]闵瑜,燕铁斌.改良Barthel指数表及其评分标准[J].广东省康复医学会会刊,2006,2:6-9.
[11]姚恺,邬军锋,杨晓波,等.神经保护剂治疗急性脑梗死患者的疗效及安全性[J].中国老年学杂志,2012,32(19):4137-4139.
[12]程红亮,胡培佳,张闻东,等.通督调神针法治疗后循环缺血性眩晕临床研究[J].中医药临床杂志,2013,25(3):208-210.
[13]冯晓东,吴明莉.督灸对脑卒中后认知障碍的临床疗效[J].中国康复理论与实践,2014,20(10):960-962.
[14]黄文雄,余秀梅,植奇明.通督调神针法治疗脑卒中后抑郁疗效观察[J].针灸临床杂志,2017,33(4):13-16.
[15]关战立.化瘀通络汤联合西医治疗缺血性卒中的疗效及神经功能恢复观察[J].光明中医,2016,31(16):2398-2400.
[16]付中应,李向荣,吴清明,等.化痰通络汤联合针刺治疗缺血性中风急性期偏瘫30例临床观察[J].中医药导报,2015,21(15):59-61.
[17]邓树荣,王贤明,李洪韬,等.中西医结合治疗对急性缺血性脑卒中的临床综合干预效果评价[J].海南医学院学报,2013,19(4):470-477.
[18]代蓉,孙海梅,莫天才,等.电针结合运动疗法对急性脑卒中患者肢体功能的影响[J].云南医药,2016,37(1):8-12.
[19]王娇,周国平,吴春晓,等.针刺治疗脑缺血再灌注损伤机制研究[J].中医学报,2017,32(1):150-154.
[20]李春明,舒适,钱小路,等.自噬与脑缺血-再灌注损伤的研究进展[J].中国脑血管病杂志,2015,12(6):330-333.
[21]张文静,崔丽艳,张捷.自噬与缺血再灌注损伤[J].检验医学,2014,29(2):182-185.
[22]李学钊,祁全.自噬及其在中枢神经系统损伤修复中作用的研究进展[J].中国脊柱脊髓杂志,2011,21(5):412-415.
[23]郭凡,刘诚明,黄艳春,等.幽门螺杆菌根除治疗对幽门螺杆菌阳性的功能性消化不良患者疗效的Meta分析[J].中国循证医学杂志,2013,13(2):218-223.
[24]张冰缘,马丽丽,朱琳,等.自噬在缺血再灌注损伤中的研究现状[J].世界最新医学信息文摘,2017,17(26):65-66,68.
[25]王晓茹,安芳.自噬及其在脑缺血再灌注损伤中作用机制[J].神经药理学报,2016,6(1):41-48.
[26]Yan W,Zhang H,Bai X,et al.Autophagy activation isinvolved in ne-uroprotection induced by hyperbaricoxygen preconditioning against focal cerebral ischemia inrats[J].Brain Res,2011,14(2):109-121.
[27]Adhami F,Schloemer A,Kuan CK.The roles of autophagy in cerebral ischemia[J].Autophagy,2007,3(1):42-44.
[2]Kang J,Park TH,Lee KB,et al.Symptomatic steno-oc-clusion in patients with acute cerebral infarction:prevalence,Distribution,and functional outcome[J].JOS,2014,6(1):36-43.
[3]张秋月.急性脑梗死治疗的研究进展[J].数理医药学杂志,2015,28(6):742-743.
[4]甘伟,王海英.电针结合康复治疗对早期急性脑梗死患者白细胞黏附分子CD11b、CD18和肿瘤坏死因子-α表达水平的影响[J].中国老年学杂志,2013,33(6):1439-1440.
[5]刘奕蕾,谢宗亮.通督调神针法对中风后轻度认知障碍临床疗效观察[J].中医药临床杂志,2017,29(4):495-497.
[6]王拥军.脑血管病量表手册[M].北京:人民卫生出版社,2009:37.
[7]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[8]田德禄.中医内科学[M].北京:人民卫生出版社,2002.
[9]张振馨,洪霞,李辉,等.北京城乡55岁或以上居民简易智能状态检查测试结果的分布特征[J].中华精神科杂志,1999,32(19):149-152.
[10]闵瑜,燕铁斌.改良Barthel指数表及其评分标准[J].广东省康复医学会会刊,2006,2:6-9.
[11]姚恺,邬军锋,杨晓波,等.神经保护剂治疗急性脑梗死患者的疗效及安全性[J].中国老年学杂志,2012,32(19):4137-4139.
[12]程红亮,胡培佳,张闻东,等.通督调神针法治疗后循环缺血性眩晕临床研究[J].中医药临床杂志,2013,25(3):208-210.
[13]冯晓东,吴明莉.督灸对脑卒中后认知障碍的临床疗效[J].中国康复理论与实践,2014,20(10):960-962.
[14]黄文雄,余秀梅,植奇明.通督调神针法治疗脑卒中后抑郁疗效观察[J].针灸临床杂志,2017,33(4):13-16.
[15]关战立.化瘀通络汤联合西医治疗缺血性卒中的疗效及神经功能恢复观察[J].光明中医,2016,31(16):2398-2400.
[16]付中应,李向荣,吴清明,等.化痰通络汤联合针刺治疗缺血性中风急性期偏瘫30例临床观察[J].中医药导报,2015,21(15):59-61.
[17]邓树荣,王贤明,李洪韬,等.中西医结合治疗对急性缺血性脑卒中的临床综合干预效果评价[J].海南医学院学报,2013,19(4):470-477.
[18]代蓉,孙海梅,莫天才,等.电针结合运动疗法对急性脑卒中患者肢体功能的影响[J].云南医药,2016,37(1):8-12.
[19]王娇,周国平,吴春晓,等.针刺治疗脑缺血再灌注损伤机制研究[J].中医学报,2017,32(1):150-154.
[20]李春明,舒适,钱小路,等.自噬与脑缺血-再灌注损伤的研究进展[J].中国脑血管病杂志,2015,12(6):330-333.
[21]张文静,崔丽艳,张捷.自噬与缺血再灌注损伤[J].检验医学,2014,29(2):182-185.
[22]李学钊,祁全.自噬及其在中枢神经系统损伤修复中作用的研究进展[J].中国脊柱脊髓杂志,2011,21(5):412-415.
[23]郭凡,刘诚明,黄艳春,等.幽门螺杆菌根除治疗对幽门螺杆菌阳性的功能性消化不良患者疗效的Meta分析[J].中国循证医学杂志,2013,13(2):218-223.
[24]张冰缘,马丽丽,朱琳,等.自噬在缺血再灌注损伤中的研究现状[J].世界最新医学信息文摘,2017,17(26):65-66,68.
[25]王晓茹,安芳.自噬及其在脑缺血再灌注损伤中作用机制[J].神经药理学报,2016,6(1):41-48.
[26]Yan W,Zhang H,Bai X,et al.Autophagy activation isinvolved in ne-uroprotection induced by hyperbaricoxygen preconditioning against focal cerebral ischemia inrats[J].Brain Res,2011,14(2):109-121.
[27]Adhami F,Schloemer A,Kuan CK.The roles of autophagy in cerebral ischemia[J].Autophagy,2007,3(1):42-44.