针刺对轻中度高血压患者颈动脉内中膜厚度及脑血流速度的影响
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摘要
目的:观察轻中度高血压患者颈动脉内中膜厚度和脑血流速度的特点,评价针刺对颈动脉内中膜厚度和大脑中动脉、椎-基底动脉血流速度的影响。方法:对符合纳入标准的240例轻中度高血压患者,采用石学敏院士"活血散风"针刺法(取穴:人迎、曲池、合谷、足三里、太冲),每日1次,每周5次,共针刺3个月。于治疗前及治疗结束后3个月进行颈动脉彩超和经颅彩色多普勒检查,评价颈动脉内中膜厚度和脑血流速度的改善情况。结果:175例患者中,94.3%的患者出现颈动脉内中膜厚度(IMT)受损,针刺干预后,IMT改善者占7.7%～10.9%,而加重者占4.6%～6.3%,治疗前后IMT变化差异无统计学意义(P>0.05)。约50%的患者出现颅内血流速度异常,针刺干预后,27.4%～33.3%颅内动脉异常血流速度转变成正常范围,但27.0%～52.5%患者的正常血流速度转为异常血流速度。针刺干预后,41～60岁女性患者大脑中动脉(MCA)、椎动脉(VA)、基底动脉(BA)低速血流及61～70岁女性患者MCA、VA低速血流均明显改善(均P<0.05);61～70岁男性患者MCA、VA高速血流及41～60岁女性患者VA、BA高速血流明显降低(均P<0.05)。结论:已有近95%轻中度高血压患者出现了颈动脉内中膜增厚,约50%出现颅内动脉血流速度异常。目前研究尚未发现针刺对颈动脉内中膜厚度有明显改善作用,但可普遍提升女性轻中度高血压患者偏低的血流速度。
Objective To observe the characteristics of carotid intima-media thickness(IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery. Methods A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with Huoxue Sanfeng acupuncture method proposed by academician SHI Xue-min. The acupoints of Renying(ST 9), Quchi(LI 11), Hegu(LI 4), Zusanli(ST 36) and Taichong(LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity. Results Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment(P>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved(all P<0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased(all P<0.05). Conclusion Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.
Objective To observe the characteristics of carotid intima-media thickness(IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery. Methods A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with Huoxue Sanfeng acupuncture method proposed by academician SHI Xue-min. The acupoints of Renying(ST 9), Quchi(LI 11), Hegu(LI 4), Zusanli(ST 36) and Taichong(LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity. Results Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment(P>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved(all P<0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased(all P<0.05). Conclusion Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.
引文
[1]国家卫生计生委脑卒中筛查与防治工程委员会.脑卒中筛查与防治技术规范[J].中国医学前沿杂志(电子版), 2013, 5(9):44-50.
[2]刘楠,樊小农,孟智宏.针刺人迎穴为主治疗原发性高血压疗效的Meta分析[J].河南中医, 2017, 37(7):1282-1287.
[3]陈丹丹,侯献兵,申鹏飞.石学敏院士以人迎为主穴治疗高血压病的经验浅析[J].上海针灸杂志, 2016, 35(7):780-781.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志, 2011, 19(8):701-743.
[5] Chobanian AV, Bakris GL, Black HK, et al. The seventh report of the joint national committee on prevention, detection,evaluation, and treatment of high blood pressure:the JNC 7report[J]. JAMA, 2003, 289(19):2560-2571.
[6]姜玉新,冉海涛.医学超声影像学[M]. 2版.北京:人民卫生出版社, 2016.
[7]华扬.实用颈动脉与颅脑血管超声诊断学[M].北京:科学出版社, 2002.
[8]张小东.颈动脉彩超在高血压病中的临床应用价值[J].云南医药, 2013, 34(3):281-282.
[9]鲁靖.颈动脉超声和TCD在高血压无症状颅内外动脉粥样硬化中的检查意义[J].中国实用医药, 2015, 10(30):36-37.
[10]张刚,贾亚薇. 300例高血压患者脑血管狭窄TCD回顾性分析[J].山西中医学院学报, 2014, 15(5):64-66.
[11]任婷婷,高楠,王维娜,等.耳穴贴压对高血压病患者脑血管反应性影响的TCD检测研究[J].上海针灸杂志, 2014, 33(8):698-701.
[12] Terenteva N, Chernykh O, Sanchez-Gonzalez MA, et al.Acupuncture therapy improves vascular hemodynamics and stiffness in middle-age hypertensive individuals[J]. Complement Ther Clin Pract, 2018, 30:14-18.
[13]王伟志,宋平,王占奎.针灸治疗颈动脉粥样硬化斑块的临床观察[J].中国针灸, 2005, 25(5):312-314.
[2]刘楠,樊小农,孟智宏.针刺人迎穴为主治疗原发性高血压疗效的Meta分析[J].河南中医, 2017, 37(7):1282-1287.
[3]陈丹丹,侯献兵,申鹏飞.石学敏院士以人迎为主穴治疗高血压病的经验浅析[J].上海针灸杂志, 2016, 35(7):780-781.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志, 2011, 19(8):701-743.
[5] Chobanian AV, Bakris GL, Black HK, et al. The seventh report of the joint national committee on prevention, detection,evaluation, and treatment of high blood pressure:the JNC 7report[J]. JAMA, 2003, 289(19):2560-2571.
[6]姜玉新,冉海涛.医学超声影像学[M]. 2版.北京:人民卫生出版社, 2016.
[7]华扬.实用颈动脉与颅脑血管超声诊断学[M].北京:科学出版社, 2002.
[8]张小东.颈动脉彩超在高血压病中的临床应用价值[J].云南医药, 2013, 34(3):281-282.
[9]鲁靖.颈动脉超声和TCD在高血压无症状颅内外动脉粥样硬化中的检查意义[J].中国实用医药, 2015, 10(30):36-37.
[10]张刚,贾亚薇. 300例高血压患者脑血管狭窄TCD回顾性分析[J].山西中医学院学报, 2014, 15(5):64-66.
[11]任婷婷,高楠,王维娜,等.耳穴贴压对高血压病患者脑血管反应性影响的TCD检测研究[J].上海针灸杂志, 2014, 33(8):698-701.
[12] Terenteva N, Chernykh O, Sanchez-Gonzalez MA, et al.Acupuncture therapy improves vascular hemodynamics and stiffness in middle-age hypertensive individuals[J]. Complement Ther Clin Pract, 2018, 30:14-18.
[13]王伟志,宋平,王占奎.针灸治疗颈动脉粥样硬化斑块的临床观察[J].中国针灸, 2005, 25(5):312-314.