| 何加林,韩咏竹,程楠,等.通督调神针刺法治疗急性脑梗死病人的临床疗效观察及疗效机制探讨[J].安徽医药,2023,27(10):1960-1965. |
| 通督调神针刺法治疗急性脑梗死病人的临床疗效观察及疗效机制探讨 |
| Clinical observation and mechanism discussion of Tongdu Tiaoshen acupuncture therapy for acute cerebral infarction patients |
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| DOI：10.3969/j.issn.1009-6469.2023.10.012 |
| 中文关键词: 脑梗死 针刺穴位 通督调神针刺 微 RNA-320 胰岛素样生长因子 -1(IGF-1) |
| 英文关键词: Brain infarction Acupuncture points Tongdu Tiaoshen acupuncture miRNA-320 Insulin-like growth factor-1(IGF-1) |
| 基金项目:2023年合肥市中医药科研项目( 202304) |
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| 中文摘要: |
| 目的 观察通督调神针刺法治疗急性脑梗死病人的疗效，探讨通督调神针刺治疗急性脑梗死病人的疗效机制。方法 前瞻性研究 2021年 4月至 2022年 10月合肥市第一人民医院住院的 72例急性脑梗死病人按随机抽签法随机分成观察组 38法例(通督调神针刺法治疗)和对照组 34例(常规针刺法治疗)。两组病人纳入研究前均错过最佳溶栓时间窗，未给予溶栓治疗，全部给予调节血糖、血压、抗血小板聚集、稳定斑块、改善脑循环及神经保护等基础治疗。观察组按通督调神针刺法选取水沟、百会、风府、大椎、至阳、腰阳关等督脉穴位，对照组按普通针刺法选取血海、内关、极泉、尺泽、三阴交、委中等穴位，均针刺 1次/天，每次留针 40 min，每周治疗 6次，共治疗 4周。使用神经功能评分量表( NIHSS评分量表)、运动功能评分量表( FMA评分量表)和日常生活能力评分量表( MBI评分量表)对两组病人治疗前及治疗 4周后进行评分，同时测定两组病人治疗前及治疗 4周后血清微 RNA-320(miRNA-320)、胰岛素样生长因子 -1(IGF-1)的表达水平。结果治疗 4周后，对照组、观察组 NIHSS评分［(16.82±1.29)、(15.97±1.72)分］、 miRNA-320表达水平［(0.90±0.98)、(0.50±0.45)mg/L］均较治疗前［ NIHSS评分为( 17.35±1.65)、(17.53±1.66)分， miRNA-320表达( 1.86±1.47)、(1.79±1.84)mg/L］明显下降( P<0.05)且观察组 NIHSS评分、 miRNA-320表达水平降低程度均显著大于对照组( P<0.05)；两组 FMA评分、 MBI评分、 IGF-1表达水平治疗前明显升高(P<0.05)且观察组 FMA评分、 MBI评分、 IGF-1表达水平升高程度显著大于对照组( P<0.05)。治疗 4周后观察组的总有效率为 94.74均较，%(36/，38)，对照组的总有效率为 85.29%(29/34)(P<0.05)。结论通督调神针刺法和普通针刺法均能改善急性脑梗死病人神经功能、运动功能及日常生活能力，且通督调神针刺组临床疗效显著高于普通针刺组，其机制可能是通过抑制 miRNA-320表达并上调 IGF-1的表达所致。 |
| 英文摘要: |
| Objective To observe the therapeutic effect of Tongdu Tiaoshen acupuncture on patients with acute cerebral infarction, and to explore the therapeutic mechanism of Tongdu Tiaoshen acupuncture on patients with acute cerebral infarction.Methods A total of 72 patients with acute cerebral infarction who were hospitalized in the First People′s Hospital of Hefei from April 2021 to October2022 were randomly divided into observation group (38 cases) and control group (34 cases) by random drawing method. All patients inthe two groups missed the optimal thrombolysis time window before being included in the study, and did not receive thrombolysis therapy. All patients received basic treatments such as regulating blood glucose, blood pressure, anti-platelet aggregation, stabilizing plaque, improving brain circulation and neuroprotection. The observation group selected Shuigou, Baihui, Fengfu, Dazhui, Zhiyang, Yaoyang? guan and other acupuncture points according to the Tongdu Tiaoshen acupuncture method, while the control group selected Xuehai, Neiguan, Jiquan, Chize, Sanyinjiao, Weizhong and other acupuncture points according to the ordinary acupuncture method. Acupuncture was performed once a day, leaving the needle for 40 minutes each time, 6 times a week for a total of 4 weeks. Neurological function rating scale (NIHSS rating scale), motor function rating scale (FMA rating scale) and daily living ability rating scale (MBI rating scale)were used to score the two groups of patients before and 4 weeks after treatment. Serum microRNA-320 (miRNA-320) and insulin-like growth factor-1 (IGF-1) expression levels were measured before and 4 weeks after treatment in 2 groups. Results After 4 weeks of treatment, NIHSS score [(16.82±1.29), (15.97±1.72) score] and expression level of miRNA-320 [(0.90±0.98), (0.50±0.45)mg/L] in thecontrol group and observation group were significantly decreased compared with those before treatment [NIHSS score (17.35±1.65),(17.53±1.66) score, miRNA-320 (1.86±1.47), (1.79±1.84) mg/L, P<0.05], and the reduction degree of NIHSS score and expression level of miRNA-320 in the observation group was significantly greater than those in the control group (P<0.05). The levels of FMA score, MBI score and IGF-1 expression in the two groups were significantly increased compared with those before treatment (P<0.05), and the levels of FMA score, MBI score and IGF-1 expression in the observation group were significantly higher than those in the control group (P<0.05). After 4 weeks of treatment, the total effective rate was 94.74% (36/38) in the observation group and 85.29% (29/34) in thecontrol group(P<0.05).Conclusion Both Tongdu Tiaoshen acupuncture and ordinary acupuncture can improve the neurological function, motor function and daily living ability of patients with acute cerebral infarction, and the clinical efficacy of Tongdu Tiaoshen acupuncture group is significantly higher than that of ordinary acupuncture group, which may be caused by inhibiting the expression ofmiRNA-320 and up-regulating the expression of IGF-1. |
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