“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

Clinical observation of “Tongdu Tiaoshen needles therapy” in treating acute cerebral infarction and its effect on autophagy

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.