针刺、穴位注射对原发性帕金森病患者中枢神经肽和一氧化氮的影响(英文)

Effects of acupuncture and point-injection on central neuropeptide and nitric oxide in patients with primary Parkinson disease

背景:针灸治疗原发性帕金森病(Parkinsondisease,PD)已经取得了一定的疗效,但其作用机制尚不清楚。目的:研究针刺、穴注治疗原发性帕金森病的疗效及可能途径。设计:随机对照单盲研究。地点和对象:1998-06/2000-10在南京脑科医院神经外科住院的PD患者,均符合1984-10全国锥体外系疾病讨论会确定的《帕金森病及帕金森综合征的诊断与鉴别诊断》,并己停止药物治疗3周以上。按就诊顺序2∶2∶1随机分为:针刺组21例,穴位注射组23例,对照组10例。干预:针刺组采用毫针针刺治疗,1次/d,治疗15d;穴位治疗组进行穴位注射脉络宁注射液[南京金陵制药(集团)有限公司,苏卫药准字(1985)第177601号],2mL/穴,2穴/次,1次/d,治疗15d;对照组不作针刺和穴注治疗。以改良Webster症状评分表评定治疗效果。在治疗前后检测患者脑脊液β-内啡肽、LEK和一氧化氮的含量。主要观察指标:各组PD患者疗效,脑脊液中β-内啡肽、亮氨酸脑啡肽(leucineenkephalin,LEK)、一氧化氮含量。结果:针刺组和穴注组的总有效率分别为71%和65%。穴注组LEK含量降低[(1.81±0.29)μg/],β-内啡肽含量升高[(184.13±9.94)μg/L],一氧化氮的含量的升高[(10.45±0.53)μmol/L];针刺组β-内啡肽含量上升[(144.73±12.72)μg/L],LEK含量降低[(4.18±0.56)μg/L],一?

BACKGROUND:A certain therapeutic effects of acupuncture have been achieved on the treatment of primary Parkinson disease (PD), but the mechanism of it has been unknown yet. OBJECTIVE:To study the therapeutic effects of needling and point injection on the treatment of primary PD and the possible therapeutic methods. DESIGN:Randomized and controlled single blind trial. SETTING and PARTICIPANTS:All the participants from the Department of Neurosurgery,Nanjing Brain Hospital from June 1998 to October 2000,were accorded with Diagnosis and Identifying Diagnosis on Parkinson disease and Parkinson Syndromes determined on National Symposium on Extrapyramidal Disease held in October 1984,and stopped medicinal treatment for more than 3 weeks. According to visiting sequence,at the ratio of 2∶2∶1,the participants were randomized into 21 cases in needling group,23 cases in point injection group and 10 cases in the control. INTERVENTIONS:In the needling group, treatment was given with filiform needles,once daily for 15 days.In point injection group, injection was given on acupoints with mailuoning injection[produced by Nanjing Jinling Pharmaceutical(Group) Co.Ltd,No.(1985) 177601],2 mL on each acupoint,two points each time, once daily for 15 days.In the control,neither needling nor point injection was given.The modified Webster evaluation table for symptoms was adopted to evaluate the therapeutic effects.Before and after treatment,the concentrations of β endorphin and leucine enkephalin(LEK) and nitric oxide in cerebrospinal fluid were measured. MAIN OUTCOME MEASURES:The therapeutic effects of PD patients, concentrations of β endorphin, leucine enkephalin and nitric oxide in cerebrospinal fluid in every group. RESULTS:The total effective rate in needling and point injection groups was 71%and 65%respectively.In point injection group, the concentration of LEK was decreased[(1.81±0.29)μg/L],of β endorphin increased[(184.13±9.94)μg/L] and of nitric oxide increased[(10.45 ±0.53) μmol/L].In needling group, the concentration of β endorphin was increased[(144.73±12.72)μg/L],of LEK decreased [(4.18±0.56)μg/L] and of nitric oxide increased[(8.46±0.55) μmol/L].Compared with the results before treatment,there were significant differences for all(t=5.74-9.47,P< 0.001).Nitric oxide increasing in needling group was significantly related with the therapeutic effects(t=3.019,P< 0.01).In the control,there were no significant differences in the concentrations of three substances during this period. CONCLUSION:Both acupuncture and point injection have achieved a certain therapeutic effects on the treatment of primary PD,the mechanism of which is probably related with the changes in concentrations of central leucine enkephalin,β endorphin and nitric oxide.