择时治疗椎基底动脉短暂缺血性眩晕的疗效及对血脂的调节(英文)

Effects of timing treatment on vertebrobasilar transient ischemic vertigo and its regulation of blood lipid

背景:椎基底动脉短暂缺血性眩晕是脑卒中的预报信号,发病多与动脉粥样硬化有关,可以是脑梗死的前驱症状,任其自然发展约有1/3患者在以后数年内会发生脑梗死,尤其是在第1次短暂缺血发作后1～6个月是发病的高危时期,因此早期治疗甚为重要。目的:观察运用时间治疗学治疗椎基底动脉短暂缺血性眩晕的疗效及对血脂、脂蛋白、载脂蛋白的调节作用。设计:完全随机分组设计,对比观察。单位:青岛大学医学院中医教研室。方法:①选择2003-01/2004-06青岛大学医学院附属松山医院中医科住院椎基底动脉短暂缺血性眩晕患者66例,男47例,女19例。患者均对检测项目知情同意。随机分为2组:择时治疗组38例和不择时治疗组28例。②择时治疗组:选择每日辰时(7:00～9:00)应用足三里穴进行温针灸,每日针灸1次,每次每穴留针20min,配合中药葛根通络汤,1次/d,辰时一次性温服,10d为1个疗程。不择时治疗组:除辰时以外,随意选择时间治疗,其治疗方法与择时治疗组相同。治疗前后用酶法测血清总胆固醇、三酰甘油、载脂蛋白A1与载脂蛋白B100;用沉淀法测定高密度脂蛋白胆固醇,低密度脂蛋白胆固醇及极低密度脂蛋白胆固醇。3个疗程结束后评定疗效。③计数和计量资料差异比较采用χ2和t检验。主要观察指标:①两组治疗前后血脂变化。②两组治疗后疗效比较。结果:椎基底动脉短暂缺血性眩晕66例患者均进入结果分析。①3个疗程结束后,择时治疗组显著好转率明显高于非择时治疗组犤79%(30/38),43%(12/28),P<0.01犦。②择时治疗组治疗后总胆固醇、三酰甘油、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、载脂蛋白B100水平明显低于治疗前和对照组治疗后(P<0.05～0.01),高密度脂蛋白胆固醇、载脂蛋白A1水平明显高于治疗前和对照组治疗后(P<0.05～0.01)。对照组治疗后总胆固醇、三酰甘油、低密度脂蛋白胆固醇、载脂蛋白B100明显低于治疗前(P<0.05～0.01),高密度脂蛋白胆固醇明显高于治疗前(P<0.01)。结论:选择适当的时间针灸并药物治疗椎基底动脉短暂性缺血性眩晕的疗效显著好于非择时治疗,且可更有效地降低血脂水平。

BACKGROUND： Vertebrobasilar transient ischemic vertigo （VBTIV） is the signal of cerebral apoplexy, which is mostly contributed to arteriosclerosis and can be the pre-symptom of cerebral infarction. 1/3 cases will suffer from cerebral infarction with its natural development in several years. Specially, it is the critical stage in 1-6 months after the 1^st transient ischemic attack, for which, early treatment is especially important for it. OBJECTIVE： To observe the effects of time treatment on VBTIV and its regulation on blood lipid, lipopretein and apalipoprotein （Apo）. DESIGN： Complete randomized groups and controlled comparison. SETTING： Department of Traditional Chinese Medicine in MediCal College of Qingdao University. METHODS： ①Totally 66 inpatients of VBTIV were selected from Department of Traditional Chinese Medical of Songshan Hospital Affiliated to Medical College of Qingdao University from January 2003 to June 2004, of which, 47 cases were male and 19 cases female. All of the patients were in the known of the observation. Two groups were randomized, named timingtreatment group （38 cases） and the control （28 cases）. ② In timing-treatment group, at certain time division （7：00 am-9：00 am）, warming acupuncture was applied on Zusanli （ST 36）, once everyday, needle retaining for 20 minutes each time. Besides, gegen tongluo tang was oral-administrated warmly in combination, one dose each day. at the specific time division, 10 days made 1 course of treatment. In the control, except at the time division, the treatment was given at any time with the same method as the timing-treatment group. Before and after treatment, enzymatic method was used to assay total cholesterol （TC）, triglyceride （TG）, Apo-A1 and Apo-B100 the precipitation was applied to assay high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C） and very low density lipoprotein cholesterol （VLDL-C）. The therapeutic effects were evaluated at the end of 3-course treatment. ③ χ^2 and t tests were applied for the difference comparison of counting and measurement data. MAIN OUTCOME MEASURES： ① Change of blood lipid before and after treatment in two groups. ② Comparison of therapeutic effects after treatment between two groups. RESULTS： Totally 66 cases of VBTIV were all in result analysis. ① At the end of 3-course treatment, the rate of significant improvement in timing-treatment group was higher remarkably than the control [79% （30/38）, 43% （12/28）, P 〈 0.01]. ② Compared with the results before treatment and those after treatment in the control, the results of TC, TG, LDL-C, VLDL-C, Apo-B100were lower remarkably （P 〈 0.05-0.01） and the results of HDL-C and Apo-A1 were higher remarkably （P 〈 0.05-0.01） after treatment in timing-treatment group. In the control, compared with the results before treatment, the resuhs of TC, TG, LDL-C and Apo-B100 were lower remarkably （P 〈 0.05-0.01） and the result of HDL-C was higher remarkably： CONCLUSION： The therapeutic effects of timing acupuncture in combination with medication are advantageous significantly compared with routine treatment on VBTIV and timing treatment reduces blood lipid much more effectively.