头针对缺血性脑卒中复发相关因素同型半胱氨酸、纤维蛋白原及抗凝血酶原Ⅲ含量的影响

Effects of scalp acupuncture on contents of homocysteine, fibrinogen and antithrombin Ⅲ related to relapse of ischemic stroke

目的:探讨头针疗法对缺血性脑卒中复发相关因素同型半胱氨酸、纤维蛋白原及抗凝血酶原Ⅲ的影响,为预防缺血性复发寻找简便有效的治疗方法。方法:纳入2004-07/2005-12在武汉市中西医结合医院针灸科住院的缺血性脑卒中患者60例。按入院先后顺序以查随机表的方法,随机分为两组,即头针组(n=32)和体针组(n=28),头针组根据《头皮针(名国际标准化方案》取健侧顶颞前斜线与顶颞后斜线治疗,用30号1.5寸毫针,在顶颞前斜线、顶颞后斜线从上而下以三段接力刺法连刺3针,留针30min,期间每隔10min行针1次,每次2～3min,同时在留针期间需配合主动或被动活动患肢。体针组选(依据《针灸学》的治则及处方,上肢取肩髃、曲池、外关等;下肢取环跳、阳陵泉、足三里等,均取双侧(位,两组治疗时间均为每日1次,6次为1个疗程,两个疗程之间间隔1d,连续治疗8个疗程,即2个月。两组分别在治疗前、治疗后第2,6个月采静脉血观察血同型半胱氨酸、纤维蛋白原及抗凝血酶原Ⅲ含量的变化。同时,在治疗后第6个月比较两组的脑卒中复发率。结果:参与观察的缺血性脑卒中患者60例全部进入结果分析。①治疗后第2个月,头针组与体针组血同型半胱氨酸、纤维蛋白原含量均较治疗前降低,差异有非常显著性意义[(12.47±2.50),(18.61±2.27)mol/L;(17.10±1.68),(18.13±1.60)mol/L;(3.68±0.88),(5.02±1.03)g/L;(4.39±0.93),(4.69±0.90)g/L;P<0.01],且头针组于治疗后第2,6个月同型半胱氨酸及纤维蛋白原含量均较体针组降低明显(P<0.01)。②治疗后第2个月,头针组与体针组血清抗凝血酶原Ⅲ含量均较治疗前升高,差异有非常显著性意义[(208.88±25.59),(193.88±23.64)mg/L;(191.89±23.23),(189.29±22.97)mg/L,P<0.01],且头针组于治疗后第2,6个月血清抗凝血酶原Ⅲ水平均较体针组升高明显(P<0.01)。③治疗后第6个月,头针组脑卒中的复发率为3%,体针组脑卒中复发率为25%,差异有显著性意义(P<0.05)。结论:头针疗法与体针疗法均可降低血同型半胱氨酸,纤维蛋白原,并可升高抗凝血酶原Ⅲ,且头针组对以上脑卒中复发危险因素的影响较体针组明显,能明显降低缺血性脑卒中的复发率,其预防脑卒中复发可能与对以上因素的调节有关。

AIM： To explore the effect of scalp acupuncture （SA） on homoeysteine （Hcy）, fibrinogen （Fg） and antithrombin （AT）-Ⅲ which are related factors to relapse of ischemic stroke, and search for the convenient and effective way to prevent recurrent of stroke. METHODS： Sixty inpatients with ischemic stroke were selected from Department of Acupuncture and Moxibustion, Wuhan Hospital of Integrated Chinese and Western Medicine from July 2004 to December 2005. They were divided into SA group （n=32） and body acupuncture （BA） group （n=28） according to the random diagnosis order. Referring to the international standardized program of scalp acupuncture, the patients of SA group were pricked on parietotemperal oblique lines from above down with No.30 needles of 1.5 cm long, for continuously 3 times and then remained for 30 minutes. Meanwhile, the needles were twisted 2 to 3 minutes once in every 10 minutes, and the paralyzed limbs were required to exercise during the treatment. The BA group selected the acupaints such as Jianyu （LI 15）, Quchi （LI 11）, Waiguan （SJ 5） of upper limbs, and Huantiao （GB 30）, Yanglingquan （GB 34）, Zusanli （ST 36） of lower limbs, based on the principle and prescription of Acupuncture Textbook. The two sides of acupoints were pricked once everyday continuously for 6 days in both groups. There was one-day interval between two courses, and the total treatment time was two months of 8 courses. Venous blood were collected respectively before the treatment and at the 2^nd and the 6^th months after treatment to observe the contents of Hey, Fg and AT-Ⅲ. Simultaneously, the recurrent rate of stroke was compared in two groups after six-month treatment. RESULTS： Totally 60 cases were involved in the result analysis. ①The contents of Hcy and Fg in blood decreased in both groups after two months of treatment, with the significant difference compared with before treatment [（12.47±2.50）, （18.61±2.27） mol/L; （17.10±1.68）, （18.13±1.60） mol/L; （3.68±0.88）, （5.02±1.03） g/L; （4.39±0.93）, （4.69±0.90） g/L; P 〈 0.01]. Moreover, the contents of Hey and Fg in blood of SA group decreased more obviously than those of BA group after two and six months of treatment （P 〈 0.01）.②The content of AT-Ⅲ in blood increased in both groups after two months of treatment, with significant difference [（208.88±25.59）, （193.88±23.64） mg/L; （191.89±23.23）, （189.29±22.97） mg/L, P 〈 0.01]. Moreover, the content of AT-Ⅲ of SA group increased more obviously than that of BA group after two and six months of treatment （P 〈 0.01）.③The recurrent rate of stroke was 3% in SA group and 25% in BA group at the 6^th month after treatment. Difference was significant between two groups （P 〈 0.05）. CONCLUSION： Both SA and BA treatments can not only decrease the contents of Hey and Fg in blood but also increase the content of AT-Ⅲ in blood. And compared with BA treatment, SA treatment plays an obvious role in decreasing the recurrent rate of ischemic stroke. Moreover, it can beestimated that the probable mechanism of preventing recurrent stroke by SA treatment is related to the adjustments of factors mentioned above.