针刺联合医痫丸治疗颅脑外伤癫痫(风痰上扰证)疗效及对NOX2/ROS通路的影响

Effect of Acupuncture Combined with Medicine in Treatment of Posttraumatic Epilepsy with Syndrome of Wind-phlegm Invading Upward on NOX2 / ROS Pathway and Efficacy Research

目的：探讨针刺联合医痫丸治疗颅脑外伤癫痫（PTE）风痰上扰证的疗效以及NOX2/ROS通路的影响。方法：选择颅脑外伤癫痫风痰上扰证患者90例,按随机数字表法分为治疗组和对照组各45例;对照组采用苯巴比妥钠肌肉注射200 mg/d,每日2次;或丙戊酸钠片内服,每日按体质量15 mg/kg;癫痫发作时给予氯硝安定内服;治疗组在对照组基础上采用针刺和医痫丸（3 g/次,每日3次）,2组均治疗12周。观察2组癫痫发作持续时间和频次;Western blot法检测2组血清烟酰胺腺嘌呤二核苷酸磷酸氧化酶（NOX2）水平;比较2组血清活性氧（ROS）、核因子-κB（NF-κB）、白细胞介素（IL）-1β、肿瘤坏死因子-α（TNF-α）和前列腺素E2（PGE2）水平。结果：治疗组治疗后患者癫痫发作持续时间和癫痫发作频次明显少于对照组,治疗组总有效率88.89%,对照组68.89%,2组比较差异有统计学意义（χ^2=4.27）;治疗组治疗后患者血清NOX2和ROS水平明显低于对照组;治疗组治疗后血清NF-κB、IL-1β、TNF-α和PGE2均显著低于对照组,2组患者疗程中无严重不良反应。结论：在常规西药基础上,针刺联合医痫丸治疗PTE风痰上扰证控制癫痫发作疗效明显,抑制NOX2/ROS通路从而减缓下游炎症反应可能是其作用机制之一。

Objective： To discuss effect and possible mechanism of acupuncture combined with medicine in treatment of posttraumatic epilepsy（ PTE） with syndrome of wind-phlegm invading upward and influence on NOX2 / ROS pathway.Method： Ninty patients of posttraumatic epilepsy with syndrome of wind-phlegm invading upward were selected and randomly divided into treatment group and control group of 45 cases each by randomized digital table. Patients in control group were injected with phenobarbital sodium muscle injection（ 200 mg / d,bid） or taken valproate orally（ 15 mg / kg,per day）.Clonazepam was given for oral administration when epileptic seizure. On the basis of control group,patients in treatment one received therapy of acupuncture combined with Yixian pills orally（ 3 g / time,tid）. Courses of treatment for two groups were12 weeks. Epileptic seizure frequency and time of duration were observed in two groups. Serum levels of adenine dinucleotide phosphate oxidase（ NOX2） were detected by Western blotting method. Serum levels of reactive oxygen species（ ROS）,nuclear factor-κB（ NF-κB）,interleukin（ IL）-1β,tumor necrosis factor-α（ TNF-α） and prostaglandin E2（ PGE2）were compared. Results： Epileptic seizure frequency and time of duration in treatment group were significantly lower than control group after treatment respectively. The total effective rate for treatment group was 88. 89%,better than control group with 68. 89% with significant differences（ χ2= 4. 27）. Serum levels of NOX2 and ROS in treatment group were obviously lower than control one after treatment. Serum levels of NF-κB,IL-1β,TNF-α and PGE2 in treatment group were obviously lower than control group after treatment. No serious adverse reaction was in both groups during treatment. Conclusion： Based on routine western medicine,acupuncture combined with medicine in treatment of PTE with syndrome of wind-phlegm invading upward brought about a striking effect on controlling epileptic attack. Inhibiting NOX2 / ROS pathway and slowing downstream inflammatory response maybe one of the mechanisms.