头穴丛刺联合康复疗法对局灶性脑梗死大鼠神经功能缺损及缺血侧皮层VEGF蛋白表达的影响

Effect of Acupuncture plus Rehabilitation on Neurologic Deficit and VEGF Protein Expression in Cortex on the Infarction Side in Rats with Focal Cerebral Infarction

目的观察针康法对局灶性脑梗死大鼠神经功能缺损情况及缺血侧大脑皮层血管内皮生长因子蛋白表达的影响,探讨针康法促进大鼠受损功能恢复的作用机制。方法选取健康雄性SD大鼠90只,随机分为模型组、针刺组、康复组、针康组、假手术组5组,每组又分为3 d、7 d、14 d 3个亚组,每个亚组6只。采用改良的Zea-Longa线栓法制备右侧大脑中动脉永久性梗死(MCAO)模型。针刺组大鼠行模拟头穴丛刺法治疗;康复组行跑台训练;针康组行头穴丛刺结合跑台训练;模型组及假手术组不予以任何治疗。采用改良的神经功能缺损评分(m NSS)评定大鼠神经功能缺损情况,并采用Western blot法测定缺血侧大脑皮层VEGF蛋白表达量。结果假手术组大鼠未见神经功能缺损。与模型组相比,针刺组、康复组及针康组治疗3 d后m NSSs比较,差异均无统计学意义(P>0.05);治疗7 d、14 d后,针刺组、康复组及针康组m NSSs评分比较,差异均有统计学意义(P<0.05)。治疗7 d、14 d后,针康组的m NSS评分均低于针刺组和康复组(P<0.05);针刺组和康复组m NSS评分比较,差异无统计学意义(P>0.05)。治疗3 d后,各治疗组大鼠VEGF蛋白表达量与模型组大鼠比较差异均无统计学意义(P>0.05),7 d、14 d各治疗组大鼠VEGF蛋白表达量较模型组大鼠明显增多(P<0.05)。治疗7 d、14 d后,针康组VEGF表达量与针刺组、康复组比较,差异具有统计学意义(P<0.05);康复组与针刺组大鼠各时间点VEGF表达量比较,差异无统计学意义(P>0.05)。结论头穴丛刺法与康复训练均能够改善局灶性脑梗死大鼠受损的神经功能,并能够提高大鼠缺血大脑皮层中VEGF蛋白表达量,且针康法联合治疗能够取得更好的效果;其机制可能与VEGF的高表达能够更好地促进脑缺血区域血管的重塑与再生相关。

Objective To observe the effect of acupuncture plus rehabilitation on neurologic deficit and the expression of vascular endothelial growth factor （VEGF） protein in cortex on the infarction side in rats with focal cerebral infarction, and to explore the action mechanism of acupuncture plus rehabilitation in promoting the recovery of impaired function in rats.Method Ninety healthy male Sprague-Dawley （SD） rats were randomized into a model group, an acupuncture group, a rehabilitation group, an acupuncture-rehabilitation group, and a sham operation group, and the five groups were further divided into three subgroups, i.e. 3 d, 7 d, and 14 d subgroups, 6 rats in each subgroup. The modified Zea-Longa method was adopted to prepare the model of middle cerebral artery occlusion （MCAO） on theright side. Rats in the acupuncture group received simulant scalp-points cluster needling; the rehabilitation group was intervened by treadmill exercise; the acupuncture-rehabilitation group was intervened by scalp-points cluster needling plus treadmill exercise; the model group and sham operation group didn＆#39;t receive any interventions. The modified Neurological Severity Score （mNSS） was adopted to evaluate the rat＆#39;s neurologic deficit, and Western blotting was used to detect the expression of VEGF protein in cortex on the infarction side.Result Neurologic deficit wasn＆#39;t found in rats in the sham operation group. After 3-day treatment, the mNSSs in the acupuncture group, rehabilitation group, and acupuncture-rehabilitation group were insignificantly different from the score in the model group （P〉0.05）, while the differences were statistically significant respectively after 7-day and 14-day treatment （P〈0.05）. Respectively after 7-day and 14-day treatment, the mNSS of the acupuncture-rehabilitation group was significantly lower than that in the acupuncture group and rehabilitation group （P〈0.05）; there was no significant difference in comparing the mNSS between the acupuncture group and rehabilitation group （P〉0.05）. After 3-day treatment, the expression of VEGF protein in each treatment group was insignificantly different from that in the model group （P〉0.05）, while the expression of VEGF protein in each treatment group was significantly higher than that in the model group respectively after 7-day and 14-day treatment （P〈0.05）. Respectively after 7-day and 14-day treatment, the expression of VEGF in the acupuncture-rehabilitation group was significantly different from that in the acupuncture group and rehabilitation group （P〈0.05）; there were no significant differences in comparing the expression of VEGF at each time point between the rehabilitation group and acupuncture group （P〉0.05）.Conclusion Scalp-points cluster needling and rehabilitation both can improve the neurologic function in rat models of focal cerebral infarction, and enhance the expression of VEGF protein in infarction cortex, and the integration of acupuncture and rehabilitation can achieve a better result; the action mechanism is possibly related to the high expression of VEGF which can better promote the reconstruction and regeneration of the vessels in cerebral infarction area.