针刺联合康复治疗对老年脑卒中患者免疫功能和神经功能的影响

Effect of Acupuncture Combined with Rehabilitation on Immune and Neural Functions in Elderly Patients with Stroke

目的:探讨针刺联合康复治疗对老年脑卒中患者免疫功能和神经功能的影响,观察其临床疗效。方法:将196例老年脑卒中患者按随机数字表法分为观察组和对照组,各98例。对照组采用康复治疗,观察组在康复治疗的基础上采用针灸治疗,取患侧头部四神聪、悬厘及两者中点,百会、曲鬓及两者中点,从上而下采用接力刺法连刺3针,每天1次,共30d。检测两组治疗前后血清T淋巴细胞亚群及白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平的变化,比较两组美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)及Barthel指数(BI)评分情况。结果:观察组治疗30d的血清IL-2、IL-6、TNF-α、hs-CRP、CD 8^+水平及NIHSS和mRS评分均明显低于本组治疗前和治疗10d(P<0.05),除CD 8^+外均明显低于对照组(P<0.05)。观察组和对照组治疗30d的CD 3^+、CD 4^+、CD 4^+/CD 8^+及BI评分均明显高于本组治疗前和治疗10d(P<0.05),且观察组均明显高于对照组(P<0.05)。观察组总有效率为93.9%(92/98),显著高于对照组的72.4%(71/98,P<0.05)。结论:针刺联合康复治疗老年脑卒中的临床疗效较好,能促进患者神经功能的恢复和有效调控T淋巴细胞亚群及炎性因子的表达。

Objective To investigate the therapeutic effect of acupuncture combined with rehabilitation and neuro-im- mune functional activities in elderly patients with stroke. Methods A total of 196 elderly stroke patients were randomly divided into control （rehabilitation exercise） and observation（acupuncture＋ rehabilitation exercise）groups （n = 98 in each）. Patients of the control group were treated by general healing treatment including good limb placement, timely conversion of body position, joint-motor exercise, sitting balance exercise, sitting-standing-walking, walking up and down stairs, daily life ability exercise, etc. and those of the observation group were treated by using the same methods mentioned in the control group and manual acupuncture stimulation of Sishencong （EX-HN 1）, Xuanli （GB 6）, the midpoint of EX-HN 1 and GB 6, Baihui （GV 20）, Qubin （GB 7）, and the midpoint between GV 20 and GB 7 on the affected side （once a day for three 10-day courses）. Serum interleukin-2 （IL-2）, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α）, and high-sensitive C-reactive protein （hs-CRP） contents were as- sayed using ELISA, and serum CD 3＋ , CD 4＋ and CD 8＋ contents assayed using flow cytometry. The disability severity was as- sessed by using National Institutes of Health Stroke Scale （NIHSS, for dysneuria）, modified Rankin Scale, （mRS, stroke severi- ty）, and Barthel Index （BI, performance in activities of daily living）, separately. The therapeutic effect was determined according to NIHSS score, clinical symptoms and daily activity ability. Results On day 30 after the treatment, serum IL-2, IL-6, TNF-α and hs-ORP contents were significantly decreased in the observation group in comparison with its own pre-treatment and day 10 after the treatment, and on day 10 and 30 after the treatment, the above were lower than the control group （P〈0.05）. On day 30 after the treatment, serum CD 3＋ , CD 4＋ and CD 4＋/CD 8＋ levels were significantly increased in both control and observation groups in comparison with their own pre-treatment and 10 days＇ treatment （P〈0.05）, while CD 8＋ levels obviously decreased in both groups relevant to their own pre-treatment and 10 days＇ treatment （P〈0.05）, and the increased OD 3＋ , OD 4＋ and OD 4＋/OD 8＋ levels were significant higher in the observation group than in the control group （P〈0.05）, and the OD 8＋ level was obviously lower in the control group than in the observation group （P〈0.05）. On day 30 after the treatment, the NIHSS and mRS scores were significantly decreased in both groups （P〈0.05）, and significantly lower in the observation group than in the control group （P〈0.05） ; the BI scores were evidently increased in both groups relevant to their own pre-treatment （ P〈0.05）, and the BI level was considerably higher in the observation group than in the control group （ P〈0.05）. The total effective rate was 72.4% （71/98） and 93.9% （92/98） respectively in the control and observation groups, being obviously higher in the latter group than in the former （ P〈0.05）. Cendusion Acupuncture combined with rehabilitation therapy is effective in promoting the recovery of neurological function and in regulating T lymphocyte subsets and the expression of inflammatory factors in elderly patients with stroke.