针灸通督法联合药物治疗缺血性卒中的疗效及对预后的影响

Efficacy of Tongdu Acupuncture-moxibustion plus Medication for Ischemic Stroke and Its Effect on Prognosis

目的观察针灸通督法联合常规药物治疗急性缺血性卒中患者的疗效及对预后的影响及其与CD40/CD40L 系统的关系。方法收治缺血性卒中患者100 例,采用随机数字表法分为药物组和针药组,每组50例,药物组采用常规药物治疗,针药组采用针灸通督法联合常规药物治疗。治疗前后抽提患者外周血单个核细胞(PBMCs)并应用Real-time PCR 及Western blot 检测其中CD40 mRNA 及蛋白的表达水平;ELISA 法检测所收集血浆中sCD40L、IL-1?、IL-6 的水平;通过NIHSS 评分评价两组患者的疗效,同时比较两组患者治疗后3 个月不良事件发生情况。结果与药物组相比,针药组PBMCs 中CD40 mRNA 及蛋白表达水平下降更为显著(P<0.05);两组患者治疗后血浆sCD40L、IL-1?、IL-6 水平均明显降低(P<0.05),但针药组降低更为显著(P<0.05);针药组神经功能恢复情况显著优于药物组(P<0.05),治疗后3 个月不良事件发生率也明显低于对照组(P<0.05)。结论针灸通督法联合常规药物治疗能够明显提升缺血性卒中患者治疗疗效并降低治疗后不良事件的发生率,其机制与针灸通督法联合治疗能更有效地抑制CD40/CD40L 系统的活性有关。

Objective To observe the treatment efficacy of Tongdu acupuncture-moxibustion method plus conventional medication in treating acute ischemic stroke, its effect on the prognosis and its relationship with CD40/CD40L system. Method One hundred ischemic stroke patients were divided into a medication group and an acupuncture-medication group by the random number table method, with 50 cases in each group. The medication group was intervened by conventional medication, and the acupuncture-medication group was treated with Tongdu acupuncture-moxibustion method plus conventional medication. Peripheral blood mononuclear cells (PBMCs) were collected before and after treatment to examine the expressions of CD 40 mRNA and protein by real-time polymerase chain reaction (PCR) and Western blot;the contents of plasma sCD40L, interleukin (IL)-1? and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA);the National Institute of Health Stroke Scale (NIHSS) was used to evaluate their therapeutic efficacy, and the adverse events were compared between the two groups 3 months after treatment. Result Compared with the medication group, the expressions of CD 40 mRNA and protein in PBMCs declined more significantly in the acupuncture-medication group (P<0.05);the contents of plasma sCD40L, IL-1? and IL-6 dropped significantly after treatment in both groups (P<0.05), while the decreases were more significant in the acupuncture-medication group (P<0.05);the improvement in neurological function was more significant in the acupuncture-medication group compared with that in the medication group (P<0.05), and the occurrence rate of adverse events was markedly lower in the acupuncture-medication group 3 months after treatment (P<0.05). Conclusion Tongdu acupuncture-moxibustion plus conventional medication can significantly enhance the treatment efficacy for ischemic stroke and reduce the happening of adverse events after treatment. Its mechanism is associated with the effective deactivation of CD40/CD40L system.