针灸疗法联合银杏二萜内酯葡胺治疗急性脑梗死(风痰瘀阻型)患者的临床疗效及其对神经功能、炎性因子、凝血状态的影响

Clinical Efficacy of Acupuncture-moxibustion Therapy Combined with Ginkgo Terpene Lactones Meglumine in the Treatment of Acute Cerebral Infarction(Wind Phlegm Collateral Obstruction Syndrome)and Its Impact on Neurological Function,Inflammatory Factor and

目的观察针灸疗法联合银杏二萜内酯葡胺治疗急性脑梗死(风痰瘀阻型)患者的临床疗效,并分析其对神经功能、炎性因子、凝血状态的影响。方法选取2018年3月—2019年11月在海南省中医院就诊的急性脑梗死(风痰瘀阻型)患者92例,采用随机数字表法分为对照组和观察组,每组46例。对照组患者采用西医常规治疗,观察组患者在西医常规治疗基础上给予针灸疗法联合银杏二萜内酯葡胺治疗,两组患者均连续治疗2周。比较两组患者临床疗效,治疗前后神经功能指标[包括神经元特异性烯醇化酶(NSE)、S100B蛋白、血管内皮生长因子(VEGF)及美国国立卫生研究院卒中量表(NIHSS)评分]、炎性因子[包括白介素18(IL-18)和白介素6(IL-6)]、凝血状态指标[包括血小板分子标志物1(PAC-1)和D-二聚体(D-D)]及血清对氧磷脂酶1(PON-1)水平;并观察两组患者治疗期间不良反应发生情况。结果与对照组相比,观察组患者临床疗效更优(P<0.05)。两组患者治疗前血清NSE、S100B蛋白、VEGF水平及NIHSS评分比较,差异无统计学意义(P>0.05);与对照组相比,治疗后观察组患者血清NSE、S100B水平及NIHSS评分降低,血清VEGF水平升高(P<0.05)。两组患者治疗前血清IL-18、IL-6、PAC-1、D-D水平比较,差异无统计学意义(P>0.05);与对照组相比,治疗后观察组患者血清IL-18、IL-6、PAC-1、D-D水平降低(P<0.05)。两组患者治疗前血清PON-1水平比较,差异无统计学意义(P>0.05);与对照组相比,治疗后观察组患者血清PON-1水平升高(P<0.001)。治疗期间,观察组患者不良反应发生率为19.5%(9/46),对照组患者为17.4%(8/46),两组比较差异无统计学意义(P>0.05)。结论针灸疗法联合银杏二萜内酯葡胺能有效提高急性脑梗死(风痰瘀阻型)患者临床疗效,改善患者神经功能,减轻炎性反应及高凝状态,且未增加不良反应的发生,安全性较高。

Objective To observe clinical efficacy of acupuncture-moxibustion therapy combined with ginkgo terpene lactones meglumine in the treatment of acute cerebral infarction(wind phlegm collateral obstruction syndrome),and analyze its impact on neurological function,inflammatory factor and coagulation status.Methods A total of 92 patients with acute cerebral infarction(wind phlegm collateral obstruction syndrome)in Hainan Hospital of Traditional Chinese Medicine from March 2018 to November 2019 were selected,and they were divided into control group and observation group according to the random number table method,46 cases in each group.The patients in the control group were treated with conventional western medicine,while the patients in the observation group were treated with acupuncture-moxibustion therapy combined with ginkgo terpene lactones meglumine on the basis of the control group,both groups were treated for 2 weeks.The clinical effect,neurological function(including NSE,S100 B protein,VEGF and NIHSS score),inflammatory factor(including IL-18 and IL-6)and coagulation status(including PAC-1 and D-D)and serum PON-1 level were compared between the two groups before and after treatment;the adverse reactions of the two groups were observed during the treatment.Results The clinical effect in the observation group was better than that in the control group(P<0.05).There was no statistically significant difference in the serum levels of NSE,S100 B protein,VEGF or NIHSS score between the two groups before treatment(P>0.05);after treatment,the serum levels of NSE,S100 B protein and NIHSS score in the observation group were lower than those in the control group,and the serum VEGF level in the observation group was higher than that in the control group(P<0.05).There was no statistically significant difference in the serum levels of IL-18,IL-6,PAC-1 or D-D between the two groups before treatment(P>0.05);after treatment,the serum levels of IL-18,IL-6,PAC-1 and D-D in the observation group were lower than those in the control group(P<0.05).There was no statistically significant difference in serum PON-1 level between the two groups before treatment(P>0.05);after treatment,the serum PON-1 level in the observation group was higher than that in the control group(P<0.001).During treatment,the incidence of adverse reactions was 19.5%(9/46)in the observation group,17.4%(8/46)in the control group,there was no statistically significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion Acupuncture-moxibustion therapy combined with ginkgo terpene lactones meglumine can effectively improve the clinical effect of patients with acute cerebral infarction(wind phlegm collateral obstruction syndrome),improve the neurological function,reduce the inflammatory reaction and hypercoagulable state,without increasing the risk of adverse reactions,with relatively high safety.