镇肝熄风汤加减联合针刺治疗阴虚风动型脑卒中的疗效及对免疫平衡的影响

Therapeutic Effect of Acupuncture Combined with Modified Zhengan Xifeng Decoction on the Treatment of Yin Deficiency Pneumatic Stroke and its Effect on Immune Balance

目的探讨镇肝熄风汤加减联合针刺治疗阴虚风动型脑卒中的疗效及对血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和辅助性T细胞17(Th17)/调节性T细胞(Treg)免疫平衡的影响。方法将126例阴虚风动型脑卒中患者采用随机数字表法分为对照组(63例)和观察组(63例)。2组患者服用抗血小板药物及保护神经药物等常规支持治疗,对照组给予针刺治疗,观察组给予针刺联合镇肝熄风汤加减治疗,治疗12周。观察2组患者治疗前后中医症状评分、Barthel指数(BI)量表评分、美国国立卫生研究院卒中量表(NIHSS)评分、血清炎症因子(IL-6和TNF-α)、Th17、Treg水平和Th17/Treg比值变化,并评价2组患者的临床疗效和安全性。结果(1)治疗后,观察组总有效率为95.24%(60/63)高于对照组的84.13%(53/63),差异有统计学意义(P<0.05);(2)治疗后,2组患者自汗、舌质暗、气短乏力及肢体麻木等中医症状评分较治疗前均显著降低,且观察组中医症状评分均低于对照组(P<0.05);(3)治疗后,2组患者BI评分较治疗前显著增加、NIHSS评分显著降低,且观察组BI评分高于对照组,NIHSS评分低于对照组(P<0.05);(4)治疗后,2组患者血清IL-6、TNF-α水平较治疗前明显降低(P<0.05),且观察组炎症因子水平低于对照组(P<0.05);(5)治疗后,2组患者Th17水平、Th17/Treg比值较治疗前显著降低,Treg水平明显升高,且观察组Th17/Treg免疫平衡调节能力优于对照组(P<0.05);(6)2组患者在治疗期间内均未发生严重的不良反应。结论镇肝熄风汤加减联合针刺治疗阴虚风动型脑卒中疗效显著,可有效地缓解患者临床症状,减低炎症因子水平,恢复Th17/Treg细胞平衡,安全性较高。

Objective To investigate the curative effect of modified Zhengan Xifeng decoction combined with acupuncture in the treatment of yin deficiency pneumatic stroke and its effect on serum IL-6,TNF-αand Th17/Treg immune balance.Methods 126 cases of patients with yin deficiency pneumatic stroke were divided into a control group(63 cases)and an observation group(63 cases)using a random number table method.Patients in the 2 groups took conventional supportive treatments,such as antiplatelet and neuroprotective therapy.The control group was treated with acupuncture,and the observation group was treated with acupuncture combined with modified Zhengan Xifeng decoction.The treatment period was 12 weeks.TCM symptom scores,BI scale scores,NIHSS scores,serum inflammatory factors(IL-6 and TNF-α),the levels of Th17,Treg and Th17/Treg ratio in 2 groups were observed,and the clinical efficacy and safety of the 2 groups of patients were evaluated.Results(1)After treatment,the total effective rate of the observation group was 95.24%(60/63),which was higher than 84.13%(53/63)in the control group,the difference was statistically significant(P<0.05).(2)After treatment,TCM symptom(spontaneous sweating,dark tongue,shortness of breath,fatigue and limb numbness)scores in the two groups decreased significantly compared with those before treatment,and TCM symptom scores of the observation group were lower than those of the control group(P<0.05).(3)After treatment,the BI scores of the two groups of patients rose significantly compared with those before the treatment,and the NIHSS score was significantly lower than that before the treatment.The BI score of the observation group was higher than that of the control group,and the NIHSS score was lower than that of the control group(P<0.05).(4)After treatment,the levels of serum IL-6 and TNF-αin the two groups were significantly lower than those before treatment(P<0.05),and the levels of inflammatory factors in the observation group were lower than those in the control group(P<0.05).(5)After treatment,the levels of Th17 and Th17/Treg ratio of the two groups of patients decreased significantly compared with those before treatment,and the level of Treg increased significantly compared with that before treatment,and the regulation of Th17/Treg immune balance of the observation group was better than that of the control group(P<0.05).(6)No serious adverse reactions occurred in the two groups of patients during the treatment period.Conclusion Modified Zhengan Xifeng decoction combined with acupuncture has a significant effect on the treatment of yin deficiency pneumatic stroke.It can effectively relieve the clinical symptoms of patients,reduce the level of inflammatory factors,and restore the balance of Th17/Treg cells.The safety is high.