丁苯酞软胶囊配合针刺星状神经节治疗后循环缺血的疗效观察及对患者氧化应激机制的干预作用

Therapeutic effect of butylphthalide soft capsule combined with acupuncture at stellate ganglion on posterior circulation ischemia and its intervention on oxidative stress mechanism

目的探讨丁苯酞软胶囊配合针刺星状神经节治疗后循环缺血的疗效观察及对患者氧化应激机制的干预作用。方法选取2016年3月—2019年3月河北省沧州中西医结合医院128例后循环缺血患者作为研究对象,采用随机数字表法分为对照A组、对照B组、观察组及空白对照组,每组32例。对照A组予丁苯酞软胶囊治疗,对照B组予针刺星状神经节治疗,观察组予丁苯酞软胶囊联合针刺星状神经节治疗,空白对照组除口服阿司匹林外不再采用其他治疗。比较4组的临床总有效率、不良反应发生率,美国国立卫生研究院卒中量表(NIHSS)评分,Barthel指数,脑血循环指标[颈内动脉(ICA)、椎动脉(VA)、基底动脉(BA)血流速度与脑血管阻力]。采用酶联免疫吸附试验检测4组患者血清丙二醛(MDA)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平并比较。采用实时荧光定量聚合酶链反应(qRT-PCR)检测4组患者microRNA-21(miR-21)、microRNA-146a(miR-146a)mRNA相对表达量并比较。结果观察组临床总有效率(90.63%)高于对照A组(68.75%)、对照B组(65.63%)及空白对照组(43.75%)(P<0.05);疗程结束后NIHSS评分低于对照A组、对照B组、空白对照组(P<0.05);Barthel指数高于对照A组、对照B组、空白对照组(P<0.05);观察组疗程结束后ICA、VA、BA血流速度,SOD、CAT水平高于对照A组、对照B组、空白对照组(P<0.05),脑血管阻力、血清MDA、miR-21、miR-146a mRNA相对表达量低于对照A组、对照B组、空白对照组(P<0.05)。结论丁苯酞软胶囊配合针刺星状神经节治疗后循环缺血,可改善患者脑血循环与神经功能,抑制氧化应激,提高患者日常生活能力,疗效良好。

Objective To investigate the effect of butylphthalide soft capsule combined with acupuncture on stellate ganglion in the treatment of posterior circulation ischemia(PCI)and its intervention on oxidative stress mechanism.Methods From March 2016 to March 2019,128 patients with PCI in Cangzhou integrated traditional Chinese and Western Medicine Hospital of Hebei Province were selected and randomly divided into 4 groups with32 cases in each group.The control group A was treated with butylphthalide soft capsule,the control group B was treated with acupuncture at stellate ganglion,and the observation group was treated with butylphthalide soft capsule combined with acupuncture at stellate ganglion.The serum levels of MDA,SOD,and cat were detected by ELISA.The relative expression of microRNA-21(miR-21)and microrna-146 a(miR-146 a)mRNA was detected by real-time fluorescent quantitative polymerase chain reaction(qRT-PCR).The clinical total effective rate,NIHSS score,Barthel index,blood flow velocity and cerebrovascular resistance of internal carotid artery(ICA),vertebral artery(VA),basilar artery(BA),oxidative stress index[serum malondialdehyde(MDA),superoxide dismutase(SOD),and catalase(CAT)],the relative expression of miR-146 a mRNA,and the incidence of adverse reactions were compared among the four groups.Results The clinical efficacy of the observation group(90.63%)was higher than that of the control group A(68.75%),the control group B(65.63%),and the blank control group(43.75%).After the treatment,the NIHSS score of the observation group was lower than that of the control group A,the control group B,and the blank control group;the Barthel index of the observation group was higher than that of the control group A,the control group B,and the blank control group(P<0.05);After the treatment,the blood flow velocity of ICA,VA and BA in the observation group was higher than that in the control group A,control group B,and blank control group;the relative expression levels of cerebrovascular resistance,serum MDA,miR-21 and miR-146 a mRNA in the observation group were lower than those in the control group A,control group B,and blank control group;the levels of SOD and cat in the observation group were higher than those in the control group A,control group B,and blank control group(P<0.05).Conclusions Butylphthalide soft capsule combined with acupuncture at stellate ganglion can improve cerebral blood circulation and nerve function,inhibit oxidative stress,and improve the ability of daily life of patients with PCI.