醒脑开窍针刺法调节FGF23-αKlotho通路改善脑小血管病患者内皮功能的研究

Xingnao Kaiqiao acupuncture method regulating FGF23-αKlotho pathway to improve endothelial function in patients with cerebral small vessel disease

[目的]探讨醒脑开窍针刺法治疗脑小血管病(CSVD)的临床疗效及与成纤维细胞生长因子23(FGF23)-αKlotho通路相关的调节机制。[方法]将符合纳入标准的CSVD患者随机分为对照组和针刺组,两组患者均给予常规治疗,针刺组另予醒脑开窍针刺法治疗。治疗前后,采用美国国立卫生院脑卒中量表(NIHSS)评价患者的神经功能缺损程度、Fugl-Meyer量表评价运动功能;采用NIHSS评价临床疗效。采用内皮功能检测仪检测反应性充血指数(RHI);酶联免疫吸附法(ELISA)检测外周血中内皮素(ET-1)、一氧化氮(NO)、血管性血友病因子(vWF)、成纤维细胞生长因子23(FGF23)和αKlotho水平。[结果]治疗后两组患者的NIHSS评分均较治疗前显著降低,上肢FMA(FMA-UE)评分显著提高(P<0.05或P<0.01);但仅有针刺组下肢FMA(FMA-LE)评分较治疗前显著提高(P<0.05)。对照组总有效率为60.00%,针刺组总有效率为76.70%,针刺组的改善情况明显优于对照组(P<0.05)。治疗后两组患者血清ET-1、vWF、FGF23水平与治疗前相比明显降低(P<0.05或P<0.01);但仅针刺组RHI值、NO和αKlotho水平较治疗前明显增加(P<0.05),且治疗后针刺组的改善情况明显优于对照组(P<0.05)。[结论]醒脑开窍针刺法是治疗CSVD的有效手段,能显著改善患者的神经损伤程度和运动功能,其机制可能与调节FGF23-αKlotho通路活性,进而促进内皮损伤修复,改善内皮功能有关。

[Objective]In this study,the clinical efficacy of Xingnao Kaiqiao acupuncture method in the treatment of cerebral small vessel disease(CSVD)and the regulatory mechanism related to fibroblast growth factor 23(FGF23)-αKlotho pathway were explored.[Methods]The CSVD patients who met the inclusion criteria were randomly divided into control group and acupuncture group.Both groups of patients were given conventional treatment;the acupuncture group was additionally treated with Xingnao Kaiqiao acupuncture.Before and after treatment,the NIHSS scale was used to evaluate the degree of neurological deficit,the Fugl-Meyer scale was used to evaluate motor function;the NIHSS change was used to evaluate the clinical efficacy.The endothelial function tester was used to detect the reactive hyperemia index(RHI);the ELISA method was used to detect the levels of ET-1,NO,vWF,FGF23 andαKlotho in the peripheral blood.[Results]After treatment,the NIHSS score of the two groups of patients was significantly lower than before treatment,and the FMA-UE score was significantly increased(P<0.05,P<0.01);but only the acupuncture group FMA-LE score was significantly higher than before treatment(P<0.05).The total effective rate of the control group was 60.00%,and the total effective rate of the acupuncture group was 76.70%.The improvement of the acupuncture group was significantly better than that of the control group(P<0.05).After treatment,the serum ET-1,vWF and FGF23 levels of the two groups of patients were significantly lower than those before treatment(P<0.05,P<0.01);but only the acupuncture group RHI value,NO andαKlotho levels were significantly increased than before treatment(P<0.05).And the improvement of the acupuncture group after treatment was significantly better than that of the control group(P<0.05).[Conclusion]Xingnao Kaiqiao acupuncture method is an effective method for the treatment of CSVD,which can significantly improve the nerve damage and motor function of patients.The mechanism may be related to regulating the activity of FGF23-αKlotho pathway,thereby promoting endothelial injury repair and improving endothelial function.