项丛刺疗法联合吞咽康复训练对脑卒中吞咽障碍患者吞咽功能及血清BDNF、NGF、IGF-1的影响

Effects of nape cluster acupuncture combined with swallowing rehabilitation training on swallowing function and serum levels of BDNF,NGF,and IGF-1 in stroke patients with dysphagia

目的:探究项丛刺疗法联合吞咽康复训练对脑卒中吞咽障碍患者吞咽功能及血清脑源性神经营养因子(BDNF)、神经生长因子(NGF)、胰岛素样生长因子-1(IGF-1)的影响。方法:选取2018年1月—2019年6月华中科技大学同济医学院附属梨园医院康复医学科收治的80例脑卒中吞咽功能障碍患者为研究对象,随机分为对照组和观察组,每组40例。对照组实施吞咽康复训练,观察组在对照组的基础上加用项丛刺疗法。比较两组临床总有效率及治疗前后吞咽功能[洼田饮水试验、标准吞咽功能评定表(SSA)、电视荧光吞咽造影检查(VFSS)]、脑血流动力学指标[最大峰值流速(VS)、平均流速(VM)、血管阻力指数(RI)]、血清学指标[BDNF、NGF、IGF-1]水平及生活质量[吞咽障碍特异性生活质量量表(SWAL-QOL)]。结果:观察组临床总有效率较对照组更高(92.50%vs75.00%,P<0.05)。治疗后,观察组洼田饮水试验、SSA、VFSS、SWAL-QOL评分及血清BDNF、NGF、IGF-1水平较均对照组更高(均P<0.05),且脑血流动力学参数VS、VM、RI改善程度均更显著(均P<0.05)。结论:项丛刺疗法联合吞咽康复训练可有效增强脑卒中吞咽障碍患者吞咽功能,改善脑血流微循环,上调血清神经因子BDNF、NGF、IGF-1水平,从而提高患者生活质量。

Objective: To explore the effects of nape cluster acupuncture combined with swallowing rehabilitation training on swallowing function and serum levels of brain-derived neurotrophic factor(BDNF), nerve growth factor(NGF), and insulin-like growth factor-1(IGF-1) in patients with dysphagia after stroke. Methods:Eighty stroke patients with dysphagia treated in Department of Rehabilitation Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2018 to June 2019 were randomly divided into control group(n=40)and observation group(n=40). The control group received conventional swallowing rehabilitation training, and the observation group received nape cluster acupuncture on the basis of conventional training. The total clinical effective rate and swallowing function were compared between the two groups before and after treatment in sub-water test, standard swallowing function assessment(SSA),videofluoroscopic swallowing study(VFSS), cerebral hemodynamics indices such as maximum peak flow velocity(VS), mean flow velocity(VM), and vascular resistance index(RI), serological indices such as BDNF, NGF and IGF-1, and Swallowing Quality of Life(SWAL-QOL). Results:The total clinical effective rate of the observation group was higher than that of the control group(92. 50% vs75. 00%, P<0. 05). After treatment, the sub-water test, the scores of SSA, VFSS, SWAL-QOL and the levels of serum BDNF, NGF, and IGF-1 in the observation group were higher than those in the control group, and the cerebral hemodynamic parameters VS, VM, and RI were improved more significantly. Conclusion:The nape cluster acupuncture combined with swallowing rehabilitation training can effectively enhance the swallowing function, improve cerebral microcirculation, and up-regulate the levels of serum neurokines BDNF, NGF, and IGF-1, thus improving the quality of life of of stroke patients with dysphagia.