芪龙胶囊联合针灸治疗脑梗死恢复期气虚血瘀证患者的临床研究及机制探讨

Effect and mechanism of Qilong capsule combined with acupuncture therapy for patients with cerebral infarction in convalescence of Qi deficiency and blood stasis syndrome

目的观察芪龙胶囊联合针灸治疗脑梗死恢复期气虚血瘀证患者的临床疗效及机制探讨。方法将60例脑梗死恢复期气虚血瘀证患者按照随机数字表法分为2组,对照组30例予针灸治疗,联合组30例在对照组的治疗基础上联合芪龙胶囊治疗。2组均治疗8周后统计疗效,比较2组治疗前后中医症状(包括上肢不遂、下肢不遂、口舌㖞斜、不语、肢体麻木、气短乏力、自汗及面色白光白)评分、美国国立卫生研究院卒中量表(NIHSS)评分、改良Barthel指数(MBI)评分、血流动力学指标[包括平均血流速度(Vm)、收缩期峰值速度值(Vs)及搏动指数(PI)]及血清细胞因子[神经元特异性烯醇化酶(NSE)、胰岛素样生长因子1(IGF-1)、同型半胱氨酸(Hcy)及神经生长因子(NGF)]水平变化情况,并观察比较2组治疗期间不良反应发生情况。结果联合组总有效率96.67%(29/30),不良反应总发生率33.33%(10/30),对照组总有效率73.33%(22/30),不良反应总发生率20.00%(6/30),治疗组总有效率高于对照组(P<0.05),不良反应总发生率与对照组相当(P>0.05)。与本组治疗前比较,2组治疗后中医症状上肢不遂、下肢不遂、口舌㖞斜、不语、肢体麻木、气短乏力、自汗及面色白光白评分均降低(P<0.05),且联合组治疗后各项中医症状评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后NIHSS评分均降低(P<0.05),MBI评分均升高(P<0.05),且联合组治疗后NIHSS评分低于对照组(P<0.05),MBI评分高于对照组(P<0.05)。与本组治疗前比较,2组治疗后Vm及Vs均增加(P<0.05),PI均下降(P<0.05),且联合组治疗后Vm及Vs均高于对照组(P<0.05),PI低于对照组(P<0.05)。与本组治疗前比较,2组治疗后NSE及Hcy水平均降低(P<0.05),IGF-1及NGF水平均升高(P<0.05),且联合组治疗后NSE及Hcy水平低于对照组(P<0.05),IGF-1及NGF水平均高于对照组(P<0.05)。结论芪龙胶囊联合针灸治疗脑梗死恢复期气虚血瘀证临床疗效确切,可有效改善患者中医症状表现,促进神经功能恢复,提高日常生活能力,两者联合具有协同作用,且不会增加不良反应的发生,其作用机制可能与改善血液动力学指标,促进IGF-1及NGF表达,抑制NSE及Hcy表达有关。

Objective To observe the clinical effect and mechanism of Qilong capsule combined with acupuncture therapy for patients with cerebral infarction(CI)in convalescence(Qi deficiency and blood stasis syndrome).Methods CI patients(n=60)in convalescence(Qi deficiency and blood stasis syndrome)were randomly assigned at 1:1 ratio to receive either acupuncture therapy(control group)or Qilong capsule+acupuncture therapy(combined group)for 8 weeks.The traditional Chinese medicine(TCM)symptom score(upper limb paralysis,lower limb paralysis,deviated tongue,logagnosia,limb numbness,shortness of breath fatigue,spontaneous sweating,pallor),National Institutes of Health Stroke Scale(NIHSS),modified Barthel index(MBI),hemodynamic indices(mean blood velocity[Vm],peak systolic velocity[Vs],pulsatility index[PI]),serum cytokines(neuron-specific enolase[NSE],human insulin-like growth factor-I[IGF-I],homocysteine[Hcy],nerve growth factor[NGF])were included as comparators;the curative effect and adverse reactions were assessed.Results The combined group had significantly higher overall effective rate(96.67%[29/30]vs73.33%[22/30],[P<0.05]respectively)and insignificantly higher adverse reactions(33.33%[10/30]vs 20.00%[6/30],[P>0.05],respectively)than control group.After treatment,the two groups had a significantly lower TCM symptom scores(P<0.05),a significantly lower significantly NIHSS scores and a significantly higher MBI scores(all P<0.05),significantly higher Vm and Vs in groups(all P<0.05),a significantly lower PI(P<0.05),significantly lower NSE and Hcy(all P<0.05),significantly higher IGF-1 and NGF(all P<0.05);in addition,the combined group was superior to the control group for these indexes(all P<0.05).Conclusion The combination has a definite clinical effect for these patients,which can effectively improvment of TCM symptoms,restore nerve function,improve daily living ability,reduce adverse reactions,its mechanism of action may be related to improving Hcy,promoting the expression of IGF-1 and NGF,and inhibiting the expression of NSE and Hcy.