针药并用治疗老年短暂性脑缺血发作的疗效观察及对血清MMP-9、VEGF和AngⅡ水平的影响

Observation of the therapeutic effect of acupuncture combined with medication in the treatment of transient ischemic attack in the elderly and its effect on serum MMP-9,VEGF and AngⅡlevels

目的观察针刺联合氯吡格雷治疗老年短暂性脑缺血发作(transient ischemic attack,TIA)的临床疗效及对血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、血管内皮生长因子(vascular endothelial growth factor,VEGF)和血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)水平和血流动力学的影响。方法将160例TIA患者随机分为对照组和观察组,每组80例。对照组给予硫酸氢氯吡格雷治疗,观察组在对照组基础上给予头颈部穴位针刺治疗。比较两组治疗前后血清因子(MMP-9、VEGF和AngⅡ)水平、血流动力学指标[平均血流速度(mean velocity,Vm)、收缩期峰流速(peak systolic velocity,Vp)和脉动指数(pulsative index,PI)]、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及神经缺损症状发作情况。结果治疗后,两组血清MMP-9和AngⅡ水平、PI、NIHSS评分及神经缺损症状发作时间、次数和频率均降低(P<0.05),血清VEGF水平、Vm和Vp均升高(P<0.05);观察组血清MMP-9和AngⅡ水平、PI、NIHSS评分及神经缺损症状发作时间、次数和频率降低值大于对照组(P<0.05,P<0.01),血清VEGF水平Vm和Vp升高值均大于对照组(P<0.05)。观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论针刺联合氯吡格雷可有效改善老年TIA患者血清VEGF水平、神经缺损功能及血流动力学,降低血清MMP-9和AngⅡ水平,减少神经缺损症状发作时间、次数及频率。

Objective To observe the clinical efficacy of acupuncture combined with clopidogrel in the treatment of transient ischemic attack(TIA)in the elderly and its effect on serum matrix metalloproteinase-9(MMP-9),vascular endothelial growth factor(VEGF),angiotensinⅡ(AngⅡ)levels,and hemodynamics.Method One hundred and sixty patients with TIA were randomly divided into a control group and an observation group,with 80 cases in each group.The control group was treated with clopidogrel bisulfate,and the observation group was treated with head and neck acupoint acupuncture in addition to the treatment used in the control group.The levels of serum factors(MMP-9,VEGF and AngⅡ),hemodynamic indexes[mean velocity(Vm),peak systolic velocity(Vp)and pulsative index(PI)],the National Institute of Health stroke scale(NIHSS)score and the onset of neurological deficit symptoms were compared between the two groups before and after treatment.Result After treatment,the levels of serum MMP-9 and AngⅡ,PI,NIHSS score,and the time,frequency and frequency of nerve defect symptoms in the two groups were decreased(P<0.05),while the levels of serum VEGF,Vm and Vp were increased(P<0.05).After treatment,the decrease from baseline in levels of serum MMP-9 and AngⅡ,PI,NIHSS score,the onset time,number and frequency of nerve defect symptoms were greater than those in the control group(P<0.05,P<0.01),and the increase from baseline in levels of serum VEGF,Vm and Vp in the observation group were greater than those in the control group(P<0.05).The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Acupuncture combined with clopidogrel can effectively improve the serum VEGF level,nerve defect function and hemodynamics,and reduce the serum MMP-9 and AngⅡlevels,the onset time,number and frequency of nerve defect symptoms in elderly patients with TIA.