针刺联合中药治疗缺血性卒中后认知障碍的疗效观察

Therapeutic observation of acupuncture combined with Chinese medicine for cognitive impairment after ischemic stroke

目的观察针刺联合口服滋阴通络汤治疗缺血性卒中后认知障碍的临床疗效,并观察其对患者脑血流动力学及β淀粉样蛋白1-42(amyloidβ-protein 1-42,Aβ1-42)、胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)、血小板内皮细胞黏附分子-1(platelet endothelial cell adhesion molecule-1,PECAM-1)和tau蛋白水平的影响。方法将90例缺血性卒中后认知障碍患者用随机数字表法分为联合组和对照组,每组45例。对照组予口服滋阴通络汤治疗,联合组予针刺联合口服滋阴通络汤治疗。观察两组治疗前后中国卒中患者临床神经功能缺损程度量表(China stroke scale,CSS)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、功能综合评定量表(functional comprehensive assessment,FCA)和改良Barthel指数(modified Barthel index,MBI)的评分变化,观察两组治疗前后大脑动脉平均血流速度、血流最大峰值和血管阻力指数的变化,比较两组治疗前后正五聚蛋白3(pentraxin 3,PTX3)、血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)、IGF-1、PECAM-1、Aβ1-42、补体C1q肿瘤坏死因子相关蛋白9(complement C1q tumor necrosis factor-related protein 9,CTRP9)、可溶性CD40配体(soluble CD40 ligands,sCD40L)和tau蛋白的水平,比较两组的临床疗效。结果联合组总有效率高于对照组(P<0.05)。联合组治疗后MoCA、FCA和MBI评分均高于对照组(P<0.05),CSS评分低于对照组(P<0.05)。联合组治疗后大脑动脉血管阻力指数低于对照组(P<0.05),大脑动脉平均血流速度和血流最大峰值高于对照组(P<0.05)。联合组治疗后CTRP9、Aβ1-42和IGF-1含量高于对照组(P<0.05),VCAM-1、PTX-3、sCD40L、PECAM-1和tau蛋白含量低于对照组(P<0.05)。结论针刺联合口服滋阴通络汤治疗缺血性卒中后认知障碍可改善患者的神经功能、认知功能和日常生活活动能力,改善大脑动脉血流动力学,疗效优于单纯口服滋阴通络汤治疗;同时可抑制机体炎症反应,调节Aβ1-42、IGF-1、PECAM-1和tau蛋白的水平。

Objective To observe the clinical efficacy of acupuncture combined with oral administration of Zi Yin Tong Luo Tang in treating cognitive impairment after ischemic stroke and investigate its effects on cerebral hemodynamics and the levels of amyloidβ-protein 1-42(Aβ1-42),insulin-like growth factor 1(IGF-1),platelet endothelial cell adhesion molecule-1(PECAM-1),and tau protein.Method Ninety patients with cognitive impairment after ischemic stroke were divided into a joint group and a control group using the random number table method,with 45 cases in each group.The control group took Zi Yin Tong Luo Tang orally,and the joint group received acupuncture combined with oral administration of Zi Yin Tong Luo Tang.The China stroke scale(CSS),Montreal cognitive assessment(MoCA),functional comprehensive assessment(FCA),and modified Barthel index(MBI)scores in the two groups were observed before and after the treatment.The mean blood flow velocity,peak blood flow,and vascular resistance index of cerebral arteries were also monitored before and after the intervention.The levels of pentraxin 3(PTX3),vascular cell adhesion molecule-1(VCAM-1),IGF-1,PECAM-1,Aβ1-42,complement C1q tumor necrosis factor-related protein 9(CTRP9),soluble CD40 ligands(sCD40L),and tau protein were compared before and after the treatment.The clinical efficacy was also compared between the two groups.Result The joint group had a higher total effective rate than the control group(P<0.05).After the treatment,the MoCA,FCA,and MBI scores were higher in the joint group than in the control group(P<0.05),and the CSS score was lower in the joint group(P<0.05).After the intervention,the cerebral artery resistance index was lower in the joint group than in the control group(P<0.05),and the mean blood flow velocity and peak blood flow were higher in the joint group(P<0.05).The contents of CTRP9,Aβ1-42,and IGF-1 were higher in the joint group than in the control group after the treatment(P<0.05),and the VCAM-1,PTX-3,sCD40L,PECAM-1,and tau protein were lower in the joint group(P<0.05).Conclusion Acupuncture combined with oral Zi Yin Tong Luo Tang can improve neurological function,cognitive function,daily living activities,and cerebral artery hemodynamics in treating patients with cognitive impairment after ischemic stroke,producing more significant efficacy than oral Zi Yin Tong Luo Tang alone.Further,this method can inhibit inflammatory responses and regulate the levels of Aβ1-42,IGF-1,PECAM-1,and tau protein.