针灸辅助高频重复经颅磁刺激对胶质瘤术后运动及神经功能恢复的影响研究

Effect of acupuncture combined with repetitive transcranial magnetic stimulation on the recovery of motor and neurological function after glioma surgery

目的观察针灸联合物理疗法对脑胶质瘤术后运动及神经功能恢复情况的影响。方法本研究为前瞻性研究,选取南阳医学高等专科学校第一附属医院2022年1月至2023年2月收治的脑胶质瘤患者100例,按照计算机随机分组法,将入组患者分别列为物理组和联合组各50例,物理组实施高频重复经颅磁刺激(rTMS)治疗,联合组采用针灸辅助rTMS治疗,比较两组患者的神经功能、肢体运动功能、认知功能及预后情况。结果联合组的热休克蛋白70(HSP70)(2.85±0.36)pg/mL高于物理组(2.12±0.41)pg/mL;和肽素、中枢神经特异性蛋白β(S100β)分别为(1.58±0.31)pmol/L、(0.34±0.16)ng/mL,均低于物理组(2.21±0.78)pmol/L、(0.61±0.29)ng/mL;联合组的Fugl-Meyer运动功能评定量表(FMA)上肢、下肢功能评分分别为(55.25±10.31)分、(28.47±5.26)分,均高于物理组(50.32±10.44)分、(25.39±5.31)分;联合组的简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分分别为(27.36±5.22)分、(27.48±5.31)分,均高于常规组(24.33±5.23)分、(24.49±5.36)分;联合组的不良预后发生率6.00%(3/50)低于物理组24.00%(12/50),差异均具有统计学意义(P<0.05)。结论针灸辅助rTMS可有效改善脑胶质瘤患者的肢体运动功能,对修复其神经功能,促进认知功能恢复,并改善预后均有积极影响。

Objective To observe the effect of acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)on the recovery of motor and neurological function after the operation of glioma.Methods This was a prospective study involving 100 glioma patients admitted to the First Affiliated Hospital to Nanyang Medical College from January 2022 to February 2023.They were randomly assigned into physical group(50 cases)and combined group(50 cases).Patients in the physical group received rTMS treatment,and those in the combined group received acupuncture combined with rTMS treatment.The neurological function,limb motor function,cognitive function and prognosis of the two groups were compared.Results The heat shock protein 70(HSP70,[2.85±0.36]pg/mL VS[2.12±0.41]pg/mL)was significantly higher in the combined group than that of physical group,while copeptin([1.58±0.31]pmol/L VS[2.21±0.78]pmol/L)and S100β([0.34±0.16]ng/mL VS[0.61±0.29]ng/mL)were significantly lower(P<0.05).The Fugl-Meyer assessment(FMA)scores of motor recovery of upper([55.25±10.31]points VS[50.32±10.44]points)and lower limbs([28.47±5.26]points VS[25.39±5.31]points)were significantly higher in the combined group than those of physical group(P<0.05).The mini-mental state examination(MMSE,[27.36±5.22]points VS[24.33±5.23]points)and the Montreal cognitive assessment(MoCA,[27.48±5.31]points VS[24.49±5.36]points)scores were significantly higher in the combined group than that of physical group(P<0.05).The incidence of poor prognosis in the combined group was significantly lower than that of physical group(6.00%[3/50]VS 24.00%[12/50],P<0.05).Conclusion Acupuncture combined with rTMS can improve the neurological function and limb motor function of patients with glioma,promote the recovery of cognitive function,and reduce the risk of adverse prognosis.