穴位结扎联合埋线法对顽固性面瘫患者面神经肌电图及血清神经营养因子的影响

Effects of Point Ligation Therapy Combined with Acupoint Catgut Embedment on Facial Nerve Electromyo-graphy and Serum Neurotrophic Factors for Patients with Refractory Facial Paralysis

目的 观察穴位结扎联合埋线法治疗顽固性面瘫的临床疗效,并从神经营养因子角度探讨可能机制。方法 将168例顽固性面瘫患者随机分为穴位结扎联合埋线组和电针组,每组84例。两组均口服甲钴胺片,在此基础上穴位结扎联合埋线组于颧髎、地仓、颊车穴行结扎术,患侧面部局部取穴结合远端配穴行埋线法,30天行穴位结扎联合埋线法1次,共治疗3次;电针组取穴同穴位结扎联合埋线组,予电针治疗,疏密波,隔日1次。两组均治疗90天。于治疗前及治疗30天、60天、90天、120天(随访时)观察两组患者面神经功能评价(HB)分级情况、改良Portmann评分;于治疗前及治疗90天时检测面神经肌电图,记录面神经运动传导的波幅及潜伏期,检测血清脑源性神经生长因子(BDNF)、神经生长因子(NGF)、碱性成纤维细胞生长因子(FGF2)水平;治疗90天时比较两组临床疗效;观察并记录所有患者治疗过程中出现的不良反应。结果 治疗30天、60天、90天、随访时两组患者HB分级较治疗前改善(P<0.05);治疗60天、90天和随访时穴位结扎联合埋线组患者HB分级人数分布情况优于电针组(P<0.05);与本组治疗前比较,两组治疗90天时面神经肌电图最大波幅均升高、潜伏期均降低(P<0.05),且穴位结扎联合埋线组最大波幅高于电针组、潜伏期短于电针组(P<0.05)。两组患者治疗30天、60天、90天及随访时改良Portmann评分比本组治疗前升高,且穴位结扎联合埋线组评分高于电针组(P<0.05)。治疗90天时两组患者血清BDNF、NGF和FGF2水平较本组治疗前上升,且穴位结扎联合埋线组显著高于电针组(P<0.05)。穴位结扎联合埋线组临床总有效率(92.68%)高于电针组(81.01%,P<0.05)。两组患者均有不良反应发生,主要包括局部血肿或皮下出血,过敏反应、剧烈疼痛、晕针,均在对症处理后症状消失。结论 穴位结扎联合埋线法可有效治疗顽固性面瘫,改善面神经功能,其作用机制可能与提高血清神经营养因子水平从而促进面神经修复有关。

Objective To observe the clinical effectiveness of point ligation therapy combined with catgut embedment in acupoint for patients with refractory facial paralysis,and to explore the possible mechanisms from the perspective of neurotrophic factors.Methods Totally 168 patients with intractable facial paralysis were randomly divided into point ligation plus catgut embedment group and electroacupuncture group,with 84 cases in each group.Both groups took methylcobalamin tablets orally,on the basis of which the point ligation plus catgut embedment group gave point ligation therapy at Quanliao(SI 18),Dicang(ST 4),Jiache(ST 6),and catgut embedment in the local acupoints on the affected side combined with the distal acupoints,and the point ligation therapy combined with catgut embedment in acupoint was performed once every 30 days for three treatments;the electroacupuncture group took the same acupoints and gave electroacupuncture,with sparse and dense waves,once every other day.Both groups were treated for 90 days.Before treatment and after 30,60,90 and 120 days(follow-up),patients of both groups were observed for House-Brackmann Facial Nerve Grading(HB)and modified Portmann score;facial nerve electromyography was performed before treatment and after 90 days of treatment to record the wave amplitude and latency of facial nerve motor conduction,and serum brain-derived nerve growth factor(BDNF),nerve growth factor(NGF),fibroblast growth factor(FGF2)levels were determined.The clinical effectiveness of both groups after 90 days of treatment was compared,and the adverse events occurred in the course of treatment in all patients were recorded.Results At 30 days,60 days,90 days and follow-up visits,the HB grading of patients in both groups improved compared with that before treatment(P<0.05);the distribution of the number of patients with HB grading in the point ligation plus catgut embedment group was superior to that in the electroacupuncture group after 60 days and 90 days of treatment and at follow-up visits(P<0.05).The maximal amplitude of the facial nerve electromyography in both groups after 90 days of treatment was large,and the latency was shorter when compared with those before treatment(P<0.05),and the maximum wave amplitude of the point ligation plus catgut embedment group was higher than that of the electro-acupuncture group,and the latency period was shorter than that of the electro-acupuncture group(P<0.05).The modified Portmann scores of the both groups of patients after 30,60 and 90 days of treatment and follow-up were higher than those before treatment,and the scores of the point ligation plus catgut embedment group were higher than those of the electroacupuncture group(P<0.05).Serum BDNF,NGF and FGF2 levels in both groups after 90 days of treatment were higher than before,and the point ligation plus catgut embedment group was significantly higher than the electroacupuncture group(P<0.05).The total clinical effective rate of the point ligation plus catgut embedment group(92.68%)was higher than that of the electroacupuncture group(81.01%,P<0.05).Adverse reactions occurred in both groups,mainly including local haematoma or subcutaneous bleeding,allergic reaction,severe pain,and needle fainting,all of which disappeared after symptomatic treatment.Conclusion The point ligation therapy combined with catgut embedment in acupoint for patients with refractory facial paralysis are effective.The therapy improve the facial nerve function,and its mechanism of action may be related to increasing the level of serum neurotrophic factor and thus promoting facial nerve repairment.