通督调神针刺联合高频重复经颅磁刺激对缺血性脑卒中伴有偏身感觉障碍患者的感觉功能及脑血流和血清因子的影响

Effects of Tongdu tiaoshen acupuncture combined with high frequency repetitive transcranial magnetic stimulation on sensory function,cerebral hemodynamics,serum factor levels in patients with cerebral ischemic stroke accompanied by hemidysesthesia

目的探讨通督调神针刺联合高频重复经颅磁刺激(rTMS)对缺血性脑卒中伴有偏身感觉障碍患者的感觉功能及脑血流和血清血管内皮生长因子(VEGF)、重组人碱性成纤维生长因子(bFGF)及血管生成素-1(Ang-1)的影响。方法回顾性选取2020年1月至2021年6月间安徽中医药大学第二附属医院入院治疗的122例缺血性脑卒中并伴有偏身感觉障碍患者。按照不同治疗方式将其分为治疗组和对照组,每组各61例。对照组患者予以常规治疗和通督调神针刺治疗,治疗组患者在对照组的基础上加以高频rTMS治疗。比较两组患者治疗后的总有效率,并比较两组治疗前、治疗3周后的感觉功能评分、神经功能缺损程度[美国国立卫生研究院卒中量表(NIHSS)]及日常生活能力(巴塞尔指数)、体感诱发电位(SEP)N20波幅与潜伏期、脑血流动力参数[平均血流速度(Vm)、平均血流量(Qm)及血流阻力指数(RI)]、血管新生指标[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)及血管生成素-1(Ang-1)]水平。结果治疗组总有效率为90.16%,明显高于对照组(75.41%),差异有统计学意义(P<0.05)。治疗组治疗3周后的感觉功能评分、巴塞尔指数分别为(27.32±6.02)、(65.18±5.93)分,均高于对照组[(23.57±6.52)、(65.18±5.93)分],NIHSS评分为(7.68±2.51)分,低于对照组[(9.11±2.59)分],差异均有统计学意义(P<0.05)。治疗组治疗3周后的N20波幅为(2.46±0.49)μV,高于对照组[(1.83±0.75)μV],潜伏期为(20.41±4.69)ms,短于对照组[(26.52±5.91)ms],差异均有统计学意义(P<0.05)。治疗组治疗3周后的Vm、Qm分别为(63.15±5.07)cm/s、(9.79±1.53)mL/s,均高于对照组[(58.12±4.53)cm/s、(9.06±1.12)mL/s],RI为0.51±0.05,低于对照组(0.55±0.06),差异均有统计学意义(P<0.05)。治疗组治疗3周后的VEGF、Ang-1水平分别为(206.34±23.76)、(33.17±5.22)pg/mL,均显著高于对照组[(181.22±22.38)、(25.68±5.61)pg/mL],bFGF水平为(11.57±3.19)pg/mL,低于对照组[(14.39±3.52)pg/mL],差异均有统计学意义(P<0.05)。结论通督调神针刺联合高频rTMS治疗缺血性脑卒中伴感觉障碍效果明显,有利于改善患者的感觉功能。其良好的疗效可能与促进血管新生及改善脑血流动力学等机制有关。

Objective To observe the effects of Tongdu tiaoshen acupuncture combined with high frequency repetitive transcranial magnetic stimulation(rTMS)on sensory function,cerebral hemodynamics,serum levels of vascular endothelial growth factor(VEGF),recombinant human basic fibroblast growth factor(bFGF),angiopoietin-1(Ang-1)in patients with cerebral ischemic stroke accompanied by hemidysesthesia.Methods A retrospective study was conducted on 122 patients with cerebral ischemic stroke accompanied by hemidysesthesia who were admitted to the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2020 to June 2021.They were divided into the treatment group and the control group by different treatment methods,61 cases in each group.The patients in the control group were treated with routine treatment and Tongdu Tiaoshen acupuncture,and the patients in the treatment group were treated with high frequency rTMS on the basis of the control group.The efficacy was compared between the two groups.The sensory function score,neurological deficit degree[National Institutes of Health Stroke Scale(NIHSS)]and daily living ability(Barthel index),N20 amplitude and latency of somatosensory evoked potential,cerebral hemodynamic parameters[mean blood flow velocity(Vm),mean blood flow(Qm)and resistance index(RI)],and angiogenesis indexes[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)and angiopoietin-1(Ang-1)]were compared between the two groups before and after 3 weeks of treatment.Results The total effective rate of the treatment group was 90.16%,which was significantly higher than that of the control group(75.41%),and the difference was statistically significant(P<0.05).After 3 weeks of treatment,the sensory function score and Barthel index of the treatment group were(27.32±6.02)and(65.18±5.93)points,respectively,which were higher than those of the control group[(23.57±6.52)and(65.18±5.93)points],and the NIHSS score was(7.68±2.51)points,which was lower than that of the control group[(9.11±2.59)points],the differences were statistically significant(P<0.05).After 3 weeks of treatment,the amplitude of N20 in the treatment group was(2.46±0.49)μV,which was higher than that in the control group[(1.83±0.75)μV],and the latency was(20.41±4.69)ms,which was shorter than that in the control group[(26.52±5.91)ms],the differences were statistically significant(P<0.05).After 3 weeks of treatment,the Vm and Qm of the treatment group were(63.15±5.07)cm/s and(9.79±1.53)mL/s,respectively,which were higher than those of the control group[(58.12±4.53)cm/s,(9.06±1.12)mL/s],RI was 0.51±0.05,which was lower than that of the control group(0.55±0.06),the differences were statistically significant(P<0.05).After 3 weeks of treatment,the levels of VEGF and Ang-1 in the treatment group were(206.34±23.76)and(33.17±5.22)pg/mL,respectively,which were significantly higher than those in the control group[(181.22±22.38)and(25.68±5.61)pg/mL],and the level of bFGF was(11.57±3.19)pg/mL,which was lower than that in the control group[(14.39±3.52)pg/mL],the differences were statistically significant(P<0.05).Conclusion Tongdu tiaoshen acupuncture combined with high frequency rTMS can significantly improve the sensory function,improve the neurological function and activities of daily living in patients with cerebral ischemic stroke accompanied by hemidysesthesia,which may be achieved by regulating cerebral angiogenesis and improving cerebral hemodynamics.