温针灸治疗脑梗死并发下肢动脉粥样硬化症及对脂蛋白相关磷脂酶A2和血管生成素样蛋白2的影响

Therapeutic effects of warm acupuncture and moxibustion on cerebral infarction complicated with LEAD and Lp-PLA2 and Angptl2

目的:探讨温针灸联合常规针刺治疗脑梗死并发下肢动脉粥样硬化症(Lower Extremity Atherosclerotic Disease,LEAD)的临床疗效及对脂蛋白相关磷脂酶A2(Lipoprotein-associated Phospholipase A2,Lp-PLA2)和血管生成素样蛋白2(Angiogenin-Like Protein 2,ANGPTL2)的影响。方法:将60例脑梗死合并LEAD患者随机分为试验组和对照组,每组30例。两组均接受常规药物治疗和康复治疗,对照组予以常规针刺治疗,试验组在对照组基础上给予温针灸治疗。治疗前后,通过简化Fugl-Meyer运动功能评定量表(Fugl-Meyer Assessment,FMA)和改良Barthel指数量表(Modified Barthel Index,MBI)评价运动功能;通过踝肱指数(Ankle Brachial Index,ABI)、胫前动脉内径及峰值流速、血清Lp-PLA2和ANGPTL2水平、血脂七项及血同型半胱氨酸等评价临床疗效。结果:试验组总有效率为93.33%(28/30),高于对照组的76.67%(23/30),两组之间存在显著差异(P<0.05);试验组的FMA评分和MBI评分较治疗前高(P<0.05),且高于对照组(P<0.05);试验组ABI、胫前动脉内径和胫前动脉血流峰值较治疗前高(P<0.05),且试验组高于对照组(P<0.05);试验组血清总胆固醇(Total Cholesterol,TC)、三酰甘油(Triglycerides,TG)、低密度脂蛋白胆固醇(Low Density Lipoprotein Cholesterol,LDL-C)、脂蛋白a(Lipoprotein a,Lp-a)、载脂蛋白(Apo)B、同型半胱氨酸(Homocysteine,Hcy)、Lp-PLA2和ANGPTL2水平均较治疗前低(P<0.05),且试验组低于对照组(P<0.05);试验组高密度脂蛋白胆固醇(High-density Lipoprotein Cholesterol,HDL-C)和ApoA1水平高于治疗前(P<0.05),且试验组高于对照组(P<0.05)。结论:温针灸结合常规针刺可以改善脑梗死并发LEAD患者的运动功能,促进下肢血液循环,改善血脂水平,临床疗效显著优于常规针刺,其作用机制可能与降低Lp-PLA2和ANGPTL2水平有关。

Objective:To explore the clinical efficacy of warm acupuncture and moxibustion combined with conventional acupuncture on cerebral infarction complicated with lower limb atherosclerosis disease(LEAD)and Lp-PLA2 and Angptl2.Methods:A total of 60 patients with cerebral infarction combined with LEAD were randomly divided into the experimental group and the control group,with 30 patients in each group.Both groups received conventional medicine and rehabilitation.The control group received conventional acupuncture.The experimental group received warm acupuncture and moxibustion more.Before and after treatment,the motor function was evaluated by the simplified Fugl Meyer Motor Function Assessment Scale(FMA)and the modified Barthel Index Assessment Scale(MBI).The clinical efficacy was evaluated by ankle brachial index(ABI),anterior tibial artery diameter and peak flow velocity,serum Lp-PLA2 and Angptl2 levels,seven items of blood lipids,blood homocysteine and other indicators.Results:The total effective rate in the experimental group was 93.33%(28/30),which was higher than 76.67%(23/30)in the control group,and there was a significant difference between the two groups(P<0.05).The FMA and MBI scores in the experimental group were higher than before treatment(P<0.05),and in the experimental group were higher than the control group(P<0.05).The ABI,anterior tibial artery diameter,and peak blood flow of the anterior tibial artery in the experimental group were higher than before treatment(P<0.05),and in the experimental group were higher than the control group(P<0.05).The levels of TC,TG,LDL-C,Lp(a),ApoB,Hcy,Lp-PLA2,and Angptl2 in the serum in the experimental group were lower than before treatment(P<0.05),and those in the experimental group were lower than the control group(P<0.05).The levels of HDL-C and ApoA1 in the experimental group were higher than before treatment(P<0.05),and in the experimental group were higher than those in the control group(P<0.05).Conclusion:Warm acupuncture and moxibustion combined with conventional acupuncture can improve the walking ability and motor function of patients with cerebral infarction complicated with LEAD,promote the blood circulation of lower limbs,and improve the level of blood lipids.The clinical efficacy is significantly better than that of conventional acupuncture.Its mechanism is related to the reduction of Lp-PLA2 and Angptl2 levels.