Research progress on the effect of the combination of Jing acupoints bloodletting therapy and Sangzhi (Mori Ramulus) on shoulder-hand syndrome after stroke

Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the general terms of acupoints that the twelve meridians are located below the elbow and knee of the body),Jing acupoints is distributed at the end of fingers and toes where the twelve meridians of the human body pass by,and has the functions of stimulating the meridians and dredging the channels and collaterals.For the effects of discharging neurons,promoting cerebral blood flow and improving the brain micro-circulation,Jing acupoints bloodletting therapy can effectively relieve the clinical symptoms of the patients with SHS after stroke.Sangzhi(Mori Ramulus),with the ability of dredging the meridian and relieving the pain,is also has certain treatment functions to the SHS.In clinical practice,the combination of Jing acupoints bloodletting and Sangzhi(Mori Ramulus)have been widely used in the treatment of various diseases,and in terms of their mechanism of action,the combined treatment has a positive effect on post-stroke SHS,but there are few reports on this.Therefore,it is worth affirming the efficacy of combined treatment of SHS after stroke.This article elaborates the theoretical basis of Jing acupoints bloodletting on SHS after stroke,and the research progress of Sangzhi(Mori Ramulus)in treating SHS after stroke,which provide the theoretical guidance for the combination.

Sensory changes, C-and A-fiber function, and shoulder-hand syndrome in hemiplegic patients after stroke

BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.

Delphi and Analytic hierarchy process for the construction of a risk assessment index system for post-stroke shoulder-hand syndrome

Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.

Clinical Research of Traditional Chinese Medicine Fumigation and Washing Combined with Rehabilitation Training in the Treatment of Post-Apoplexy Shoulder-Hand Syndrome

Objective:To observe the clinical effect of traditional Chinese medicine fumigation and washing combined with routine rehabilitation training on post-stroke shoulder and hand syndrome(SHS).Comparing and analysing the effects of this treatment on the living ability of patients with post-stroke shoulder and hand syndrome.Methods:Fifty patients with post-stroke SHS who met the inclusion criteria were divided into observation group and control group by random number table method with 25 cases in each group.Both groups were given post-stroke secondary prophylactic drugs,while the control group was given routine rehabilitation training,20-30 minutes at a time,once a day,5 days a week,4 weeks as a course of treatment.On the basis of treatment in the control group,the observation group was combined with traditional Chinese medicine fumigation and washing,decocted with water to extract 3,000-4,000 ml juice,and added into the medicine bath bucket to soak the affected limb for 30-40 minutes,once a day,5 days a week,4 weeks as a course of treatment.The changes of upper limb edema degree,Numeric Rating Scale(NRS)score,Barthel index(MBI)and Fugl-Meyer Rating(FMA)scores before and after treatment were observed between the two groups,and the differences of clinical efficacy between the two groups were compared.Results:After treatment,the total effective rate in observation group was significantly better than that in control group(P<0.05).After treatment,the degree in upper limb edema in the two groups was significantly reduced(P<0.05),NRS score was decreased(P<0.05).Barthel index and FMA score were significantly increased(P<0.05),and the degree of upper limb edema and NRS score in the observation group were significantly lower than those in the control group(P<0.05).Barthel index and FMA score were significantly higher than those in the control group(P<0.05).Conclusion:The combination of traditional Chinese medicine fuming and washing with rehabilitation training has a better therapeutic effect on SHS,and the clinical efficacy of the former is more significant than that of single rehabilitation training.In clinical application,the former shows low cost,simple and easy operation,high acceptance by patients,and is conducive to promotion and use.

Timeliness of the analgesic effect of superficial needling on shoulder-hand syndrome after stroke

Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.

Effect of kinetic needling combined with blood-letting puncturing and cupping on functions of upper limbs of patients with shoulder-hand syndrome after apoplexy

Objective To observe influence of kinetic needling on functional restoration of upper limbs of patients with apoplexy-induced shoulder-hand syndrome. Methods Ninety patients were randomly divided into an observation group （45 cases） and a control group （45 cases）. Basic treatments selected according to corresponding stroke units were applied to both groups. Besides, scalp acupuncture at Dingnie Qianxiexian （MS 6, 顶颞前斜线）, Dingnie Houxiexian （MS 6, 顶颞前斜线） and Dingzhongxian （NS 5, 顶中线）, was applied in the treatment group. In the observation group, active and passive movement was carried out during the process of scalp acupuncture, and then needling plus bloodletting puncturing and cupping was applied. In the control group, only needling plus blood-letting puncturing and cupping was given. Therapeutic effects, pain scoring obtained by visual analogue scales （VAS）, FugI-Meyer and FugI-Meyer＇s scoring reflecting moving functions of upper limbs were made after 4 courses of treatments in both groups. Results The total effective rate was 95.5% and 91.1% in the observation group and control group, respectively, showing superiority of the former to the latter （P〈0.05）. After treatment, VAS scores were all obviously reduced in both groups （P〈0.01）, and the reduction in the former was significantly more than that in the latter （P〈0.01）. Moving functions of upper limbs shown by Fugl-Meyer＇s scoring were improved after 2 courses of treatment in both groups （P〈0.01）. The improvement was more obvious after 4 courses of treatment than that after 2 courses of treatment in both groups （P〈0.05）. After 4 courses of treatment, moving functions shown by FugI-Meyer＇s scoring were more remarkably improved in the observation group than those in the control group（t=3.9, P〈0.01）. Conclusion Both kinetic needling combined with needling plus blood-letting puncturing and cupping and simple needling plus blood-letting puncturing and cupping are effective in treating shoulder-hand syndrome after apoplexy, and the former is better than the latter.

川芎提取物通过miR-23a-3p/SNCA轴对帕金森综合征模型MPP^(+)诱导的SH-SY5Y细胞的影响

目的探究川芎提取物对MPP^(+)诱导的SH-SY5Y细胞和帕金森综合征的影响。方法1-甲基-4苯基吡啶离子(MPP^(+))干预SH-SY5Y建立帕金森综合征细胞模型(SH-SY5Y-MPP^(+)),川芎提取物干预后检测细胞增殖、凋亡以及miR-23a-3p、SNCA的表达情况。另观察调控miR-23a-3p、SNCA表达后SH-SY5Y-MPP^(+)的变化,双荧光素报告酶验证miR-23a-3p与SNCA的关系。结果SH-SY5Y-MPP^(+)的细胞增殖能力明显低于SH-SY5Y,而凋亡率则高于SH-SY5Y(P<0.05)。川芎提取物干预下,SH-SY5Y-MPP^(+)的增殖能力、Bcl-2、SNCA蛋白升高,凋亡率与miR-23a-3p、Bax蛋白降低(P<0.05)。沉默miR-23a-3p与升高SNCA均可以促进SH-SY5Y-MPP^(+)的增殖能力,抑制凋亡;而升高miR-23a-3p与沉默SNCA则反之(P<0.05)。在线靶基因预测网站发现,miR-23a-3p与SNCA存在可结合的互补位点,双荧光素报告酶显示SNCA-wt的萤火活性在转染了miR-23a-3p模拟物序列后受到了明显的抑制(P<0.05)。在升高miR-23a-3p后,SH-SY5Y-MPP^(+)中SNCA蛋白表达降低,而沉默miR-23a-3p则反之(P<0.05)。拯救实验显示,川芎提取物对SH-SY5Y-MPP^(+)的干预效果被升高miR-23a-3p或沉默SNCA完全逆转(P>0.05);升高miR-23a-3p对SH-SY5Y-MPP^(+)产生的影响则升高SNCA逆转(P>0.05)。结论川芎提取物通过调控miR-23a-3p/SNCA轴影响MPP^(+)诱导的SH-SY5Y生物学行为改变,未来可能是治疗帕金森综合征的新方向。

Therapeutic effect of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients:a clinical two-center randomized controlled trial

OBJECTIVE:To evaluate the therapeutic effects of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients.METHODS:One hundred and twenty hemiplegia patients with stage I shoulder-hand syndrome were randomly divided into a group treated with standardized electric acupuncture and massage,and a group treated with rehabilitation therapy for 6 weeks.The primary indices evaluated were pain on passive movement of the shoulder using the numeric pain rating scale(NPRS),and the number of patients with shoulder-hand syndrome at Steinbrocker stage II or III after treatment.The secondary indices were Fugl-Meyer evaluation of functional movement of the upper limb and hand using the modified rankin scale(MRS).RESULTS:At post-treatment evaluation and a 12-week follow-up visit,NPRS score,number of patients with stage II or III shoulder-hand syndrome,and MRS score were all improved in the acupuncture-massage group compared with the rehabilitation group(P<0.05).On Fugl-Meyer evaluation,functional movement of the upper limb was also improved in the acupuncture-massage group compared with the rehabilitation group(P<0.05).CONCLUSION:Standardized acupuncture-massage therapy may have curative effects on shoulder-hand syndrome in hemiplegia patients.

Clinical Observation on Electroacupuncture Treatment of Shoulder-Hand Syndrome in Apoplectic Hemiplegia

Objective： To investigate the therapeutic effect of electroacupuncture on shoulder-hand syndrome in apoplectic hemiplegia. Methods： One hundred and sixty patients were randomly divided into two groups. 80 cases in the control group was treated by conventional acupuncture by filiform needles and 80 cases in the treatment group were treated by electroacupuncture. The therapeutic effects were evaluated after two courses of treatment. Results： After two courses of treatment, the therapeutic effect for edema on back of the hand and hand pain in digital flexion and the total effective rate were better in the treatment group than in the control group （P〈0.05）. Conclusion： Electroacupuncture is of significant importance for relieving pain on back of hand, preventing the muscular atrophy of hand and promoting recovery from apoplexy.

Treatment of 40 Cases of Poststroke Shoulder-Hand Syndrome by Acupuncture

Acupuncture and rehabilitation therapies were used to treat 40 cases of shoulder-hand syndrome, the results show that integration of acupuncture and rehabilitation can increase therapeutic effects and shorten treatment courses to accelerate recovery.

Muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in the treatment of shoulder-hand syndrome after stroke

Objective To observe the effect of muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in improving nail fold microcirculation in the patients with shoulder-hand syndrome(SHS)after stroke,and the effects on hemorrheology,calcitonin gene-related peptide(CGRP)and serum substance P(SP).Methods A total of 72 patients were randomized into an observation group and a control group by the random number table method,with 36 cases in each group.The control group was treated with physical rehabilitation training,and the observation group was treated with additional muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment.The treatment course lasted for 4 weeks.After treatment,the clinical efficacy of the two groups was compared.The changes in shoulder-hand syndrome scale(SHSS),simplified Fugl-Meyer assessment-upper extremity(FMA-UE),visual analog scale(VAS),activities of daily living(ADL),traditional Chinese medicine(TCM)syndrome score,nail fold microcirculation hemorheology indictors[whole blood viscosity(high-shear,low-shear),hematocrit,erythrocyte sedimentation rate(ESR)],CGRP and SP levels were observed.Results The total effective rate in the observation group was 86.1%,higher than 63.9%in the control group(P<0.05).The overall curative effect in the observation group was better than that in the control group(P<0.05).After treatment,the scores of pain sensation,edema,external turn and rotation of the arm in SHSS,and the total score were significantly decreased in both groups(all P<0.05),and each score in the observation group was lower than that in the control group(all P<0.05).After treatment,the scores of VAS and TCM syndrome in both groups decreased significantly(all P<0.05),and the scores of FMA-UE and ADL increased significantly(all P<0.05).The scores of VAS and TCM syndrome in the observation group were lower than those in the control group(both P<0.05),and the scores of FMA-UE and ADL were higher than those in the control group(both P<0.05).After treatment,the whole blood viscosity(high-shear and low-shear)and hematocrit in both groups decreased obviously(all P<0.05),and ESR increased obviously(both P<0.05),and the whole blood viscosity(high-shear and low-shear)and hematocrit in the observation group were lower than those in the control group(all P<0.05),and ESR was higher than that in the control group(P<0.05).After treatment,the peritubular state,loop shape,blood flow and total score of nail fold microcirculation in both groups decreased significantly(all P<0.05),and each score in the observation group was lower than that in the control group(all P<0.05).After treatment,SP in both groups decreased obviously(both P<0.05),CGRP increased obviously(both P<0.05),and SP in the observation group was lower than that in the control group(P<0.05),CGRP was higher than that in the control group(P<0.05).Conclusion Compared with conventional physical rehabilitation training,muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment can significantly reduce the clinical symptoms of SHS,promote the recovery of physical functions,improve the nail fold microcirculation and hemorrheology indictors,and regulate the serum cytokine levels such as CGRP and SP.

锰中毒对SH-SY5Y细胞线粒体自噬作用的影响

[目的]探讨锰中毒对SH-SY5Y细胞线粒体自噬作用的影响。[方法]取对数生长期的人神经母细胞瘤SH-SY5Y细胞,予MnCl2处理24 h,采用酶联免疫吸附试验(ELISA)检测细胞中多巴胺(DA)的分泌量,蛋白免疫印迹法检测自噬标记蛋白LC3、线粒体分裂蛋白Drp1、线粒体融合蛋白Mfn1、Mfn2的表达。[结果]与正常对照组相比,MnCl2组多巴胺的分泌量显著减少(P<0.05),LC3-Ⅱ表达增加(P<0.05),Drp1表达降低(P<0.05),Mfn1及Mfn2表达增加(P<0.05)。[结论]锰中毒可显著降低SH-SY5Y细胞中多巴胺的分泌量,抑制线粒体的分裂并促进线粒体融合,导致线粒体自噬增多,这可能是锰中毒性帕金森综合征的病理机制之一。

Clinical observation on the effect of acupuncture and moxibustion combined with rehabilitation training on post-stroke shoulder hand syndrome

Objective:To compare the clinical effects of body acupuncture,moxibustion,and body acupuncture plus moxibustion in the treatment of post-stroke shoulder hand syndrome(SHS).Methods:A total of 90 SHS patients after stroke were randomly divided into the body acupuncture group,the moxibustion group,and the body acupuncture plus moxibustion group,with 30 cases in each.On the basis of rehabilitation and routine treatment,the patients in different groups were treated with body acupuncture,moxibustion,and body acupuncture plus moxibustion respectively.Treatment was given once a day,5 times a week,and 4 weeks in all.The visual analogue scale(VAS)scores,edema grading scores,and simplified Fugl-Meyer assessment(FMA)scores were evaluated before and after treatment,and the therapeutic effects of patients were evaluated as well.Results:After treatment,the VAS and edema grading scores of the three groups were all lower and the FMA scores were all higher than those before treatment,with statistically significant differences(all P<0.05).The VAS and edema grading scores of the acupuncture plus moxibustion group were lower and the FMA score was higher than those of the body acupuncture group and the moxibustion group,with statistically significant differences(all P<0.05).The total effective rate of the acupuncture plus moxibustion group was 96.7%,higher than 80.0%of the body acupuncture group and 83.3%of the moxibustion group,with statistically significant differences(both P<0.05).Conclusion:Body acupuncture,moxibustion,and body acupuncture plus moxibustion are all effective for post-stroke SHS,while the effect of acupuncture plus moxibustion is the best in relieving the pain and swelling,and improving effectively the joint movement of post-stroke SHS patients,which should be popularized in clinical practice.

针刺联合超短波理疗治疗脑卒中后肩手综合征临床观察

目的:观察针刺联合超短波理疗治疗脑卒中后肩手综合征(SHS)的效果。方法:84例分为参照组和研究组各42例,两组均用针刺治疗,研究组加用超短波理疗。结果:总有效率研究组高于参照组(P<0.05),治疗后研究组FMA、MBI评分高于参照组而VAS、水肿程度评分低于参照组(P<0.05),治疗后研究组SEP N9、SEP N20、SSR潜伏期低于参照组而SEP N9、SEP N20、SSR波幅高于参照组(P<0.05)。结论:针刺联合超短波理疗治疗SHS效果较好。

Fifty two cases of entrapment syndrome of superficial radial nerve treated with short thrust needling at Shànglián(上廉LI 9)

Objective: To observe the clinical therapeutic effects on entrapment syndrome of superficial radial nerve treated with the short thrust needling at Shànglián(上廉LI 9).Methods: A total of 52 patients of entrapment syndrome of superficial radial nerve were treated with the short thrust needling at LI 9. Firstly, the needle was inserted gradually and deeply until the needle tip touched the radial periosterum. Secondly, the needle body was tilted to form an angle about 30° with the skin surface. Thirdly, the needle handle was lifted and trusted shortly and swiftly to induce the gentle rubbing of the needle tip on the periosterum. The stimulation intensity of this needling technique was determined by the obvious soreness and distention in the local area or the needling sensation radiated to the radial sides of the thumb, the index figure and the middle figure of the affected limb. Afterward, the needle was retained for 20 min. The treatment was given once a day, five treatments made one course and a total of 2 courses of treatment were required.Results: Of 52 cases, 50 cases were cured, accounting for 96.2% and 2 cases remarkably effective, accounting for 3.8%. The mean conduction velocity of the superficial radial nerve was(49.38 ±2.97) m/s after treatment, faster than(29.31 ±5.94) m/s before treatment, indicating the significant difference(P< 0.05).Conclusion: The short thrust needling at LI 9 achieves the satisfactory clinical therapeutic effects on entrapment syndrome of superficial radial nerve. This therapeutic method is feasible to be promoted in clinical practice because of its less point selection and short treatment course.

去骨瓣减压术后早期颅骨修补术对颅脑创伤患者神经功能和认知功能的影响

目的探讨早期颅骨修补术对颅脑创伤患者去骨瓣减压术后神经功能和认知功能的影响。方法 2016年1月至2019年12月共106例颅脑创伤去骨瓣减压术后行颅骨修补的患者,分为早期颅骨修补组(去骨瓣减压术后1~3个月,48例)和常规颅骨修补组(去骨瓣减压术后3~6个月,58例),分别于颅骨修补术前和术后6个月采用Glasgow预后分级(GOS)评价预后、改良Rankin量表(mRS)评价日常生活活动能力、美国国立卫生研究院卒中量表(NIHSS)评价神经功能、简易智能状态检查量表(MMSE)评价认知功能,同时记录术后6个月环锯综合征发生率。结果术后6个月时,两组患者GOS评分(P=0.000)和MMSE评分(P=0.000)均高于、mRS评分(P=0.000)和NIHSS评分(P=0.000)均低于术前;术后6个月时,早期颅骨修补组患者GOS评分(P=0.041)和MMSE评分(P=0.040)均高于、mRS评分(P=0.021)和NIHSS评分(P=0.043)均低于常规颅骨修补组,且环锯综合征发生率亦低于常规颅骨修补组[18.75%(9/48)对39.66%(23/58);χ~2=5.446,P=0.020]。结论颅脑创伤患者去骨瓣减压术后早期行颅骨修补术可以有效提高日常生活活动能力、神经功能和认知功能,减少环锯综合征的发生,改善预后和远期生活质量。

耳针治疗卒中后肩手综合征临床疗效分析

目的:探讨耳针疗法对卒中后肩手综合征的治疗效果。方法:将60例卒中后肩手综合征患者,予以相同的基础治疗,随机分为耳针组(观察组30例)以及体针组(对照组30例),采用非盲法随机对照研究。以VAS法评定患肢疼痛和水肿,以彩色超声多普勒测定患肢血液流速,以Fugl-m eyer法评定上肢综合性运动功能。4疗程后统计疗效,计分结果进行统计分析。结果:耳针对于卒中后肩手综合征患肢的疼痛、水肿等症状的改善,以及对患肢尺静脉、桡静脉和中指指间动脉血液流速的改善高于体针组(P<0.05)。结论:耳针能促进卒中后肩手综合征患肢静脉血液的回流,改善微循环,能明确缓解病人疼痛、水肿症状,从而明显改善患肢综合性运动功能。

多囊卵巢综合征胰岛素抵抗与调节性T细胞功能的关系

目的探讨调节性T细胞（Treg）在多囊卵巢综合征（PCOS）患者胰岛素抵抗（IR）发生中的作用。方法收集IR、非IR的Pcos患者及同龄段正常妇女各20例，使用胰岛素增敏剂吡格列酮治疗IR与非IR患者，比较治疗前后外周血Treg数量、细胞因子转化生长因子B1（TGF-B1）及白介素10（IL-10）的含量，并比较两组患者胰岛素抵抗水平（HOMA—IR）、性激素水平及I临床指标的差异。结果治疗前IR组Treg、TGF—B1及IL-10均显著高于非IR组（t=3．261～15．822，P〈0．05）；治疗后两组以上三者的水平均显著低于治疗前（IR组t：2．374～8．534；非IR组t=2．894—10．292；均P〈0．05），但IR组仍显著高于非IR组（t=3．561—8．658，均P〈0．05）。IR组治疗前后的HOMA—IR均明显高于非IR组（t=2．463，2．037；均P〈0．05）；治疗后，IR组的HOMA—IR明显低于治疗前（t=2．572，P〈0．05），但该水平仍高于非IR组（t=1．723，P〈0．05）。治疗后，两组黄体生成素（LH）及睾酮（T）水平均明显低于治疗前（IR组t=3．632，1．726；非IR组t=2．017，1．246；均P〈0．05），但治疗后IR组LH水平仍高于非IR组（t=2．024，P〈0．05）。治疗后，两组的多毛（F—G）评分、腰围／臀围（WHR）及体重指数（BMI）均明显低于治疗前（IR组t=1．286～1．653；非IR组t=1．065～2．774，均P〈0．05），且IR组的F—G仍显著高于非IR组（t=1．241，P〈0．05）。相关性分析显示Treg与TGF—B1、IL-10、HOMA—IR、LH及F—G评分6项指标的变化具有良好的-致性，呈显著正相关性（，=0．060-O．079，均P〈0．05）。结论Treg在PCOS患者佩发生中起到重要作用，并且与IR的程度、性激素代谢及临床指标密切相关。

电针配合穴位注射治疗脑出血后肩-手综合征临床观察

目的:观察电针配合穴位注射治疗脑出血后肩-手综合征(SHS)的临床疗效,及对患者上肢功能恢复、日常生活能力的影响。方法:选取96例脑出血后SHS患者,按随机数字表法分为对照组40例和治疗组56例。2组均给予常规西药治疗及康复训练,对照组在此基础上加用中频理疗,治疗组则加用电针及穴位注射。对比分析2组综合疗效,观察患者上肢功能的恢复情况及日常生活能力的改善情况。结果:治疗组总有效率91.1%,对照组总有效率70.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组Fugl-Meyer运动功能评分法(FMA)及Barthel指数(B)I评分均较治疗前上升,视觉模拟评分法(VAS)评分均较治疗前下降,差异均有统计学意义(P<0.05);治疗组FMA及BI评分均高于对照组,VAS评分低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组肩关节前屈、后伸、外展、内收、外旋度均较治疗前增大,差异均有统计学意义(P<0.05);治疗组肩关节前屈、后伸、外展、内收、外旋度均大于对照组,差异均有统计学意义(P<0.05)。结论:电针配合穴位注射治疗脑出血后SHS疗效确切,可有效改善患者的上肢功能和提高生活能力。

耳针治疗肩手综合征对患肢血液流速的临床研究

目的:探讨耳针疗法对卒中后肩手综合征的治疗效果。方法:将60例卒中后肩手综合征患者,予以相同的基础治疗,按照随机法分为观察组(耳针与作业疗法组30例)以及对照组(单纯作业疗法组30例),比较两组患者治疗前后患肢血液流速的变化情况。治疗7周后评定疗效。结果:治疗后,观察组患者的患肢尺静脉、桡静脉和中指指间动脉血液流速的改善高于对照组(P<0.05)。结论:耳针能促进卒中后肩手综合征患者的上肢静脉血液的回流,改善微循环,缓解病人疼痛、水肿症状,从而明显改善患肢运动功能。