培元还五汤联合针灸治疗缺血性脑卒中恢复期患者的疗效及对血清细胞因子和睡眠质量的影响
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摘要
目的:探讨培元还五汤联合针灸治疗缺血性脑卒中恢复期患者的疗效及对血清细胞因子和睡眠质量的影响。方法:选取北京王府中西医结合医院于2017年1月～2018年12月间接收的99例缺血性脑卒中恢复期患者,根据数表法将患者随机分为对照组(n=49,给予基础治疗和常规康复训练)和研究组(n=50,在对照组基础上给予培元还五汤联合针灸治疗),比较两组患者临床疗效、神经功能缺损情况、上肢运动功能、睡眠质量以及血清超敏C-反应蛋白(hs-CRP)、妊娠相关蛋白A(PAPP-A)、神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平变化,记录两组治疗期间不良反应发生情况。结果:研究组治疗后临床总有效率为92.00%(46/50),显著高于对照组患者的71.43%(35/49)(P<0.05)。两组患者治疗2个月后神经功能缺损(NIHSS)评分、睡眠质量评分降低,且研究组低于对照组(P<0.05),Fugl-Meyer运动(FMA)评分则升高,且研究组高于对照组(P<0.05)。两组患者治疗2个月后血清hs-CRP、PAPP-A水平降低,且研究组低于对照组(P<0.05),血清NGF、BDNF水平则升高,且研究组高于对照组(P<0.05)。两组不良反应发生率比较无差异(P>0.05)。结论:培元还五汤联合针灸治疗缺血性脑卒中恢复期患者,疗效确切,可有效改善患者神经功能、上肢运动功能、睡眠质量,改善相关细胞因子水平,且不增加不良反应发生率,具有一定的临床应用价值。
Objective: To explore the curative effect of Peiyuan Huanwu decoction combined with acupuncture and moxibustion on serum cytokines and sleep quality in patients with recovery stage of ischemic stroke. Methods: 99 patients with recovery stage of ischemic stroke received indirectly in Beijing Royal Integrative Medicine Hospital from January 2017 to December 2018 were selected,and they were randomly divided into control group(n=49, given basic treatment and routine rehabilitation training) and study group(n=50, given Peiyuan Huanwu decoction combined with acupuncture and moxibustion treatment on the basis of the control group). The clinical efficacy, neurological deficit, motor function of upper limbs, sleep quality and serum levels of high sensitivity C-reactive Prot(hs-CRP), pregnancy-associated protein A(PAPP-A), nerve growth factor(NGF) and brain-derived neurotrophic factor(BDNF) were compared between the two groups. The occurrence of adverse reactions during the treatment of the two groups were recorded. Results:The total effective rate of the study group was 92.00%(46/50) after treatment, which was significantly higher than 71.43%(35/49) of the control group(P<0.05). 2 months after treatment, the national-institute of health stroke scale(NIHSS) score and sleep quality score of the two groups decreased, and the study group was lower than the control group(P<0.05), while the FMA score increased, and the study group was higher than the control group(P<0.05). The levels of serum hs-CRP and PAPP-A decreased in two groups at 2 months after treatment, and the study group was lower than the control group(P<0.05). The levels of serum NGF and BDNF increased, and the study group was higher than the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Peiyuan Huanwu decoction combined with acupuncture and moxibustion in the treatment of patients with recovery stage of ischemic stroke has definite curative effect. It can effectively improve the neurological function, upper limb motor function, sleep quality, improve the level of related cytokines, and do not increase the incidence of adverse reactions. It has certain clinical application value.
Objective: To explore the curative effect of Peiyuan Huanwu decoction combined with acupuncture and moxibustion on serum cytokines and sleep quality in patients with recovery stage of ischemic stroke. Methods: 99 patients with recovery stage of ischemic stroke received indirectly in Beijing Royal Integrative Medicine Hospital from January 2017 to December 2018 were selected,and they were randomly divided into control group(n=49, given basic treatment and routine rehabilitation training) and study group(n=50, given Peiyuan Huanwu decoction combined with acupuncture and moxibustion treatment on the basis of the control group). The clinical efficacy, neurological deficit, motor function of upper limbs, sleep quality and serum levels of high sensitivity C-reactive Prot(hs-CRP), pregnancy-associated protein A(PAPP-A), nerve growth factor(NGF) and brain-derived neurotrophic factor(BDNF) were compared between the two groups. The occurrence of adverse reactions during the treatment of the two groups were recorded. Results:The total effective rate of the study group was 92.00%(46/50) after treatment, which was significantly higher than 71.43%(35/49) of the control group(P<0.05). 2 months after treatment, the national-institute of health stroke scale(NIHSS) score and sleep quality score of the two groups decreased, and the study group was lower than the control group(P<0.05), while the FMA score increased, and the study group was higher than the control group(P<0.05). The levels of serum hs-CRP and PAPP-A decreased in two groups at 2 months after treatment, and the study group was lower than the control group(P<0.05). The levels of serum NGF and BDNF increased, and the study group was higher than the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Peiyuan Huanwu decoction combined with acupuncture and moxibustion in the treatment of patients with recovery stage of ischemic stroke has definite curative effect. It can effectively improve the neurological function, upper limb motor function, sleep quality, improve the level of related cytokines, and do not increase the incidence of adverse reactions. It has certain clinical application value.
引文
[1]Oana Darabont R,Stoicescu C,Tiu C.Therapeutic Challenges in Patients with Noncardioembolic Acute Ischemic Stroke in Need of Double Antiplatelet Therapy for Coronary Artery Disease[J].Am J Ther,2019,26(2):e213-e221
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[4]贾春燕,池礼捷,牛瑞芳,等.自拟活血化瘀方对缺血性脑卒中患者生活质量的影响[J].现代生物医学进展,2016,16(36):7176-7178,7193
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[10]杨永红,陈星玲,李志伟,等.急性脑梗死患者血清脂联素与神经功能缺损程度的相关性[J].广东医学,2017,38(z2):68-70
[11]林艳.运动疗法联合Fugl-Meyer量表对大面积脑梗死功能预后评估[J].贵州医药,2016,40(11):1208-1210
[12]单丹丹.认知行为干预对缺血性脑卒中失眠患者的影响[J].中国实用神经疾病杂志,2017,20(22):97-100
[13]Fukuta T,Ishii T,Asai T,et al.Applications of Liposomal Drug Delivery Systems to Develop Neuroprotective Agents for the Treatment of Ischemic Stroke[J].Biol Pharm Bull,2019,42(3):319-326
[14]Kim C,Kim SE,Jeon JP.Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke:Meta-Analysis[J].Neurointervention,2019,14(1):17-26
[15]Jing Y,Yue X,Yang S,et al.Association of Aspirin Resistance with Increased Mortality in Ischemic Stroke[J].J Nutr Health Aging,2019,23(3):266-270
[16]Bajaj D,Agrawal A,Gupta S,et al.Recreational Nitrous Oxide Abuse Causing Ischemic Stroke in a Young Patient:A Rare Case Report[J].Cureus,2018,10(12):e3761
[17]林阁,刘扬,诸剑芳,等.针药结合康复治疗气虚血瘀型恢复期缺血性脑卒中患者的临床观察[J].中国生化药物杂志,2017,37(10):221-222
[18]吴俊晓.针灸辅助治疗对缺血性脑卒中炎性细胞因子的影响[J].中国老年学杂志,2018,38(21):5140-5142
[19]朱丽,李静.不同剂量黄芪配伍的补阳还五汤对缺血性脑卒中患者血液流变学及疗效的影响[J].陕西中医,2014,35(9):1145-1147
[20]刘燕妮,冯卫星,闫咏梅,等.地黄饮子结合VitalStim吞咽障碍治疗仪治疗脑卒中后吞咽障碍临床研究[J].现代中西医结合杂志,2018,27(29):3200-3202
[21]吴丽霜,李琳.培元还五汤对缺血性脑卒中的疗效及对血清hs-CRP和PAPP-A水平的影响[J].中国中医急症,2016,25(3):484-486
[22]Fei Y,Fei R,Zhang J,et al.Systematic Evaluation of Efficacy and Safety of Acupuncture Treatment for Patients with Atrial Fibrillation[J].Open Access Maced J Med Sci,2019,7(3):461-466
[23]Noh SM,Lee KM,Kim BJ.Teaching NeuroImages:Cerebrospinal fluid leakage observed from skin after acupuncture[J].Neurology,2019,92(10):e1141-e1142
[24]邹利云.培元还五汤合康复治疗对Po SF疗效及血清致炎因子的影响[D].广州中医药大学,2014
[25]Kitagawa K,Hosomi N,Nagai Y,et al.Reduction in High-Sensitivity C-Reactive Protein Levels in Patients with Ischemic Stroke by Statin Treatment:Hs-CRP Sub-Study in J-STARS[J].J Atheroscler Thromb,2017,24(10):1039-1047
[26]Wang YJ,Gong ZQ,Bi XM,et al.Correlation of plasma soluble cluster of differentiation 40 ligand,alpha fetoprotein A,andpregnancy-associated plasma protein A with carotid plaque in patients with ischemic stroke[J].Genet Mol Res,2015,14(3):8091-8099
[27]Liu H,Zhong L,Zhang Y,et al.Rutin attenuates cerebral ischemiareperfusion injury in ovariectomized rats via estrogen-receptor-mediated BDNF-TrkB and NGF-TrkA signaling[J].Biochem Cell Biol,2018,96(5):672-681
[28]Adnyana IMO,Sudewi R,Samatra P,et al.Balinese Cultivar of Purple Sweet Potato Improved Neurological Score and BDNF and Reduced Caspase-Independent Apoptosis among Wistar Rats with Ischemic Stroke[J].Open Access Maced J Med Sci,2019,7(1):38-44
[29]Lin W,Chen XL,Chen Q,et al.Jin's three-needle acupuncture technique for chronic fatigue syndrome:a study protocol for a multicentre,randomized,controlled trial[J].Trials,2019,20(1):155
[30]黎小雅.培元还五汤改善中风后疲劳提高运动功能的临床研究[D].广州中医药大学,2012
[2]孟庆莲,盛宝英,韩凤,等.利伐沙班预防非瓣膜性心房颤动缺血性脑卒中的安全性和疗效观察[J].浙江医学,2016,38(4):293-294,299
[3]Qin C,Tian DS.Acute ischemic stroke due to painless long-segmental aortic dissection[J].Neurology,2019,92(10):484-485
[4]贾春燕,池礼捷,牛瑞芳,等.自拟活血化瘀方对缺血性脑卒中患者生活质量的影响[J].现代生物医学进展,2016,16(36):7176-7178,7193
[5]朱德军,杨小琼,袁婉丽,等.针灸联合通络扶正汤在老年缺血性脑卒中偏瘫早期干预中的临床疗效[J].中国老年学杂志,2014,34(11):2948-2950
[6]刘军兵,陈蓉,任胜洪,等.针灸配合中医定向透药疗法对缺血性脑卒中患者肢体功能恢复及高凝状态的影响[J].现代中西医结合杂志,2018,27(19):2129-2133
[7]余大云.培元还五汤联合康复训练对脑卒中后疲劳临床疗效及炎性因子影响[J].四川中医,2018,36(11):134-137
[8]任占利,范吉平.《中风病证候诊断标准》的临床验证研究[J].北京中医药大学学报,1994,17(6):41-43
[9]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153
[10]杨永红,陈星玲,李志伟,等.急性脑梗死患者血清脂联素与神经功能缺损程度的相关性[J].广东医学,2017,38(z2):68-70
[11]林艳.运动疗法联合Fugl-Meyer量表对大面积脑梗死功能预后评估[J].贵州医药,2016,40(11):1208-1210
[12]单丹丹.认知行为干预对缺血性脑卒中失眠患者的影响[J].中国实用神经疾病杂志,2017,20(22):97-100
[13]Fukuta T,Ishii T,Asai T,et al.Applications of Liposomal Drug Delivery Systems to Develop Neuroprotective Agents for the Treatment of Ischemic Stroke[J].Biol Pharm Bull,2019,42(3):319-326
[14]Kim C,Kim SE,Jeon JP.Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke:Meta-Analysis[J].Neurointervention,2019,14(1):17-26
[15]Jing Y,Yue X,Yang S,et al.Association of Aspirin Resistance with Increased Mortality in Ischemic Stroke[J].J Nutr Health Aging,2019,23(3):266-270
[16]Bajaj D,Agrawal A,Gupta S,et al.Recreational Nitrous Oxide Abuse Causing Ischemic Stroke in a Young Patient:A Rare Case Report[J].Cureus,2018,10(12):e3761
[17]林阁,刘扬,诸剑芳,等.针药结合康复治疗气虚血瘀型恢复期缺血性脑卒中患者的临床观察[J].中国生化药物杂志,2017,37(10):221-222
[18]吴俊晓.针灸辅助治疗对缺血性脑卒中炎性细胞因子的影响[J].中国老年学杂志,2018,38(21):5140-5142
[19]朱丽,李静.不同剂量黄芪配伍的补阳还五汤对缺血性脑卒中患者血液流变学及疗效的影响[J].陕西中医,2014,35(9):1145-1147
[20]刘燕妮,冯卫星,闫咏梅,等.地黄饮子结合VitalStim吞咽障碍治疗仪治疗脑卒中后吞咽障碍临床研究[J].现代中西医结合杂志,2018,27(29):3200-3202
[21]吴丽霜,李琳.培元还五汤对缺血性脑卒中的疗效及对血清hs-CRP和PAPP-A水平的影响[J].中国中医急症,2016,25(3):484-486
[22]Fei Y,Fei R,Zhang J,et al.Systematic Evaluation of Efficacy and Safety of Acupuncture Treatment for Patients with Atrial Fibrillation[J].Open Access Maced J Med Sci,2019,7(3):461-466
[23]Noh SM,Lee KM,Kim BJ.Teaching NeuroImages:Cerebrospinal fluid leakage observed from skin after acupuncture[J].Neurology,2019,92(10):e1141-e1142
[24]邹利云.培元还五汤合康复治疗对Po SF疗效及血清致炎因子的影响[D].广州中医药大学,2014
[25]Kitagawa K,Hosomi N,Nagai Y,et al.Reduction in High-Sensitivity C-Reactive Protein Levels in Patients with Ischemic Stroke by Statin Treatment:Hs-CRP Sub-Study in J-STARS[J].J Atheroscler Thromb,2017,24(10):1039-1047
[26]Wang YJ,Gong ZQ,Bi XM,et al.Correlation of plasma soluble cluster of differentiation 40 ligand,alpha fetoprotein A,andpregnancy-associated plasma protein A with carotid plaque in patients with ischemic stroke[J].Genet Mol Res,2015,14(3):8091-8099
[27]Liu H,Zhong L,Zhang Y,et al.Rutin attenuates cerebral ischemiareperfusion injury in ovariectomized rats via estrogen-receptor-mediated BDNF-TrkB and NGF-TrkA signaling[J].Biochem Cell Biol,2018,96(5):672-681
[28]Adnyana IMO,Sudewi R,Samatra P,et al.Balinese Cultivar of Purple Sweet Potato Improved Neurological Score and BDNF and Reduced Caspase-Independent Apoptosis among Wistar Rats with Ischemic Stroke[J].Open Access Maced J Med Sci,2019,7(1):38-44
[29]Lin W,Chen XL,Chen Q,et al.Jin's three-needle acupuncture technique for chronic fatigue syndrome:a study protocol for a multicentre,randomized,controlled trial[J].Trials,2019,20(1):155
[30]黎小雅.培元还五汤改善中风后疲劳提高运动功能的临床研究[D].广州中医药大学,2012
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