A型肉毒毒素治疗脑卒中患者肢体痉挛过程中对免疫功能的影响:随机、双盲、安慰剂对照  

Effect of type A borulinus toxin on immunological function in the treatment of post stroke limb spasticity:a randomized,double blind,placebo controlled trial

作　　者：付庆元[1] 陈桂兰[1] 孟凡琴[1] 付蕾蕾[2] 

机构地区：[1]济南市第一人民医院内科,山东省济南市250011 [2]山东大学第二医院,山东省济南市250033

出　　处：《中国临床康复》2005年第13期16-17,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察A型肉毒毒素对脑卒中后肢体痉挛患者肌张力和免疫功能的影响。方法:1996-03/2004-06年济南市第一人民医院收治脑血管病患者60例,均有肢体痉挛,且患肢手握力及肌力在3级以上,随机分为A型肉毒毒素组和安慰剂组各30例。A型肉毒毒素组应用A型肉毒毒素,以痉挛肌肉的肌腹为注射点进行多点皮下注射;安慰剂组注射药物改为安慰剂(生理盐水),治疗和评估采用双盲法。治疗前和治疗后12周应用修订Ashworth量表进行肌张力分级比较,手法肌力评定评估肌力;治疗前1周和治疗后6周检测细胞免疫及体液免疫。结果:按实际处理分析,60例患者进入结果分析。①肌张力:A型肉毒毒素组治疗前II级3例,III级18例,IV级9例,治疗后0级2例,I级5例,II级17例,III级6例,治疗前后比较差异显著(χ2=31.8,P<0.01)。安慰剂组治疗前后无差异。②肌力:A型肉毒毒素组治疗前3级16例,4级14例,治疗后3级7例,4级22例,5级1例,治疗后较治疗前好转,但无统计学意义。安慰剂组治疗前后无差异。③免疫功能:A型肉毒毒素组治疗前后免疫功能比较差异无显著性意义(P>0.05)。结论:局部注射A型肉毒毒素可降低脑卒中后肢体痉挛患者的肌张力,以利于开展功能训练,且对患者的免疫功能无影响。AIM:To observe the effects of type A borulinus toxin on muscular tension and immunological function in patients with post stroke limb spasticity. METHODS:Totally 60 patients with stroke selected from First People's Hospital of Jinan from March 1996 to June 2004 were divided randomly into type A borulinus toxin group and placebo group(n=30).Patients in type A borulinus toxin group received multipoint subcutaneous injection in muscle belly of spasmodical muscle with type A borulinus toxin. Patients in placebo group were injected with saline.The double blind method was used. The muscular tension was classified with modified Ashworth scale pre and six months post treatment, the muscle force was detected with manual muscle test (MMT). Cellular immunity and humoral immunity were detected one week pre treatment and 6 weeks post treatment. RESULTS:All 60 patients were involved in the result. ①The muscular tension: 2 cases showed Ⅱgrade, 18 cases showed Ⅲgrade, and 9 cases showed Ⅳgrade before treatment;2 cases showed 0 grade,5 cases showed I grade, 17 cases showed Ⅱgrade, and 6 cases showed Ⅲgrade after treatment in type A borulinus toxin group, and there was significant different(χ2=31.8, P< 0.01). But there was no significant different in placebo group between pre and post treatment.②The muscle force:16 cases showed Ⅲgrade, and 4 cases showed Ⅳgrade before treatment, 7 cases showed Ⅲgrade, 22 cases showed Ⅳgrade, and 1 case showed Ⅵgrade after treatment in type A borulinus toxin group. The muscle force became better post treatment as compared with pre treatment, but there was no statistical significance. There was no significant different in placebo group between pre and post treatment. ③There was no significant different in immunological function in type A borulinus toxin group between pre and post treatment (P >0.05). CONCLUSION: The injection of type A borulinus toxin is effective for limb spasticity post stroke, and it can not affect the immunological function of the patie

关 键 词：脑血管意外 痉挛/药物疗法 肉毒杆菌毒素 A型 免疫测定 

分 类 号：R743[医药卫生—神经病学与精神病学]