尼麦角林联合针刺治疗对脑卒中患者吞咽、认知功能及炎性标志物的影响  

Effects of nicergoline combined with acupuncture on swallowing,cognitive function and inflammatory markers in stroke patients

作　　者：赵鹏[1] 郜静[1] 吕建东 姚玉婷 肖志娟[1] ZHAO Peng;GAO Jing;LV Jian-dong;YAO Yu-ting;XIAO Zhi-juan(The Second Department of Neurology,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei,China;Department of Acupuncture,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei,China)

机构地区：[1]河北北方学院附属第二医院神经内二科,河北张家口075100 [2]河北北方学院附属第二医院中医针灸科,河北张家口075100

出　　处：《川北医学院学报》2020年第2期271-275,共5页Journal of North Sichuan Medical College

基　　金：河北省张家口市科技攻关计划课题(1821036D)。

摘　　要：目的:探讨尼麦角林联合针刺治疗对脑卒中患者吞咽困难、认知功能障碍及炎性标志物的影响。方法:选取120例脑卒中并伴有吞咽困难和轻中度认知功能障碍患者为研究对象,随机分为A组(常规治疗)、B组(常规治疗配合尼麦角林)、C组(常规治疗配合尼麦角林与针刺),每组各40例。分别于治疗前后,采用洼田饮水试验及电视X线透视吞咽功能检查(VFSS)评估患者治疗前后吞咽功能,采用蒙特利尔认知评估(MoCA)评分和简易智力状态检查量表(MMSE)评分评估患者认知功能;并取空腹肘静脉血,采用ELISA实验测定神经生化标志物脑源性神经营养因子(BDNF)、神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)水平,炎性损伤标志物肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和C反应蛋白(CRP)水平;统计各组治疗过程中肺炎发生情况。结果:治疗前,各组洼田饮水试验分级、VFSS、MoCA和MMSE评分比较,差异无统计学意义(P>0.05);治疗后,各组洼田饮水试验分级降低,且C组低于B组,B组低于A组;VFSS、MoCA和MMSE评分升高,且C组高于B组,B组高于A组,组间与组内比较,差异均有统计学意义(P<0.05)。治疗前,各组BDNF、NGF、NSE、TNF-α、IL-6和CRP水平比较差异无统计学意义(P>0.05);治疗后,各组BDNF、NGF水平升高,且C组高于B组,B组高于A组;NSE、TNF-α、IL-6和CRP水平降低,且C组低于B组,B组低于A组,组间与组内比较差异均有统计学意义(P<0.05)。A组肺炎发生率为20.00%,B组为15.00%,C组为2.50%,C组发生率明显低于A、B组,差异有统计学意义(P<0.05)。结论:尼麦角林联合针刺治疗可显著改善患者吞咽和认知功能,有助于提高临床疗效,并可调节神经功能因子水平,抑制炎症反应,减少肺炎的发生。Objective:To investigate the effects of nicergoline combined with acupuncture on dysphagia,cognitive dysfunction and inflammatory markers in stroke patients.Methods:120 stroke patients with dysphagia and mild to moderate cognitive impairment were selected as the study subjects,and randomly divided into 3 groups,40 cases in each group,group A(routine therapy),group B(routine treatment with nicergoline)and group C(routine treatment with nicergoline and acupuncture).The swallowing function of patients before and after treatment was evaluated by water swallow test and VFSS.MoCA score and MMSE score were used to evaluate the cognitive function of patients.Serum levels of brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),neuron-specific enolase(NSE),tumor necrosis factor-α(TNF-α),Interleukin-6(IL-6)and C-reactive protein(CRP)before and after treatment were observed.The incidence of pneumonia in each group during the treatment was counted.Results:Before treatment,there was no significant difference in water swallow test grading,VFSS,MoCA and MMSE scores in each group(P>0.05).After treatment,the grade of water swallow test in each group was decreased,and group C was lower than group B,and group B was lower than group A.VFSS,MoCA and MMSE scores were increased,and group C was higher than group B,while group B was higher than group A,with statistically significant differences between groups and within groups(P<0.05).Before treatment,there was no significant difference in BDNF,NGF,NSE,TNF-α,IL-6 and CRP levels in each group(P>0.05).After treatment,the levels of BDNF and NGF in each group were increased,and the levels in group C were higher than those in group B and group B were higher than those in group A.The levels of NSE,TNF-α,IL-6 and CRP were decreased,and the levels in group C were lower than those in group B,and those in group B were lower than those in group A.The differences between groups and within groups were statistically significant(P<0.05).The incidence of pneumonia in group A was 20.00%,gr

关 键 词：脑卒中 吞咽困难 认知功能 神经生化标志物 炎症因子 

分 类 号：R749.13[医药卫生—神经病学与精神病学]