自拟通窍逐瘀汤联合针刺治疗对老年常压性脑积水患者术后神经功能及脑脊液p73、p38因子的影响  

Effect of Self-made Tongqiao Zhuyu Decoction Combined with Acupuncture Treatment for Postoperative Neurological Function and Cerebrospinal Fluid p73 and p38 Factors in Elderly Patients with Hydrocephalus

作　　者：邱光庭 廖环 邹钒 郭兆玮 QIU Guangting;LIAO Huan;ZOU Fan(The Fourth People's Hospital of Shanghai City,Hongkou Shanghai 200081,China)

机构地区：[1]上海市第四人民医院,上海虹口200081

出　　处：《四川中医》2020年第10期126-130,共5页Journal of Sichuan of Traditional Chinese Medicine

摘　　要：目的:观察自拟通窍逐瘀汤联合针刺治疗对老年常压性脑积水(NPH)(后相同)患者术后神经功能及脑脊液p73、p38因子的影响。方法:选取2012年5月~2019年5月于同济大学附属上海市第四人民医院接受治疗的122例老年NPH患者为受试对象,随机数字表法分为观察组与对照组各61例。两组患者均给予脑室-腹腔分流术治疗,对照组患者在其基础上给予常规治疗,观察组在对照组基础上给予自拟通窍逐瘀汤联合针刺进行治疗。比较两组治疗前、治疗14d后的中医证候积分(尿失禁、步态不稳、认知功能障碍、舌暗紫)变化情况,评估其短期内(14d内)临床疗效,并记录其治疗前、治疗14d后的血清神经生化标志物[中枢神经特异蛋白(S100β)、人脑髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)]、相关酶学指标(p73、p38)水平及神经功能[美国国立卫生院神经功能缺损评分(NIHSS)、简易精神状态评价量表(MMSE)]变化。结果:治疗14d后,两组(尿失禁、步态不稳、认知功能障碍、舌暗紫)的中医证候积分、血清神经生化标志物(S100β、MBP、NSE)、酶学指标中p38水平、神经功能量表中NIHSS量表评分较治疗前均显著降低(P<0.05),且观察组治疗后的各项指标均显著低于对照组(P<0.05);经治疗,两组临床疗效各级别比较有统计学意义(P<0.05),且观察组临床治疗总有效率为91.80%,显著高于对照组的78.69%(P<0.05);治疗14d后,两组相关酶学指标中p73水平、MMSE量表评分较治疗前均显著升高(P<0.05),且观察组治疗后显著高于对照组(P<0.05)。结论:自拟通窍逐瘀汤联合针刺治疗老年NPH安全有效,能够缓解患者临床症状,减轻血清神经生化标志物的表达并纠正p73、p38异常,有利于神经功能的改善,于其病情转归有利。Objective:To observe the effect of Self-made Tongqiao Zhuyu Decoction combined with acupuncture on postoperative neurological function and cerebrospinal fluid p73 and p38 factors in elderly patients with normal pressure hydrocephalus(NPH).Methods:122 elderly patients with NPH who were treated in the Fourth People's Hospital of Shanghai City Affiliated to Tongji University from May 2012 to May 2019 were selected as subjects,and they were divided into observation group and controlled group according to the random number table method,with 61 cases in each group.The patients in both groups were treated with ventricular peritoneal shunt,and the patients in the controlled group were given conventional treatment on this basis,and the patients in the observation group were given Self-made Tongqiao Zhuyu Decoction combined with acupuncture on the basis of the controlled group.The changes of TCM syndromes scores(urinary incontinence,gait instability,cognitive dysfunction,dark purple tongue)were compared between the two groups before treatment and after 14d of treatment.The short-term(within 14d)clinical efficacy was evaluated,and the serum neurobiochemical markers[central nervous specific protein(S100β),human brain myelin basic protein(MBP),neuron-specific enolase(NSE)],related enzymatic indicators(p73,p38)and neurological function[National InstitutesofHealth Stroke Scale(NIHSS),Mini-Mental State Examination(MMSE)]were recorded before treatment and after 14d of treatment.Results:After 14d of treatment,the scores of TCM syndromes of urinary incontinence,gait instability,cognitive dysfunctionand dark purple tongue,levels of serum neurobiochemical markers(S100β,MBP,NSE)and enzymatic indicator p38,and neurological function NIHSS scale score in the two groups were significantly lower than those before treatment(P<0.05),and the above-mentioned indexes in the observation group after treatment were significantly lower than those in the controlled group(P<0.05).After treatment,there was a statistically significant difference in t

关 键 词：自拟通窍逐瘀汤 针刺 老年常压性脑积水 临床疗效 血清神经生化标志物 

分 类 号：R742.7[医药卫生—神经病学与精神病学]