电针对弥漫性轴索损伤运动功能障碍改善机制的初步研究  

Preliminary research on the mechanism of electroacupuncture in improving motor dysfunction in patients with diffuse axonal injury

作　　者：戴伟川[1] 郭协力[1] 蔡文华[1] 郑艳菲 朱玉燕 陈英贤 洪天生 田夏阳 Dai Weichuan;Guo Xieli;Cai Wenhua;Zheng Yanfei;Zhu Yuyan;Chen Yingxian;Hong Tiansheng;Tian Xiayang(Department of Neurosurgery,Jinjiang Municipal Hospital,Jinjiang 362200,China;Department of Rehabilitation,Jinjiang Municipal Hospital,Jinjiang 362200,China)

机构地区：[1]晋江市医院神经外科,福建晋江362200 [2]晋江市医院康复理疗科,福建晋江362200

出　　处：《中华脑科疾病与康复杂志（电子版）》2020年第4期248-253,共6页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：2015年福建省泉州市卫生计生研究资助项目(泉卫计函[2015]248号);2019年福建省泉州市卫生计生研究资助项目(泉卫办医政函[2019]3号);2019年福建省泉州市科技计划项目(泉科[2019]229号)。

摘　　要：目的通过分析Ⅱ型弥漫性轴索损伤(DAI)患者经电针治疗前后运动功能的变化,对其可能的作用机制进行初步探索。方法选取晋江市医院神经外科自2015年1月至2020年8月收治的87例Ⅱ型DAI运动障碍患者,将其分为对照组(42例)和治疗组(45例),对照组予常规西医治疗,治疗组在常规西医治疗基础上加用电针刺激穴位治疗。应用肢体运动功能Fugel-Meyer评定(FMA)量表及功能独立性评测(FIM)量表中运动功能方面分别测定2组治疗前后的运动功能。采用酶联免疫吸附技术测定2组患者的血清乙酰胆碱酯酶E(AchE)浓度,应用速率法测定其活性;多元逐步回归法分析治疗组运动功能与电针治疗、AchE浓度及活性的相关性。结果与治疗前比较,2组患者治疗后FMA、FIM评分均有所升高,差异具有统计学意义(P<0.05);治疗后,治疗组患者的FMA、FIM评分较对照组显著升高(P<0.05)。2组患者治疗前AchE浓度及活性比较差异无统计学意义(P>0.05);治疗后,治疗组血清AchE浓度高于对照组(P<0.05),但2组AchE活性比较差异无统计学意义(P>0.05);AchE浓度与FMA、FIM评分呈负相关性,其浓度对评分影响大于活性(P<0.05);治疗组运动功能与电针治疗、AchE浓度具有线性回归关系,偏相关系数和标准化回归系数均表明电针治疗对运动功能影响最大,其次是AchE浓度[|Beta|(X1)=|0.3541|>|Beta|(X2)=|-0.2001|]。结论电针对DAI运动功能障碍有改善作用,其可能通过影响神经递质乙酰胆碱的浓度,从而在改善DAI患者认知运动功能障碍的病理生理机制中发挥了一定的作用。Objective To analyze the changes of motor function of patients with diffuse axonal injury(DAI)(typeⅡ)before and after electroacupuncture treatment,and to explore its possible mechanism.Methods Eighty-seven patients with DAI(typeⅡ)dyskinesia admitted to the Department of Neurosurgery of Jinjiang Municipal Hospital from January 2015 to August 2020 were selected.They were divided into control group(n=42)and treatment group(n=45).The control group was treated with routine western medicine,while the treatment group was treated with electroacupuncture on the basis of routine treatment.The scores of motor function before and after treatment in the treatment group and the control group were measured by using the limb motor function Fugel-Meyer assessment(FMA)scale and the functional independence measure(FIM)scale.The concentration of serum acetylcholinesterase E(AchE)in the two groups was determined by ELISA technique,and its activity was determined by rate method.Multiple stepwise regression method was used to analyze the correlation between motor function and electroacupuncture treatment,AchE concentration and activity in the treatment group.Results Compared with those before treatment,the scores of FMA and FIM in control group and treatment group increased after treatment(P<0.05).The scores of FMA and FIM in the treatment group after treatment were significantly higher than those in the control group(P<0.05).There was no significant difference in AchE concentration and activity between the control group and the treatment group before treatment(P>0.05).After treatment,the level of serum AchE in treatment group was higher than that in control group(P<0.05).There was no significant difference in activity(P>0.05).The concentration of AchE was negatively correlated with the score of FMA and FIM,and the effect of concentration on the score was greater than that of activity(P<0.05).There was a linear regression relationship between motor function and electroacupuncture and AchE concentration in the treatment group.Standa

关 键 词：弥漫性轴索损伤 运动功能障碍 电针 乙酰胆碱酯酶E 

分 类 号：R246.6[医药卫生—针灸推拿学]