针刺督脉腧穴联合镜像神经元康复训练对脑卒中后上肢屈肌痉挛协调功能、动脉血流速度和GDF-15、Trk B蛋白表达的影响  

Effect of Acupuncture on the Acupoints of the Governor Vessel and Mirror Neuron Rehabilitation Training on the Coordination Function of Upper Limb Flexor Spasm,Arterial Blood Flow Velocity and the Expression of GDF-15 and TrkB Protein After Stroke

作　　者：王殷 张颖 常永霞[1] 曲淑婕 李超 王正田 WANG Yin;ZHANG Ying;CHANG Yongxia;QU Shujie;LI Chao;WANG Zhengtian(The First Affiliated Hospital of Hebei North University,Shijiazhuang 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000

出　　处：《辽宁中医药大学学报》2022年第11期154-158,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：河北省财政厅老年病防治项目(冀财预复[2020]459号)。

摘　　要：目的 探讨针刺督脉腧穴联合镜像神经元康复训练对脑卒中后上肢屈肌痉挛协调功能、动脉血流速度和GDF-15、TrkB蛋白表达的影响。方法 选择96例脑卒中后上肢屈肌痉挛患者为研究对象,病例时间选择2019年3月—2020年3月,将纳入研究的病例根据随机数字表法分为针刺联合组和对照组。两组患者均采取对症生活指导和镜像神经元康复训练,针刺联合组在对照组基础上行督脉腧穴针刺治疗,两组疗程均为12周,疗程结束后对比疗效。采用Fugl-Meyer评分量表(FMA)评估患者治疗前和疗程结束后的上肢运动协调功能,采用Barthel指数(BI)评估两组患者治疗前和疗程结束后日常生活活动能力,采用经颅多普勒超声检查检测并对比两组患者治疗前和疗程结束后脑动脉收缩期峰值血流速度(Vmax)和平均血流速度(Vmean)以及阻力指数(PI),采用酶联免疫吸附法测定并对比两组患者治疗前和疗程结束后血清中生长分化因子-15(GDF-15)、酪氨酸受体激酶受体B(TrkB)含量。结果 针刺联合组治疗总有效率97.92%(47/48)明显高于对照组85.42%(41/48)(P<0.05);治疗后两组患者FMA评分均明显升高(P<0.05),针刺联合组明显高于对照组(P<0.05);治疗后两组患者BI指数均明显升高(P<0.05),针刺联合组明显高于对照组(P<0.05);治疗后两组患者Vmax、Vmean均明显升高(P<0.05),针刺联合组明显高于对照组(P<0.05);治疗后两组患者PI均明显降低(P<0.05),针刺联合组明显低于对照组(P<0.05);治疗后两组患者血清GDF-15含量均降低(P<0.05),针刺联合组明显低于对照组(P<0.05);治疗后两组患者血清TrkB含量均升高(P<0.05),针刺联合组明显高于对照组(P<0.05)。结论 针刺督脉腧穴联合镜像神经元康复训练对脑卒中后上肢屈肌痉挛患者肢体运动协调功能改善效果较好,促进动脉血液循环,降低GDF-15含量并增加TrkB表达,从而促进神经元再生。Objective To explore the effects of acupuncture at the acupoints of the governor vessel combined with mirror neuron rehabilitation training on the coordination function of upper limb flexor spasm,arterial blood flow velocity and the expression of GDF-15 and TrkB protein after stroke.Methods Ninety-six patients with upper limb flexor spasm after stroke were selected into this study,and the case time was selected from March 2019 to March 2020. The cases included in the study were divided into acupuncture combination group and control group according to a random number table. Both groups of patients were given symptomatic life guidance and mirror neuron rehabilitation training. The combined acupuncture group was treated with acupuncture at governor vessel acupoints on the basis of the control group. The course of treatment in both groups was 12 weeks. Comparison of efficacy after treatment. The Fugl-Meyer score scale(FMA)was used to evaluate the upper limb motor coordination function before and after the treatment,and the Barthel index(BI)was used to evaluate the activities of daily living of the two groups before and after the treatment. Pule ultrasonography detected and compared the peak blood flow velocity(Vmax),average blood flow velocity(Vmean)and resistance index(PI)of the cerebral arteries before and after the treatment of the two groups of patients. The enzyme-linked immunosorbent method was used to determine and compare the serum levels of growth differentiation factor-15(GDF-15)and tyrosine receptor kinase receptor B(TrkB)in the two groups of patients before and after the treatment. Results After treatment,the total effective rate of 97.92%(47/48)in the combined acupuncture group was significantly higher than 85.42%(41/48)in the control group(P<0.05);the FMA scores of the two groups were significantly increased(P<0.05),and the acupuncture combination group was significantly higher than the control group(P<0.05);after treatment,the BI index of the two groups were significantly increased(P<0.05). The combine

关 键 词：针刺 镜像神经元 康复训练 脑卒中 上肢屈肌痉挛 动脉血流 生长分化因子-15 酪氨酸受体激酶受体B 

分 类 号：R246[医药卫生—针灸推拿学]