头针治疗痉挛型脑性瘫痪疗效观察及机制研究  

Efficacy and mechanism of scalp acupuncture for spastic cerebral palsy

作　　者：许金波 童光磊 XU Jin-bo;TONG Guang-lei(Anhui Hospital of Pediatric Hospital of Fudan University,Hefei 230051,China)

机构地区：[1]复旦大学附属儿科医院安徽医院,合肥230051

出　　处：《中国针灸》2023年第2期163-169,共7页Chinese Acupuncture & Moxibustion

基　　金：安徽省重点研究与开发计划项目:1804h08020254;安徽医科大学校科研基金项目:2020xkj076。

摘　　要：目的:观察头针治疗痉挛型脑性瘫痪(CP)的临床疗效,并基于脑白质纤维束及神经生长相关蛋白、炎性细胞因子探讨其可能作用机制。方法:将90例痉挛型CP患儿随机分成头针组与假头针组,每组45例。两组均予常规综合康复治疗,头针组针刺患侧顶颞前斜线、顶颞后斜线及顶中线,假头针组于上述穴线旁开1寸处行假针刺,均留针30 min,每日1次,每周5 d,连续治疗12周。分别于治疗前后观察两组患儿磁共振扩散张量成像(DTI)指标[大脑脚部位皮质脊髓束(CST)、内囊前肢(ICAL)、内囊后肢(ICPL)、内囊膝部(ICGL)、胼胝体膝部(GCC)、胼胝体体部(BCC)和胼胝体压部(SCC)的分数各向异性(FA)值]、血清神经生长相关蛋白[神经元特异性烯醇化酶(NSE)、神经胶质纤维酸性蛋白(GFAP)、髓鞘碱性蛋白(MBP)、泛素羧基末端水解酶L1(UCH-L1)]及炎性细胞因子[白介素33(IL-33)、肿瘤坏死因子α(TNF-α)]含量、脑血流动力学指标[脑动脉平均血流速度(Vm)、动脉收缩期峰流速度(Vs)及血管阻力指数(RI)、搏动指数(PI)]、表面肌电(SEMG)信号指标[股直肌、腘绳肌、腓肠肌、胫前肌均方根(RMS)值]、粗大运动功能(GMFM-88)评分、改良Ashworth痉挛量表(MAS)评分、日常生活活动能力(ADL)评分,并比较两组临床疗效。结果:治疗后,两组患儿各纤维束FA值、Vm、Vs、GMFM-88评分、ADL评分较治疗前增高(P<0.05),且头针组上述指标均高于假头针组(P<0.05);两组患儿血清NSE、GFAP、MBP、UCH-L1、IL-33、TNF-α含量及RI、PI、MAS评分、各肌肉RMS值较治疗前降低(P<0.05),且头针组上述指标均低于假头针组(P<0.05)。头针组总有效率为95.6%(43/45),高于假头针组的82.2%(37/45,P<0.05)。结论:头针可有效治疗痉挛型脑性瘫痪,改善患儿脑血流动力及粗大运动功能,降低肌张力及痉挛程度,提高日常生活活动能力,其机制可能为修复脑白质纤维束及调控神经生长相关蛋白、Objective To observe the clinical efficacy of scalp acupuncture for spastic cerebral palsy(CP), and to explore its possible mechanism based on brain white matter fiber bundles, nerve growth related proteins and inflammatory cytokines. Methods A total of 90 children with spastic CP were randomly divided into a scalp acupuncture group and a sham scalp acupuncture group, 45 cases in each group. The children in the two groups were treated with conventional comprehensive rehabilitation treatment. The children in the scalp acupuncture group were treated with scalp acupuncture at the parietal temporal anterior oblique line, parietal temporal posterior oblique line on the affected side, and parietal midline. The children in the sham scalp acupuncture group were treated with scalp acupuncture at 1 cun next to the above point lines. The needles were kept for 30 min, once a day, 5 days a week, for 12 weeks. Before and after treatment, the diffusion tensor imaging(DTI) indexes of magnetic resonance(FA values of corticospinal tract [CST], anterior limb of internal capsule [ICAL], posterior limb of internal capsule [ICPL], genu of internal capsule [ICGL], genu of corpus callosum [GCC], body of corpus callosum [BCC] and splenium of corpus callosum [SCC]), serum levels of nerve growth related proteins(neuron-specific enolase [NSE], glial fibrillary acidic protein [GFAP], myelin basic protein [MBP],ubiquitin carboxy terminal hydrolase-L1 [UCH-L1]) and inflammatory cytokines(interleukin 33 [IL-33], tumor necrosis factor α [TNF-α]), cerebral hemodynamic indexes(mean blood flow velocity [Vm], systolic peak flow velocity [Vs] and resistance index [RI], pulsatility index [PI] of cerebral artery), surface electromyography(SEMG) signal indexes(root mean square [RMS] values of rectus femoris, hamstring muscles, gastrocnemius muscles, tibialis anterior muscles), gross motor function measure-88(GMFM-88) score, modified Ashworth scale(MAS) score, ability of daily living(ADL) score were observed in the two groups. The clinical effect of th

关 键 词：痉挛型脑性瘫痪 头针 脑白质 纤维束 神经生长相关蛋白 炎性细胞因子 扩散张量成像 

分 类 号：R246.4[医药卫生—针灸推拿学]