| 头穴透刺联合丁苯酞可改善大脑中动脉狭窄患者的低灌注侧支循环及认知功能 |
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| 作者姓名： | 马宇 路凯 马龙 崔友祥 孙云川 |
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| 作者单位： | 1.河北省沧州中西医结合医院影像中心，河北 沧州 0610012.河北省沧州中西医结合医院神经内科，河北 沧州 0610013.河北省沧州中西医结合医院放疗中心，河北 沧州 061001 |
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| 基金项目： | 河北省中医药管理局科研计划项目2022227 |
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| 摘 要： | 目的 探讨头穴透刺联合丁苯酞对严重大脑中动脉狭窄低灌注区脑灌注及认知功能的影响。 方法 选取2019年3月~2020年12月我院神经内科门诊收治的符合入选标准的单侧大脑中动脉狭窄患者96例为研究对象，根据随机数字表法将其分为研究组及对照组，48例/组。两组均给予基础药物治疗:阿托伐他汀+氯吡格雷，每种口服1片/d，连服4周；研究组增加头穴透刺联合丁苯酞软胶囊。两组患者治疗前后行CT灌注成像，观测患区及对称非患病区脑血容量（CBV）、脑血流量（CBF）、平均通过时间（MTT）和达峰时间（TTP），计算患区灌注参数与对称非患区灌注参数比值，即rCBV、rCBF、rMTT、rTTP；采集两组患者治疗前后空腹静脉血检测血清一氧化氮、内皮素-1、血栓素B2、血管紧张素Ⅱ、血管内皮生长因子、脑源性神经营养因子、神经元特异性烯醇化酶、s100β蛋白水平，并行简易精神状态评价量表评价患者认知能力。 结果 治疗后，研究组的CBV、CBF高于治疗前及治疗后对照组（P<0.05），MTT、TTP、rCBV、rCBF、rMTT、rTTP均低于治疗前及治疗后对照组（P<0.05）；治疗后两组血清一氧化氮、内皮素-1、血管内皮生长因子、脑源性神经营养因子、神经元特异性烯醇化酶、s100β蛋白水平均高于治疗前，且研究组高于对照组（P<0.05）；两组治疗后血栓素B2、血管紧张素Ⅱ均低于治疗前，且研究组低于对照组（P<0.05）；治疗后两组认知功能各指标均显著高于治疗前，且研究组高于对照组（P<0.05）。 结论 头穴透刺联合丁苯酞可有效改善严重大脑中动脉狭窄患者远端侧支循环开放，提高脑血流量，上调神经营养因子，促进认知功能恢复。
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| 关 键 词： | 头穴透刺 丁苯酞 大脑中动脉狭窄 侧支开放 认知功能 |
| 收稿时间： | 2022-07-13 |
Effect of scalp acupuncture combined with butylphthalide on the stenosis and hypoperfusion area of middle cerebral artery and cognitive function |
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| Authors: | MA Yu LU Kai MA Long CUI Youxiang SUN Yunchuan |
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| Affiliation: | 1.Imaging Center, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061001, China2.Department of Neurology, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061001, China3.Radiotherapy Center, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061001, China |
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| Abstract: | Objective To explore the effect of scalp acupuncture combined with butylphthalide on cerebral perfusion and cognitive function in severe middle cerebral artery stenosis hypoperfusion area. Methods A total of 96 patients with unilateral middle cerebral artery stenosis who were admitted to the department of Neurology outpatient department of our hospital from March 2019 to December 2020 were selected as the subjects. They were randomly divided into study group and control group according to random number table method, with 48 patients in each group. Both groups were given basic drug therapy: atorvastatin + clopidogrel, 1 tablet per day orally for 4 weeks. In the study group, the combination of head point penetration and butylphthalide soft capsule was added. CT perfusion imaging (CTP) was performed before and after treatment in 2 groups. Cerebral blood volume (CBV), cerebral blood flow (CBF), mean time to pass (MTT) and peak time (TTP) in affected area and symmetric non- affected area were observed. The ratio of affected area perfusion parameters to symmetric nonaffected area perfusion parameters, namely rCBV, rCBF, rMTT and rTTP were calculated. Serum nitric oxide, endothelin-1, thromboxane B2 and AngII were detected in fasting venous blood of two groups before and after treatment, vascular endothelial growth factor, brain-derived neurotrophic factor, neuron specific enolase, S100 β protein and the Simple Mental State Assessment Scale were used to evaluate the cognitive ability of the patients. Results After treatment, CBV and CBF in the study group were significantly higher than those before and after treatment (P<0.05). MTT, TTP, rCBV, rCBF, rMTT and rTTP were significantly lower than those in the control group (P<0.05). After treatment, the levels of nitric oxide, endothelin-1, vascular endothelial growth factor, brain- derived neurotrophic factor, neuron specific enolase and s100β in the two groups were significantly higher than before, and the study group was significantly higher than the control group. After treatment, thromboxane B2 and AngII in both groups were significantly lower than before, and the study group was significantly lower than the control group (P<0.05). After treatment, the indexes of cognitive function in the two groups were significantly higher than before, and the study group was higher than the control group (P<0.05). Conclusion Head point penetrating acupuncture combined with butylphthalide can effectively improve distal collateral circulation opening, increase cerebral blood flow, upregulate neurotrophic factors and promote cognitive function recovery in patients with severe middle cerebral artery stenosis. |
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