针灸辅助治疗对急性缺血性脑卒中患者外周血炎性因子水平及神经功能的影响研究

背景针灸治疗可降低炎性因子水平，但其对急性缺血性脑卒中患者神经功能、日常生活能力及临床疗效的影响尚未明确。目的探究针灸辅助治疗对急性缺血性脑卒中患者外周血炎性因子水平及神经功能的影响。方法选取2018年3月至2021年3月在海安市中医院进行诊治的急性缺血性脑卒中患者为研究对象，依据入院先后顺序将患者分为对照组和针灸组。对照组采用静脉溶栓药物（尿激酶联合乌司他丁）治疗，针灸组在对照组基础上结合针灸辅助治疗。两组患者均治疗4周。比较两组患者治疗前（基线）、治疗中（治疗第2周）及治疗后（治疗结束）外周血C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白介素（IL）-1β、IL-6、IL-8水平。采用日常生活能力量表（ADL）及美国国立卫生研究院神经功能缺损量表（NIHSS）对患者进行日常生活能力和神经功能的评价。比较两组治疗前后ADL、NIHSS评分及治疗后临床疗效。结果本研究共纳入患者324例，其中对照组162例，针灸组162例。两组患者性别、年龄、平均发病至就诊时间、合并高血压发生率、合并糖尿病发生率、合并高脂血症发生率比较，差异无统计学意义（P>0.05）。两组患者治疗前CRP、TNF-α、IL-1β、IL-6、IL-8水平及ADL、NIHSS评分比较，差异无统计学意义（P>0.05）；针灸组患者治疗中、治疗后CRP、TNF-α、IL-1β、IL-6、IL-8水平低于对照组（P<0.05）。针灸组患者治疗后ADL评分高于对照组，NIHSS评分低于对照组（P<0.05）。针灸组患者治疗后总有效率〔91.36%（148/162）〕高于对照组〔79.01%（128/162）〕（χ2=9.783，P=0.002）。结论针灸辅助治疗可进一步降低急性缺血性脑卒中患者外周血炎性因子水平，提高神经功能恢复程度及日常生活能力，临床疗效较好。

Effect of Acupuncture as an Adjuvant Therapy for Intravenous Thrombolytic Treatment on Peripheral Inflammatory Factors and Neurologic Function in Patients with Acute Ischemic Stroke

Background Acupuncture has proved effective in reducing inflammatory cytokine levels.However,it is still unclear about its improvement on the neurologic function and activities of daily living as well as over all clinical efficacy in patients with acute ischemic stroke.Objective To explore the effects of acupuncture as an adjuvant therapy for intravenous thrombolytic treatment on peripheral inflammatory cytokines and neurologic function in acute ischemic stroke patients.Methods Acute ischemic stroke patients who were treated in Hai'an Traditional Chinese Medicine Hospital from March 2018 to March 2021 were selected,and divided into a control group(intravenous thrombolytic treatment with urokinase and ulinastatin)and an acupuncture group(intravenous thrombolytic treatment with urokinase and ulinastatin and acupuncture)by the order of admission.The treatment for both groups lasted for four consecutive weeks.The levels of peripheral CRP,TNF-α,IL-1β,IL-6,and IL-8 were compared at baseline,two and four weeks of treatment between the groups.Activities of Daily Living Scale(ADL)and NIH Stroke Scale(NIHSS)were used to assess pre-and post-treatment activities of daily living and neurologic function,respectively.Clinical efficacy was evaluated.Results A total of 324 patients were included,equally divided into control and acupuncture groups.Both groups had no significant differences in sex ratio,mean age,time interval between symptom onset,the first medical visit,incidence of hypertension,diabetes mellitus and hyperlipidemia(P>0.05).The levels of peripheral CRP,TNF-α,IL-1β,IL-6 and IL-8 demonstrated no significant intergroup differences at baseline(P>0.05),but they decreased more obviously at two and four weeks of treatment in the acupuncture group(P<0.05).The ADL and NIHSS scores were similar in both groups at baseline(P>0.05),but ADL score increased and NIHSS score decreased significantly in acupuncture group at four weeks of treatment(P<0.05).The overall clinical efficacy of the acupuncture group〔91.36%(148/162)〕was significant higher than that of the control group〔79.01%(128/162)〕(χ²=9.783,P=0.002).Conclusion As an adjuvant therapy for intravenous thrombolytic treatment,acupuncture could enhance the treatment effects on reducing peripheral inflammatory cytokines,and improving neurologic function recovery as well as activities of daily living,indicating that it may have a good clinical efficacy.