针刺联合认知康复训练治疗卒中后认知障碍疗效及对细胞因子的影响

目的观察针刺联合认知康复训练治疗卒中患者认知功能障碍的临床疗效及对血清细胞因子的影响。方法选取卒中后认知障碍患者208例,采用随机数字表法将患者分为对照组和治疗组,每组104例,均行认知康复训练,治疗组加用针刺百会、神庭、四神聪等穴位治疗。治疗前后检测血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、胱抑素C(CPI)、视锥蛋白样蛋白-1(VILIP-1)、脑源性神经营养因子(BDNF)、胶质纤维酸性蛋白(GFAP)水平。治疗后对两组临床疗效进行比较,评价患者治疗前后简易精神状态检查量表(MMSE)和日常生活活动能力评分(ADL)的改善程度。结果治疗组临床疗效与对照组比较差异具有统计学意义(P<0.05),治疗组疗效优于对照组。治疗组治疗后MMSE和ADL评分与对照组比较差异均具有统计学意义(P<0.05),均优于对照组。两组治疗后BDNF水平均升高,Hcy和hs-CRP、CPI及血清VILIP-1、GFAP水平均降低,且治疗组上述指标均优于对照组(P<0.05)。两组患者均未出现不良反应。结论针刺联合认知康复训练可明显提高卒中认知障碍患者的认知能力,改善生存质量,有效改善相关血清细胞因子的表达,临床疗效显著,未见不良反应。

Efficacy of Acupuncture plus Cognitive Rehabilitation Training for Post-stroke Cognitive Impairment and Its Effect on Cytokines

Objective To observe the clinical efficacy of acupuncture plus cognitive rehabilitation training in treating cognitive impairment in stroke patients and its effect on serum cytokines. Method A total of 208 patients with post-stroke cognitive impairment were recruited and divided into a control group and a treatment group by the random number table method, with 104 cases in each group. The two groups both received cognitive rehabilitation training, while the treatment group was additionally intervened by acupuncture at acupoints including Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1). Before and after treatment, the levels of serum homocysteine (Hcy), highsensitivity C-reactive protein (hs-CRP), cysteine proteinase inhibitor (CPI), visinin-like protein-1 (VILIP-1), brainderived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) were detected. The clinical efficacies of the two groups were compared. The improvements in Mini-Mental Statement Examination (MMSE) and Activities of Daily Living (ADL) were evaluated. Result There was a significant difference in the clinical efficacy between the treatment group and the control group (P<0.05), and the efficacy in the treatment group was superior to that in the control group. After treatment, the MMSE and ADL scores in the treatment group were significantly different from those in the control group (P<0.05), and the treatment group was better than the control group. The level of BDNF increased, and the levels of Hcy, hs-CRP, CPI and serum VILIP-1 and GFAP all declined in the two groups after treatment, and the treatment group was better than the control group (P<0.05). No adverse events occurred in the two groups. Conclusion Acupuncture plus cognitive rehabilitation training can significantly enhance the cognition in patients with post-stroke cognitive impairment, improve their quality of life and the relevant serum cytokine expressions. Its therapeutic efficacy is significant, without causing adverse reactions.