摘要
目的观察电针结合早期康复治疗对急性脑梗死（ACI）患者的运动、神经功能，白细胞黏附分子CD11b、CD18和肿瘤坏死因子-α（TNV-α）表达水平变化的影响。方法165例ACI患者分为对照组（50例）、一般康复组（50例）、综合康复组（65例）3组，并选择32例健康者作为健康组。测定4组治疗前和治疗后1、2、4周外周血多形核细胞（PMN）、单核细胞（MN）黏附分子CD11b、CD18和TNF-α的表达水平，并分别用改良爱丁保堡-斯堪的纳维亚脑卒中评定表（MESSS）、Fugle—Meyer功能评定（FMA）、Barthel指数（BI）评定功能评分。结果综合康复组和一般康复组疗效高于对照组，综合康复组较一般康复组疗效更优。对照组、一般康复组、综合康复组患者在治疗前与治疗后1、2、4周时PMN、MNCD11b、CD18和TNF-α的表达水平均高于健康组，差异有统计学意义（P〈0．05）。一般康复组、综合康复组治疗后1周PMN、MN CD11b、CD18和TNF-α表达水平较对照组降低，综合康复组较一般康复组明显降低，差异均有统计学意义（P〈0．05）；治疗后2周时一般康复组、综合康复组MN CD11b、CD18和TNF—α表达水平较对照组降低，综合康复组较一般康复组降低更明显，差异均有统计学意义（P〈0．05）。一般康复组、综合康复组治疗后2、4周神经功能评分低于对照组，综合康复组较一般康复组降低更明显；运动功能评分明显高于对照组，综合康复组较一般康复组增高更明显，差异均有统计学意义（P〈0．05）。一般康复组、综合康复组患者治疗后4周日常生活能力（ADL）评分高于对照组，综合康复组较一般康复组增高更明显，差异有统计学意义（P〈0．05）。结论电针结合早期康复训练能促进ACI患者运动功能的恢复，其机制可能与调节CD11b、CD18和TNF-α的表达水平有关。
Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CDI lb and CD18 in the polymorphonuclear leucocytes （PMN） and monocytes and serum tumor necrosis factor-α （TNF-α） levels in patients with acute cerebral infarction （ACI）. Methods A total of 165 ACI patients were randomly divided into control group （group A, n=50）, conventional rehabilitation group （group B, n=50） and comprehensive rehabilitation group （group C, n=65）. The expressions of CD1 lb and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group （group N）. The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale （MESSS） and Fugl-Meyer Assessment （FMA）, and their activity of daily living （ADL） was assessed using Barthel index （BI）. Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment （P〈0.05）. CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B （/9〈0.05）. At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C （P〈0.05）. The scores ofmESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, but the FMA and ADL score significantly higher in groups B and C than in the control group （P〈0.05）, and the differences were more obvious in group C. Groups B and C had greater effective rate than group A （P〈0.05）, and the rate was the highest in group C （P〈0.05）. Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2009年第6期569-573,577,共6页
Chinese Journal of Neuromedicine
