子午流注法针刺对老年缺血性卒中后痉挛性偏瘫的肢体功能及神经修复因子的影响OA
Ziwu Liuzhu Acupuncture for Spastic Hemiplegia in Elderly Stroke Patients:Effects on Motor Function and Neurorestorative Factors
目的:探讨子午流注理论指导下的针刺治疗对老年缺血性卒中后痉挛性偏瘫患者肢体功能及神经修复因子水平的影响.方法:纳入2022年6月~2024年10月咸宁市中医医院收治的70例老年缺血性卒中后痉挛性偏瘫患者,采用随机数字表法分为观察组(予子午流注法针刺)与对照组(予假针刺),每组35例;最终观察组33例、对照组34例完成4周干预及随访.两组均接受基础药物治疗,观察组于辰时、巳时选取脾胃经及局部解痉穴位行针刺治疗,对照组采用外观一致的钝头安慰针模拟针刺.比较治疗前后两组改良Ash‐worth量表(MAS)、临床痉挛指数(CSI)、Fugl-Meyer运动功能量表(FMA)、改良Barthel指数(MBI)评分变化,并检测血清胶质衍生神经营养因子(GDNF)、神经生长因子-3(NT-3)、血管内皮生长因子(VEGF)水平.结果:治疗前,两组MAS等级分布、CSI、FMA、MBI评分及血清GDNF、NT-3、VEGF水平比较,差异均无统计学意义(P>0.05),具有可比性.治疗后,两组MAS等级分布均较治疗前改善(观察组:Z=-5.35,P<0.01;对照组:Z=-3.92,P<0.01),且观察组0级比例显著高于对照组(33.3%vs 17.6%,Z=-2.27,P=0.023);两组CSI、MBI、FMA评分及血清GDNF、NT-3、VEGF水平均较治疗前显著改善(P<0.05),且观察组上述指标改善幅度均显著优于对照组(P<0.05).结论:子午流注法针刺可有效缓解老年缺血性卒中后痉挛性偏瘫患者的肌张力增高,提升肢体运动功能及日常生活活动能力,其机制可能与上调GDNF、NT-3、VEGF等神经修复因子水平、促进神经血管重塑相关.
Objective:To investigate the effect of acupuncture guided by the Ziwu Liuzhu theory on limb function and serum levels of neurorestorative factors in elderly patients with spastic hemiplegia after ischemic stroke.Methods:A total of 70 elderly patients with spastic hemiplegia after ischemic stroke,admitted to Xianning Hospital of Traditional Chinese Medicine from June 2022 to October 2024,were randomly assigned to an observation group(receiving Ziwu Liuzhu-guided acupuncture)and a control group(receiving sham acupuncture),with 35 cases in each group.Finally,33 cases in the observation group and 34 cases in the control group completed the 4-week intervention and follow-up.Both groups received conventional basic medication.The observation group was treated with acupuncture at acupoints along the Stomach and Spleen meridians and local spasm-relieving acupoints during the Chen(7:00-9:00)and Si(9:00-11:00)hours.The control group received sham acupuncture using non-penetrating placebo needles identical in appearance.Outcome measures included the Modified Ashworth Scale(MAS),Clinical Spasticity Index(CSI),Fugl-Meyer Assessment(FMA),Modified Barthel Index(MBI),and serum levels of glial cell line-derived neurotrophic factor(GDNF),neurotrophin-3(NT-3),and vascular endothelial growth factor(VEGF),assessed before and after treatment.Results:Before treatment,there were no statistically significant differences between the two groups in MAS grade distribution,CSI,FMA,and MBI scores,or serum GDNF,NT-3,and VEGF levels(P>0.05),indicating comparability.After treatment,both groups showed significant improvement in MAS grade distribution(observation group:Z=-5.35,P<0.01;control group:Z=-3.92,P<0.01),with the observation group exhibiting a significantly higher proportion of grade 0(33.3%vs.17.6%,Z=-2.27,P=0.023).Both groups demonstrated significant improvements in CSI,MBI,and FMA scores and serum GDNF,NT-3,and VEGF levels compared to baseline(P<0.05),and the observation group showed significantly greater improvements in all these parameters than the control group(P<0.05).Conclusion:Acupuncture guided by the Ziwu Liuzhu theory effectively alleviates muscle hypertonia and enhances motor function and activities of daily living in elderly patients with spastic hemiplegia after ischemic stroke.The underlying mechanism may be associated with the upregulation of neurorestorative factors such as GDNF,NT-3,and VEGF,thereby promoting neurovascular remodeling.
廖志高;余晖
咸宁市中医医院,湖北 咸宁 437100咸宁市中医医院,湖北 咸宁 437100
医药卫生
子午流注针刺缺血性卒中痉挛性偏瘫神经修复因子随机对照试验
Ziwu Liuzhuacupunctureischemic strokespastic hemiplegianeurorestorative factorsrandomized controlled trial
《中医康复》 2026 (10)
29-36,8
湖北省卫生健康委员会中医药科研项目(ZY2021M078)
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