摘要
目的:观察龙虎交战针法治疗缺血性脑卒中的临床疗效及其对血清miR-431和miR-1247的影响。方法:选取2020年5月—2022年1月就诊的缺血性脑卒中气虚血瘀证患者98例为研究对象,随机分为2组各49例。对照组给予脑心通胶囊,观察组在对照组治疗方案的基础上采用龙虎交战针刺法治疗,2组均治疗4周。比较2组美国国立卫生研究院卒中量表(NIHSS)评分、Fugal-Meyer运动功能评估量表(FMA)评分、Barthel指数(BI)评分及临床疗效。比较2组炎症指标[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、免疫功能(T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+))、血清miR-431、血清miR-1247等指标。采用Pearson相关分析miR-431、miR-1247与炎症、免疫指标的关系,多因素Logistic回归和ROC曲线分析miR-431、miR-1247对卒中复发的影响。结果:治疗后,2组NIHSS评分均低于治疗前,FMA评分、BI评分均高于治疗前,且观察组NIHSS评分低于对照组,FMA、BI评分高于对照组,差异均有统计学意义(P<0.05);治疗后,2组IL-1β、IL-6、TNF-α均低于治疗前,且观察组IL-1β、IL-6、TNF-α水平均低于对照组,差异均有统计学意义(P<0.05);2组CD3^(+)、CD4^(+)、CD8^(+)T细胞水平均高于治疗前,且观察组CD3^(+)、CD4^(+)、CD8^(+)T细胞水平均高于对照组,差异均有统计学意义(P<0.05);治疗后,2组miR-431、miR-1247水平均低于治疗前,且观察组miR-431、miR-1247水平均低于对照组,差异均有统计学意义(P<0.05)。血清miR-431、miR-1247水平与CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞水平呈负相关(P<0.05),与IL-1β、IL-6、TNF-α水平呈正相关(P<0.05)。miR-431、miR-1247是脑卒中复发的独立危险因素(P<0.05),二者联合预测脑卒中复发的AUC为0.942。结论:龙虎交战针法能改善缺血性脑卒中气虚血瘀证患者运动功能和生活质量,减轻炎症反应,提高免疫功能,降低血清miR-431、miR-1247水平,上述miRNA是卒中复发的独立危险因素,具有较高的临床预测价值。
Objective:To observe the clinical effect of dragon-tiger contending needling method for ischemic stroke and its effects on miR-431 and miR-1247 in serum.Methods:A total of 98 cases of patients who had ischemic stroke with qi deficiency and blood stasis syndrome and treated from May 2020 to January 2022 were selected as study objects and randomly divided into two groups,with 49 cases in each group.Clinical effects and the scores of National Institute of Health stroke scale(NIHSS),Fugal-Meyer Assessment Scale(FMA),and Barthel Index(BI)were compared between the two groups.Inflammatory indicators[interleukin-1β(IL-1β),interleukin 6(IL-6),tumor necrosis factor-α(TNF-α)],immune function(T-lymphocytes:CD3^(+),CD4^(+),CD8^(+)),serum miR-431,serum miR-1247 and other indicators were compared between the two groups.Pearson correlation analysis was used to analyze the relationship between miR-431 and miR-1247 and inflammatory and immune indicators.Multifactor logistic regression and ROC curve were used to analyze the impact of miR-431 and miR-1247 on stroke recurrence.Results:After treatment,NIHSS scores in the two groups were lower than those before treatment,and the scores of FMA and BI were higher than those before treatment;NIHSS score in the observation group was lower than that in the control group,and the scores of FMA and BI in the observation group were higher than those in the control group,differences being significant(P<0.05).After treatment,levels of IL-1β,IL-6,and TNF-αin the two groups were lower than those before treatment,and the three levels in the observation group were lower than those in the control group,differences being significant(P<0.05);the levels of T-lymphocyte including CD3^(+),CD4^(+),CD8^(+)in the two groups were higher than those before treatment,and the three levels in the observation group were higher than those in the control group,differences being significant(P<0.05).After treatment,the levels of miR-431 and miR-1247 in the two groups were lower than those before treatment,and the two levels in the observation group were lower than those in the control group,differences being significant(P<0.05).There was a negative correlation between the levels of serum miR-431 and miR-1247 and the levels of CD3^(+),CD4^(+),and CD8^(+)T lymphocytes(P<0.01),and a positive correlation between the levels of serum miR-431 and miR-1247 and the levels of IL-1β,IL-6,and TNF-α(P<0.01).MiR-431 and miR-1247 were independent risk factors for stroke recurrence(P<0.05),and the AUC was 0.942 for stroke recurrence with a combined forecast of miR-431 and miR-1247.Conclusion:For patients with ischemic stroke with qi deficiency and blood stasis syndrome,dragon-tiger contending needling method can improve their motor function,quality of life,and immune function and reduce inflammatory reactions and the levels of miR-431 and miR-1247 in serum.The above two miRNAs are independent risk factors for stroke recurrence and have high clinical predictive values.
作者
许嘉隆
应晓明
赵钰琦
郭少卿
XU Jialong;YING Xiaoming;ZHAO Yuqi;GUO Shaoqing(Zhejiang Chinese Medical University,Hangzhou Zhejiang 310053,China;The Third Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou Zhejiang 310005,China)
出处
《新中医》
CAS
2023年第20期125-131,共7页
New Chinese Medicine
基金
浙江省医药卫生科研计划项目(2020KY479)
作者简介
许嘉隆(1993-),男,硕士研究生,中医师,E-mail:xujialong93@163.com;通信作者:郭少卿(1981-),男,医学硕士,主治中医师,E-mail:ljun7879@163.com
