针刺联合镇肝熄风汤对肝肾阴虚型高血压性脑出血患者早期临床症状及氧化应激状态的影响

The Influence of Acupuncture Combined with Modified Zhengan Xifeng Decoction on Early Clinical Symptoms and Oxidative Stress Status in Patients with Hypertensive Intracerebral Hemorrhage of Liver-Kidney Yin Deficiency Type

    摘要
  • 摘要:
    目的 观察针刺联合镇肝熄风汤加减对肝肾阴虚型高血压性脑出血（Hypertensive intracerebral hemorrhage，HICH）患者早期临床症状及氧化应激状态的影响。
    方法 选取2021年7月至2023年1月南京中医药大学附属昆山医院（昆山市中医医院）脑病外科、针刺康复科及病房成功接受24 h急性期治疗的肝肾阴虚型HICH患者60例，以SPSS 22.0软件生成随机排列表，将患者分为对照组和观察组各30例。对照组予对症处理、常规康复训练及镇肝熄风汤加减治疗，观察组在对照组基础上加用针刺治疗，疗程均为1个月。观察2组患者治疗前后临床有效率、中医证候积分、运动及神经功能评分日常生活能力（Activity of daily living，ADL）量表、美国国立卫生研究院卒中量表（National institute of health stroke scale，NIHSS）、改良阿什沃思量表（Modified Ashworth scale，MAS）、简化Fugl-Meyer运动功能评分量表（Fugl-Meyer assessment scale，FMA）、血肿病灶改善情况、各向异性分数（Fraction anisotropy，FA）比率（FA ratio，rFA）、抗氧化应激反应因子血清Kelch样ECH相关蛋白1（Kelch-like ECH-associated protein 1，Keap1）和核因子-E2相关因子2（Nuclear factor-E2-related factor 2，Nrf2）水平。
    结果 治疗后，观察组临床有效率显著优于对照组（P < 0.05）；2组中医证候积分均显著下降（P < 0.05），观察组优于对照组（P < 0.05）；2组ADL、FMA评分均显著下降（P < 0.05，P < 0.01），NIHSS、MAS评分显著上升（P < 0.05，P < 0.01），观察组优于对照组（P < 0.05）；2组血清Keap1水平均显著下降（P < 0.01），Nrf2水平显著上升（P < 0.05，P < 0.01），观察组优于对照组（P < 0.05）；影像学显示，治疗后，2组血肿残余量均显著降低（P < 0.05，P < 0.01），rFA值显著上升（P < 0.05，P < 0.01），观察组优于对照组（P < 0.01）。
    结论 急性期常规治疗基础上，针刺联合镇肝熄风汤治疗可显著改善肝肾阴虚型HICH患者早期临床症状，降低氧化应激水平，促进神经、运动功能恢复。

     

    Abstract:
    OBJECTIVE To observe the effect of acupuncture combined with a modified Zhengan Xifeng Decoction on the early clinical symptoms and oxidative stress status of patients with hypertensive intracerebral hemorrhage (HICH) of liver-kidney yin deficiency syndrome.
    METHODS A total of 60 patients with hypertensive intracerebral hemorrhage (liver-kidney yin deficiency syndrome) who successfully received 24-hour acute-phase treatment at the Department of Neurosurgery, Acupuncture and Rehabilitation Department, and wards of Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine (Kunshan Traditional Chinese Medicine Hospital) from July 2021 to January 2023 were recruited. A randomization table generated by SPSS 22.0 software was used to divide the patients into a control group and an observation group, with 30 patients in each group. The control group received symptomatic treatment, conventional rehabilitation training, and modified Zhengan Xifeng Decoction, while the observation group received additional acupuncture treatment on the basis of the control group. The treatment course was 1 month for both groups. Clinical effective rate, TCM syndrome scores, motor and neurological function scores Activity of Daily Living (ADL) scale, National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), Simplified Fugl-Meyer Assessment (FMA) scale, improvement in hematoma lesions, Fraction anisotropy (FA) ratio (rFA), and serum levels of antioxidant stress response factors Kelch-like ECH-associated protein 1 (Keap1) and nuclear factor-E2-related factor 2 (Nrf2) were observed before and after treatment in both groups.
    RESULTS After treatment, the clinical effective rate in the observation group was significantly higher than that in the control group (P < 0.05); the TCM syndrome scores in both groups decreased significantly (P < 0.05), with the observation group showing better results than the control group (P < 0.05); the ADL and FMA scores in both groups reduced significantly (P < 0.05, P < 0.01), while the NIHSS and Ashworth Scale scores increased significantly (P < 0.05, P < 0.01), with the observation group showing better improvement than the control group (P < 0.05); serum Keap1 levels decreased significantly in both groups (P < 0.01), while Nrf2 levels enhanced significantly (P < 0.05, P < 0.01), with the observation group showing better improvement than the control group (P < 0.05); imaging studies showed that after treatment, the residual hematoma volume decreased significantly in both groups (P < 0.05, P < 0.01), and the rFA value increased significantly (P < 0.05, P < 0.01), with the observation group showing better results than the control group (P < 0.01).
    CONCLUSION On the basis of standard treatment for the acute phase, acupuncture combined with Zhengan Xifeng Decoction can significantly improve the early clinical symptoms of HICH patients with liver-kidney yin deficiency, reduce oxidative stress levels, and promote the recovery of nerve and motor functions.

     

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