Abstract:

Objective　To observe the effect of acupuncture combined with transcranial magnetic stimulation (TMS) in the treatment of cerebral infarction with Parkinson's disease (PD). Methods　In this prospective study, 127 patients with cerebral infarction complicated with PD admitted to Shangqiu Municipal Hospital from March 2020 to March 2022 were selected as the research objects. All patients were divided into an observation group (64 cases) and a control group (63 cases) after analyzing their clinical data. In the observation group, there were 34 males and 30 females, aged (60.33±0.12) years; in the control group, there were 33 males and 30 females, aged (60.28±0.25) years. Both groups were treated with conventional western medicine and TMS, and the observation group was treated with acupuncture on the basis. The changes of brain-derived neurotrophic factor (BDNF) levels before treatment and 3, 7, and 14 days after treatment and the improvement of cerebral hemodynamics before and after treatment were compared between the two groups. A short-term follow-up of 6 months was conducted after treatment to compare the improvement of motor function and the occurrence of adverse reactions between the two groups after treatment. t test and χ² test were used. Results　After 3, 7, and 14 days of treatment, the levels of BDNF [(4.82±0.33) μg/L, (5.62±0.31) μg/L, and (7.22±0.37) μg/L] in the observation group were higher than those in the control group [(4.02±0.41) μg/L, (4.95±0.47) μg/L, and (6.13±0.25) μg/L], with statistically significant differences (t=12.123, 9.497, and 19.422; all P<0.001). After treatment, the peak systolic blood flow velocity (VP) [(51.33±8.28) cm/s] and end-diastolic blood flow velocity (MFV) [(45.62±0.45) cm/s] in the observation group were higher than those in the control group [(43.16±8.17) cm/s and (40.12±0.33) cm/s], and the resistance index (RI) [(0.36±0.22)] was lower than that in the control group [(0.49±0.15)], with statistically significant differences (t=5.596, 78.443, and 3.885; all P<0.001). After treatment, the Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS-Ⅲ) score of the observation group [(42.45±0.31) points] was lower than that of the control group [(45.85±0.44) points], and the limits of stability (LOS) [(90.25±5.22) cm²] and Berg Balance Scale (BBS) score [(32.16±1.16) points] were higher than those of the control group [(87.62±5.17) cm² and (30.25±1.33) points], with statistically significant differences (t=50.404, 2.852, and 8.629; all P<0.001). The incidence of adverse reactions in the observation group was 7.81% (5/64), which was slightly higher than that in the control group [6.35% (4/63)], without a statistically significant difference (χ²=0.162, P=0.687). Conclusion　At the same time of routine western medicine combined with TMS treatment for patients with cerebral infarction and PD, acupuncture treatment can enhance the efficacy, improve their motor function while promoting the recovery of brain tissue function and cerebral hemodynamics, and it is not easy to cause serious adverse reactions in patients undergoing acupuncture treatment, with high safety.

Key words:

Cerebral infarction, Parkinson's disease, Transcranial magnetic stimulation, Acupuncture, Brain derived neurotrophic factor,  , Cerebral hemodynamics, Adverse reactions

摘要：

目的　观察针刺联合经颅磁刺激（TMS）治疗脑梗死合并帕金森综合征（PD）患者的效果。方法　本文为前瞻性研究，选取2020年3月至2022年3月期间商丘市立医院收治的127例脑梗死合并PD患者为研究对象，分析患者临床病例资料后将所有患者分为观察组（64例）和对照组（63例）。观察组男34例、女30例，年龄（60.33±0.12）岁；对照组男33例、女30例，年龄（60.28±0.25）岁。两组患者均统一接受常规西药治疗以及TMS治疗，观察组在其治疗基础上联合应用针刺治疗。对比两组治疗前及治疗3、7、14 d后脑源性神经营养因子（BDNF）水平变化情况，治疗前后脑血流动力学改善情况，并在治疗后实施为期6个月的短期随访，对比两组治疗后运动功能改善情况以及不良反应发生情况。采用t检验、χ²检验。结果　治疗3、7、14 d后，观察组BDNF［（4.82±0.33）μg/L、（5.62±0.31）μg/L、（7.22±0.37）μg/L］均高于对照组［（4.02±0.41）μg/L、（4.95±0.47）μg/L、（6.13±0.25）μg/L］，差异均有统计学意义（t=12.123、9.497、19.422，均P<0.001）。治疗后，观察组收缩期峰值血流速度（VP）［（51.33±8.28）cm/s］、舒张末期血流速度（MFV）［（45.62±0.45）cm/s］均高于对照组［（43.16±8.17）cm/s、（40.12±0.33）cm/s］，阻力指数（RI）［（0.36±0.22）］低于对照组［（0.49±0.15）］，差异均有统计学意义（t=5.596、78.443、3.885，均P<0.001）。治疗后，观察组统一帕金森病评分量表-Ⅲ（UPDRS-Ⅲ）评分［（42.45±0.31）分］低于对照组［（45.85±0.44）分］，稳定极限范围（LOS）［（90.25±5.22）cm²］、Berg平衡量表（BBS）评分［（32.16±1.16）分］均高于对照组［（87.62±5.17）cm²、（30.25±1.33）分］，差异均有统计学意义（t=50.404、2.852、8.629，均P<0.001）。观察组不良反应发生率为7.81%（5/64），略高于对照组6.35%（4/63），差异无统计学意义（χ²=0.162，P=0.687）。结论　在予以脑梗死合并PD患者常规西药联合TMS治疗同时，予以针刺治疗可增强疗效，可在促进患者脑组织功能、脑血流动力学恢复同时，改善患者运动功能，且配合针刺治疗不易导致患者发生严重不良反应，安全性较高。

关键词:

脑梗死, 帕金森综合征, 经颅磁刺激, 针刺, 脑源性神经营养因子, 脑血流动力学, 不良反应