徐珊珊 曾友华 包烨华

[摘要] 目的 探討针灸通督法联合黄连温胆汤对脑卒中患者Rivermead运动指数（RMI）、外周血miR-132、miR-134水平及简易智力状况检查量表（MMSE）评分的影响。 方法 将本院2017年8月～2018年9月收治的92例脑卒中患者随机分成对照组与观察组。两组均接受常规神经内科治疗，在此基础上对照组采取黄连温胆汤治疗，观察组则在对照组基础上联合针灸通督法治疗。对比两组临床疗效、外周血miR-132、miR-134相对表达量、认知功能、运动功能及日常生活能力。 结果 观察组总有效率达95.65%，较对照组的80.43%高（P<0.05）;两组治疗后外周血miR-132相对表达量均高于治疗前（P<0.05），miR-134相对表达量均低于治疗前（P<0.05）;两组治疗后MMSE、蒙特利尔认知评估量表（MoCA）、RMI及日常生活能力表（ADL）评分均高于治疗前（P<0.05），且观察组治疗后MMSE、MoCA、RMI及ADL评分均高于对照组（P<0.05）。 结论 对脑卒中患者实施针灸通督法联合黄连温胆汤治疗效果显著，不仅可显著增强患者认知功能及运动功能，有效调节外周血miR-132、miR-134水平，且对提高日常生活能力也尤为重要。

[关键词] 针灸通督法;黄连温胆汤;脑卒中;认知功能;运动功能

[中图分类号] R245          [文献标识码] B          [文章编号] 1673-9701（2019）24-0137-04

[Abstract] Objective To investigate the effect of acupuncture and moxibustion tongdu method combined with Huanglian Wendan decoction on Rivermead exercise index（RMI）， peripheral blood miR-132， miR-134 and mini-mental state examination（MMSE） scores in stroke patients. Methods 92 stroke patients admitted to our hospital from August 2017 to September 2018 were randomly divided into two groups， including the control group and the observation group. Both groups were treated with conventional neurology treatment. On this basis， the control group was treated with Huanglian Wendan decoction， and the observation group was treated with acupuncture and moxibustion tongdu method based on the treatment of the control group. The clinical efficacy， the relative expression of miR-132 and miR-134 in peripheral blood， cognitive function， motor function and daily living ability between two groups were compared. Results The total effective rate of the observation group was 95.65%， which was higher than that of the control group（80.43%）， P<0.05. The relative expression of miR-132 in the peripheral blood of the two groups after treatment was higher than that before treatment （P<0.05）. The relative expression level of miR-134 in the two groups after treatment was lower than that before treatment（P<0.05）， and the expression level of the above indicators in the observation group was superior to that of the control group（P<0.05）. The scores of MMSE， Montreal Cognitive Assessment Scale（MoCA）， RMI and ability of daily living（ADL） in two groups after treatment were higher than those before treatment（P<0.05）. And the scores of MMSE， MoCA， RMI and ADL were higher in the observation group than those in the control group（P<0.05）. Conclusion The treatment of stroke patients with acupuncture and moxibustion tongdu combined with Huanglian Wendan Decoction has significant effects，which can not only significantly enhance the cognitive function and motor function of patients，but also effectively regulate the levels of miR-132 and miR-134 in peripheral blood， and is also very important for improving the ability of daily living. 

[Key words] Acupuncture and moxibustion tongdu method;Huanglian Wendan decoction;Stroke;Cognitive function;Motor function

脑卒中是神经内科的一种重大疾患，其发病急骤，病情变化无常，该疾病以病灶性神经功能缺失为主要病理特征，临床表现为半身不遂、认知功能障碍、失语、意识障碍等，可对患者日常生活能力及生存质量造成极大的影响，甚至给其家庭带来巨大的负担。目前，针对该病多采取降颅内压、抗凝、神经营养等常规西医治疗方法，虽能够使病情得到控制，但无法有效逆转患者神经功能损害，对患者认知功能、日常生活能力的改善效果有限[1]。有关中医专家认为[2]，脑卒中病因虽复杂，但无外乎虚、火、风、痰、瘀痹阻脑络，充分发挥中医多靶点、多途径综合治疗优势，以针灸助阳行气、疏通脑络瘀滞，并辅以中药调理各脏腑气血阴阳，内外合治，获效甚佳。微小RNA（microRNAs，miRNAs）含有约21～23个核苷酸，且具有各种生物学调控功能的非编码RNA，在脑内大量表达，在突触可塑性形成中起重要作用。……