The Study On Clinical Efficacy And CT Image Analysis And Anti-inflammatory Effect Of Early Acupuncture Therapeutic Interventions To Traumatic Brain Edema

Background and Objective:Traumatic brain edema(TBE)originates from traumatic brain injury(TBI),which is a common clinical emergency with high mortality and morbidity.Approximately 50%of deaths in patients with severe brain injury are attributed to TBE.And the treatment of TBE,a hot issue in medical research,has always been difficult.Currently,the brain operation and the mannitol for injection have certain limitations.Acupuncture,which can remove blood stagnation,promote qi circulation,unblock the collaterals and regain consciousness and lead to the rehabilitation of TBE patients,has the potential to become an auxiliary treatment for TBE.However,there were few studies on acupuncture treatment in the acute phase of TBI.This research evaluated the added value of early acupuncture intervention in the treatment of TBE by randomized controlled trials(RCT).Methods:1.Clinical research.(1)RCT.A total of 72 TBE patients who met the inclusion criteria was divided into two groups by stratified block randomization,which the score of Glasgow Coma Scale(GCS)ranged from 6 to 12 points.The control group was treated with conventional western medicine,while on this basis,the experimental group additionally received early acupuncture treatment(within 72 hours after injury).Acupoint selections mainly included Baihui(GV20),Shuigou(GV26),Fengchi(GB 20),Fenglong(ST 40),etc.The acupuncture treatment was conducted once a day for 4 weeks,and rested for 1 day after 6 days of continuous treatment.(2)Clinical efficacy.Main outcome measure was Glasgow Outcome Scale(GOS).Secondary outcome indicators were GCS,modified Barthel index score(MBI),modified Edinburgh-Scandinavian stroke scale(MESSS)and simplified Fugl-Meyer assessment score(SFMA).(3)Safety evaluation.Adverse events were observed and recorded at any time during the trials.2.CT image analysis.3D-slicer software was used to measure the total intracranial lesion volume(TV)and calculate the average change speed of the intracranial lesions(VE).At the same time,a statistical analysis of the correlation between TV and GCS was performed.3.Research on anti-inflammatory effect.(1)Meta-Analysis.A systematic evaluation was made of the relationship between serum interleukin-6(IL-6).C-reactive protein(CRP),homocysteine(Hcy)and the degree of brain injury,as well as their relationship with prognosis.(2)Inflammatory cytokines.All participants received detections of the serum of CRP,Hcy and IL-6.For the different indicators,it was selected specific observation time points including baseline,the 7th day,the 14th day and the 28th day after the first acupuncture treatment and the 90th day after the treatment.Results:1.Clinical research results.Finally,30 patients in each group were included in statistical analysis.(1)Clinical efficacy.①Results of main outcome indicator.The GOS showed that there was no difference in mortality between the two groups(both 10.00%),while the effective survival rate(77.78%vs 48.15%)of the experimental group was better than that of the control group(P<0.05).②The results of secondary outcome indicators.Comparing the 28-day wake-promoting rates(36.67%vs 12.50%),the experimental group was better than the control group(P<0.05).For MESSS,the experimental group was better than the control group(P<0.05).As for the curative effect,there was no difference in the total effective rate(both 80.00%)between the two groups,but the markedly effective rate(70.00%vs 40.00%)of the experimental group was better than that of the control group(P<0.05).For the MBI and the SFMA,the experimental group was better than the control group(all P<0.05).(2)Safety observation.Only 11 cases of minor adverse events were recorded.2.CT image analysis.There was a correlation between TV and GCS(P<0.05),the larger the TV value,the lower the GCS.For the TV,the experimental group was smaller than the control group(P<0.05).The comparison of VE between the two groups showed that the experimental group was greater than the control group(P<0.05).This indicated that the combination of acupuncture and medicine had more advantages in alleviating the brain edema.3.Anti-inflammatory effect study results.(1)Meta-analysis showed that serum IL-6,CRP and Hcy were not only positively correlated with the clinical severity of TBI,but also negatively correlated with the prognosis of TBI patients.(2)Changes in inflammatory factors.For the content of CRP on the 14th day and IL-6 on the 7th day,the experimental group was significantly lower than that of the control group(both P<0.05).However,there was no significant difference in the content of Hey within or between groups.Conclusion:1.Acupuncture interventional therapy had advantages in promoting wakefulness of coma patients and improving prognosis.Moreover,it was safe and feasible to start acupuncture intervention in the acute phase of TBE.Therefore,acupuncture could be used as an alternative treatment for TBE.2.CT could quantitatively monitor the evolution of TBE,and acupuncture could accelerate the dissipation of brain edema.3.Acupuncture can counteract the effect of neuroinflammation mediated by CRP and IL-6,which might be one of the effective mechanisms of acupuncture in curing TBE.