Scalp Treatment Of Acute Ischemic Stroke Clinical And Experimental Research

ObjectivesThe acute ischemic stroke,including cerebral infarction,cerebral thrombosis,lacunar cerebral infarction and transient ischemic attack,is classified in acute ischemic cerebrovascular diseases in western medicine.It has been one of the three causes of death worldwide,and,it attacks every age groups,severely threatens human health and brings great burden to society and family.After cerebral ischemia,once the neural damage becomes irreversible,the neural function will be unrecoverable.Therefore, treatment in acute stage is crucial for the patients' development and prognosis,and concerns the lowering the death rate and disability.The recent domestic researchers have conducted comprehensive and profound study on acupuncture on stroke, especially on scalp acupuncture,on which good efficacy has been attained.A series of reports showes that the scalp acupuncture can be applied not only to treating ischemic stroke,but also herrhemorrhage stroke;not only improves symptoms and sign in rehabilitating stage,but also has immediate effect in acute stage.This study applied the Internationally standardized Scheme of Scalp Acupuncture,compared the NSS of scalp acupuncture group(SA)and body acupuncture(BA)group before and after treatment so as to compare the difference of SA and BA.And we observed the effects of SA on NSS, inflammatory infiltration,blood plasma and ischemic cerebral tissue contents of cytokines as TNF-α,IL-1β,IL-10,ICAM-1 in rats with acute cerebral ischemic reperfusion injury.We did this to explore clinically and experimentally the therapeutic effect of SA on acute ischemic stroke and the possible mechanisms.Method92 cases of stroke patients selected from the in -patients sections of acupuncture and moxibustion department of Wuhan Chinese and Western Medicine Hospital were involved in the clinical observation,and were randomized into 2 groups as SA Treatment Group(n=46)and routine BA Group(n-46).All involved cases were received a 28 days treatment,and scored on the neural function.Comparisons were made between SA Group and BA Group on their differences of clinical therapeutic effects.In experimental part of this study,rat models of midlde cerebral artery occlusion were used to produce the ischemic/reperfusion.The NSS was scored for each rat,and inflammatory cells infiltration,blood plasma and ischemic brain tissue contents of TNF-α,IL- 1β,ICAM-1,IL-10were measured.Results1.Clinical Observation:(1)NSS of patients in both SA Group and BA Group were significantly lowered when compared to that of before treatment(P＜0.05).(2)No significant differences were observed on NSS between SA Group and BA Group after treatment(P＞0.05).The obvious effective rate of SA Group is 91.30%,with the total effective rate 97.83%,and of BA Group,respectively 89.13%and 95.65%.The statistical analysis showed no significant difference between the two groups(P＞0.05). 2.Experimental Study:(1)NSS:The 72h SA Group showed obvious lowered NSS than that of Model Group,when compared in each time phases(P＜0.01).(2)Inflammatory infiltration:On observation of HE stained ischemic cerebral tissue,very little leukocytes infiltration was seen in sham group;an obvious increase was shown in model group at 24h and peak in 48h and a decrease,however still existed leukocytes infiltration,in 72h;while in SA group,an apparent reduce was demonstrated,especially in 72h sub-group(P＜0.01).(3)On TNF-alpha,IL-1beta and ICAM-1:Obvious increases were demonstrated in model group at 24h obviously in TNF-alpha while slightly in IL-1beta and ICAM-1,and the peak emerged in 72h in TNF-alpha and 48h in IL-1beta and ICAM-1,and when compared with sham group at each phase points,the differences were sinificant(P＜0.05,for ICAM-1:P＜0.01);apparent decreases were seen in SA group at each phase point,and significant difference was observed in comparing SA group with model group at 72h(P＜0.01).(4)On IL-10:Increase was demonstrated in model group at 24h in IL-10 content,and the peak emerged in 48h.When compared with sham group at each phase points,the differences were significant(P＜0.05). Apparent increases were seen in SA group at each phase point,and significant difference was observed in comparing SA group with model group at 48h and 72h(for plasma IL-10 content:P＜0.05 and P＜0.01;for cerebral tissue:P＜0.01 and P＜0.05).Conclusions 1.SA therapy significantly attenuates the neural functional damage of stroke patients, excels in improving the symptoms and promotes the neural functional rehabilitation, and serves to lower the disability rate.It is an efficient method of treating acute ischemic stroke.2.Both SA and BA have affirmative effects in treating acute ischemic stroke patients. The obvious effective rate of SA Group is 91.30%,with the total effective rate 97.83%, and of BA Group,respectively 89.13%and 95.65%.The statistical analysis showed no significant difference between the two groups(P＞0.05).And SA nevertheless facilitates the patient to move passviely or actively during treatment,and is beneficial for functional recovery.In addition,the Internationally Standardised Scheme of Scalp Acupuncture gives prominence to Traditional Chinese Medicine,and is easy to operate, also,featured with the standardized treatment,it is apt for international exchange, therefore is deserved widespread application.3.Scalp-acupuncture is beneficial for neurofunctional rehabilitation,which can suppress leukocytes infiltration and,within a certain range,TNF-alpha,IL-1beta and ICAM-1 expression,and increase IL-10 content,in acute ischemia/reperfusion injury. Thus,the possible mechanisms of SA against brain ischemia may be concemed with the effectiveness of inhibiting inflammatory cell factors and suppressing cytokines-mediated inflammatory reaction,so the cerebral ischemia/reperfusion injury can be reduced by the regulation for the disordered immune state.