| Background and Objective:At present, our country is gradually entered the aging society, with the population structure changing, the incidence of stroke patients in China will continue to rise as a result of the changes of life style and environment,work pressure as well as the lacking of a variety of physical exercise. In recent years, due to the improvement of healthy level, especially to carry out thrombolytic and interventional treatment technology and other advanced technology, the mortality rate of patients with cerebral infarction is gradually decreased, but there is still a high rate of disability, according to statistics, the disability rate is up to 70%-80%. However, the sequelaes of neurologic deficits caused by cerebral infarction lead to heavy burden to the patient,family and society.At present, with the progress of medical technology, most of the patients of cerebral infarction can survive by active rescue and treatment,but there are a lot of legacy after cerebral infarction, such as mental retardation, vegetative state, partial numbness, visual field defect,aphasia,alexia, psychiatric symptoms, paralysis of limbs, drinking cough,difficulty in swallowing,which lead to serious problems to their life. The people with motor dysfunction after infarction apts to cause osteoporosis,and they are more likely to fall down.The pathogenesis of osteoporosis after stroke, most of the current research view agreed that it is the comprehensive effect of local andsystemic factors.The research shows that the brake is the most important factor of osteoporosis. Stroke patients with long-term bedridden and movement disorders can have different degree of osteoporosis. The osteoporosis after stroke (immobilization osteoporosis) belongs to a type of secondary osteoporosis in the cases of all kinds of immobilization osteoporosis. When the balance of bone reabsorption and bone formation in the human body is broken,, the bone reabsorption increased and bone formation decreased significantly. If the bone formation and absorption loss coupling, it can result the negative balance of bone reconstruction. The continuous loss of bone mass result the decrease of bone mineral content in the body, the bone trabecular become thin and sparse,while the bone strength decreased.The research found that even the healthy adults, who staying in bed for 1 week can also observed reduction of bone formation and the increasing of bone resorption, the former is mainly mediated by osteoblast and the latter is mediated by the osteoclast.The diagnosis of osteoporosis mainly depends on bone mineral density and the determination of a series of different biochemical markers of bone metabolism. The bone density measured by dual energy X-ray absorptiometry is the "gold standard" of the the diagnosis of osteoporosis which was recognized by the World Health Organization. Bone mineral density (BMD) can be applied to predict the risk of fracture and to judge the effect of drugs or therapeutic measure in osteoporosis patients. The biochemical indexes of bone metabolism, also known as bone turnover markers, include biochemical markers of bone reabsorption and bone formation.In the human skeletal system, the destruction or resorption of old bone and the formation of new bone is actually a continuing process. Bone is a continuous structure transformation, which adapt to changing the tension and stress, and bone reconstruction periodically can also play an important role in the repair of the defect. Bone resorption and formation remains in a state of dynamic balance. When this balance is broken, the bone was gradually developted to osteoporosis, while this process is accompanied by changes in biochemical markers of bone metabolism, so then the detection of these biochemical markers of bone metabolism plans an important role in the diagnosis of osteoporosis. Recent studies showed that osteoclasts although regulated by a variety of hormones and cytokines, but the final effect factor is osteoprotegrin (osteoprotegerin,OPG) system. Osteoprotegrin (OPG) is a new member of the tumor necrosis factor receptor family. It is first identified in 1997 by Simonet who was analysing the sequencing of cDNA in rat’s small intestine.Because it has the role of increasing cancellous bone,it was named osteoprotegerin (OPG). The OPG have important influence on pathogenesis and treatment of osteoporosis. OPG’s mRNA expressed widely in the human tissues and cells, such as lung, heart, kidney, liver, stomach, brain, spinal cord, thyroid and bone.Studies have shown that there is a close relationship between OPG and osteoporosis including senile osteoporosis, drug-induced osteoporosis and postmenopausal osteoporosis. The lack of OPG is one of the causes of osteoporosis.At present, the main therapies to prevent osteoporosis in clinic include taking in calcium, vitamin D and appling physical therapy as well as hyperbaric oxygen treatment measures, But the effect of those therapies is not obvious and there is considerable side effects.As we know, there is very little study about the influence of NFT in prevention and treatment of osteoporosis after stroke. NFT is an important method of rehabilitation in the treatment of nervous system diseases,which including a variety of specific rehabilitation techniques, it was mainly used for the rehabilitation of the central nervous system.Our experiment will observe the motor function, osteoporosis and osteoprotegerin level of the rats after stroke which was treated by conventional treatment and (or) NFT. We will investigate the feasibility of the treatment about osteoporosis after cerebral infarction by neuromuscular facilitation techniques.[Methods]Randomly selecting 10 aged female rats (Wistar) as sham operation group, the remaining 30 mice with MCAO model were randomly divided into three groups(each group had 10 rats), named control group, conventional treatment group, conventional treatment combined with neuromuscular facilitation technique group,whose nerve function score was 1 point to 3 points. After treatment for 0.5,1, 2,and 3 months,the motor function was evaluated by using beam walking test (BWT), the (BMD) of the proximal paralyzed limbs was examined, the expression level of OPG was observed by enzyme-linked immunosorbent assay.[Result]The rats with treatment showed significant increase in BWT scores after half month, contrasted with control group, (P<0.05); with neuromuscular facilitation technique being more potent in ameliorating motor function than conventional treatment after one month (P<0.05);Further studies demonstrated that the bone mineral density were remarkably increased in the treated groups from treatment for 2 months in contrast to the control group.The bone mineral density of the conventional treatment combined with NFT group was significantly higher than that of the conventional treatment group after 3 months (P<0.05)After half month, the level of OPG in the operative groups were significantly higher than those in the sham operation group(P<0.05).Compaired to control group,the groups with treatment showed significant increase in the level of OPG(P <0.05); In the group with neuromuscular facilitation technique, the level of OPG is obviously higher than that of the conventional treatment group after 3 months(P<0.05).[Conclusion]1. Treatment with neuromuscular facilitation technique is shown to promote the recovery of motor function of paralyzed limbs and prevent osteoporosis.2. The treated groups showed significant increace in the level of OPG,with neuromuscular facilitation technique(NFT) being more potent.3. we speculate the mechanism of ameliorating bone mineral density andpreventing of osteoporosis may involve the up-regulation of OPG. |
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