| Objective:In this clinical trial,scalp acupuncture was used to treat limb spasm after stroke,and the effect of scalp acupuncture on improving the degree of limb spasm,motor function and activities of daily living was evaluated.In animal experiments,scalp acupuncture was used to intervene the rat model of limb spasticity after middle cerebral artery occlusion,to explore the expression of inhibitory neurotransmitter GABA and receptors GABAA and GABAB,and the effect on BDNF / Trkb-kcc2 signaling pathway,so as to explore the possible mechanism of scalp acupuncture in the treatment of limb spasticity after stroke.Methods:Clinical research: 72 patients with limb spasm after stroke were randomly divided into scalp acupuncture group and control group according to the random number table method.The control group was only treated with exercise therapy alone,while the scalp acupuncture group was treated with cluster needling on the basis of exercise therapy in the apical and anterior regions of the control group.The needles were retained for 6hours each time.The two groups were treated once a day,5 days a week,for a total of4 weeks Week.After 4 weeks of intervention,the modified Ashworth Scale(MAS)was used to evaluate the muscle tension of the patients,the simplified Fugl Meyer motor assessment(FMA)was used to evaluate the motor function of the patients,and the modified Barthel Index(MBI)was used to evaluate the activities of daily living of the patients.Before treatment(-3-0 days)and after treatment(4 weeks ± 3 days).Spss26.0statistical analysis software was used to process the experimental data.The measurement data were expressed as mean(（？）)± standard deviation(s).Independent sample t test was used for inter group comparison,paired t test was used for intra group comparison;chi square test was used for inter group comparison of count data;test level α = 0.05.Animal experiment: 25 rats were randomly divided into control group(n = 5),model group(n = 10)and scalp acupuncture group(n = 10).The rats in the control group were fed routinely without any treatment,while the middle cerebral artery occlusion(MACO)was used to establish the model of cerebral ischemia in the model group and scalp acupuncture group.After modeling,the rats in the scalp acupuncture group were acupunctured at Baihui and the left and right sides of the rats by cluster needling at head points 24 hours after modeling,and the needles were quickly twisted for 1 minute,then the needles were retained for 2 hours,once a day,for 14 days;the rats in the model group were fed normally after modeling,and were given the same intensity and time of grasping stimulation in the scalp acupuncture group every day;the rats in the control group were only given the same intensity and time of grasping stimulation in the same scalp acupuncture group every day.Zealonga score was used to evaluate the neurological damage of rats in each group 24 hours after model establishment,and narrow ally test was used to evaluate the behavior of rats in each group 24 hours after model establishment and 14 days after intervention,and bl-420 s biological function experiment system was used to detect the muscle tension of rats in each group.After 14 days of intervention,the infarct volume was measured by TTC staining.The expression of GABA and its receptors GABAA and GABAB in the infarcted cortex of rats were detected by paraffin section and immunofluorescence double labeling.The expression of Trk B and KCC2 in the infarcted cortex of rats in three groups were detected by immunofluorescence method.The content of BDNF and the expression of Trk B in the infarcted cortex of rats in three groups were detected by Western blot.Spss26.0 software was used for statistical analysis,and graphpad prism9.0 was used to describe the statistical results.Results1.Clinical studyThe results of clinical research showed that cluster needling of scalp points combined with exercise therapy could significantly reduce the degree of spasticity of upper and lower limbs of patients with stroke,and the curative effect was better than that of exercise therapy alone(P < 0.05);After treatment,the Fugl Meyer scale scores of the two groups were significantly improved,and there was no statistical difference between the scalp acupuncture group and the control group,but the average score of the scalp acupuncture group was still slightly higher than that of the control group(P >0.05);Both groups can significantly improve the activities of daily living of patients,and scalp cluster acupuncture combined with exercise therapy is significantly better than exercise therapy alone(P < 0.05).2.Animal experimentTwenty four hours after the successful establishment of cerebral infarction model,zealonga score was used to evaluate the neurological damage of rats.There was no neurologic impairment in the control group.The neurologic impairment in the model group and the scalp acupuncture group was more obvious than that in the control group(P < 0.05),but there was no significant difference between the model group and the scalp acupuncture group(P > 0.05).After 24 hours of modeling,the rats were treated with narrow ally Test behavioral test results showed that: compared with the control group,the model group and the scalp acupuncture group had significantly increased the turning probability of standing and turning to the cerebral infarction side(P < 0.05),but there was no significant difference between the model group and the scalp acupuncture group(P > 0.05);after14 days of intervention,compared with the control group,the turning probability of the model group and the scalp acupuncture group to the cerebral infarction side was still significantly higher(P < 0.05).Compared with the model group,scalp acupuncture significantly reduced the behavioral score of narrow ally test.After 24 hours of modeling and 14 days of intervention,the muscle tension of the three groups was detected.The results showed that: after 24 hours of modeling,the muscle tension of the control group did not change significantly;compared with the control group,the muscle tension of the model group and the scalp acupuncture group increased significantly(P < 0.05);after 14 days of treatment,the muscle tension of the control group and the model group did not change significantly,and the muscle tension of the scalp acupuncture group after treatment was higher than that before treatment and the model group After treatment,the muscle tension decreased significantly(P <0.05).After 14 days of intervention,TTC staining was used to observe the brain tissue sections of rats.The results showed that there was no infarction area in the brain tissue of the control group,compared with the control group,the model group and scalp acupuncture group had obvious infarction area(P < 0.05).Compared with the model group,the infarct volume of the scalp acupuncture group decreased significantly(P <0.05).After 14 days of intervention,the contents of GABA,GABAA and GABAB in cerebral cortex of rats in each group were detected by immunofluorescence.The results showed that compared with the control group,the expression of GABA in cerebral cortex of rats in model group was significantly decreased(P < 0.05);compared with the model group,the expression of GABA in cerebral cortex of rats in scalp acupuncture group was increased(P < 0.05),but its expression level was significantly lower than that in the control group(P < 0.05).Compared with the control group,the expression of GABAA in the ischemic cerebral cortex of the model group was significantly decreased(P < 0.05);compared with the model group,the expression of GABAA in the ischemic cerebral cortex of the scalp acupuncture group was increased(P < 0.05),but its expression level was still lower than that of the control group(P < 0.05);compared with the control group,the expression of GABAB in the ischemic cerebral cortex of the model group was significantly decreased(P < 0.05);and Compared with the model group,the expression of GABAB in cerebral cortex of ischemic side in scalp acupuncture group was increased(P < 0.05),but its level was also lower than that in the control group(P < 0.05).After 14 days of intervention,the expression of KCC2 and Trk B in cerebral cortex of rats in each group was detected by immunofluorescence method.The results showed that compared with the control group,the expression of KCC2 in the injured cortex of rats in the model group was significantly decreased(P < 0.05),while the expression of KCC2 in the scalp acupuncture group was increased after cluster needling of scalp points,with statistical difference compared with the model group(P < 0.05);Compared with the control group,the expression of Trk B in the cortex of the injured side in the model group was significantly lower(P < 0.05).However,compared with the model group,the expression of Trk B in the scalp acupuncture group was further lower(P <0.05).After 14 days of intervention,Western blot was used The content of BDNF and Trk B in cerebral cortex of infarction area of three groups were detected.The results showed that compared with the control group,the expression of BDNF in cortex of injured side of model group was decreased,the expression of BDNF in scalp acupuncture group was significantly increased compared with the model group after treatment(P < 0.05);compared with the control group,the expression of Trk B in cortex of injured side was significantly decreased(P < 0.05),Compared with the model group,the expression of Trk B was further decreased,and the difference was statistically significant(P < 0.05).Conclusion:1.Clinical research results show that scalp acupuncture combined with exercise therapy can significantly reduce the degree of spasticity of upper and lower limbs of patients with stroke,and can significantly improve the motor function and activities of daily living of patients,indicating that scalp acupuncture is clinically effective in the treatment of limb spasticity after stroke.2.Scalp acupuncture can reduce cerebellar infarct size,reduce the degree of spasticity,improve the action ability of rats and protect the injured nerves.3.Scalp acupuncture can up regulate the expression of inhibitory neurotransmitter and its receptor in the injured cortex of ischemic stroke model rats,and reduce the occurrence of spasticity.4.Scalp acupuncture can regulate the expression of BDNF / Trkb-kcc2 signal pathway in the injured cortex of ischemic stroke model rats.BDNF / Trkb-kcc2 signal pathway may be the mechanism of scalp acupuncture in reducing spasticity of rats.Combined with the clinical and basic research results,it can be concluded that scalp acupuncture has a clear therapeutic effect on limb spasm after stroke,and its mechanism may be related to the regulation of neurotransmitters in the injured brain tissue.This study provides clinical and experimental evidence for the treatment of poststroke limb spasm. |
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