益脑增智针法联合Bobath疗法治疗手足徐动型脑瘫患儿的临床疗效

摘要

目的 观察益脑增智针法联合Bobath疗法治疗手足徐动型脑瘫患儿的临床疗效.方法 选取2014年3月—2016年3月广西中医药大学第一附属医院收治的手足徐动型脑瘫患儿104例,采用随机数字表法分为对照组与观察组,每组52例.对照组患儿予以Bobath疗法,观察组患儿予以益脑增智针法联合Bobath疗法;两组患儿均连续治疗6个月.比较两组患儿临床疗效和治疗前后精细运动发育商(FMQ)评分、Caroll手功能评定量表评分、日常生活能力量表(ADL)评分、智力发育量表评分、CD4+CD25+Foxp3 high调节性T细胞比例、Foxp3 mRNA相对表达量、CTLA-4 mRNA相对表达量、血清白介素10(IL-10)水平、血清肿瘤坏死因子α(TNF-α)水平,并观察治疗后临床症状发生情况.结果 观察组患儿临床疗效优于对照组(P<0.05).治疗前两组患儿FMQ评分比较,差异无统计学意义(P>0.05);治疗后观察组患儿FMQ评分高于对照组(P<0.05).治疗前两组患儿Caroll手功能评定量表评分比较,差异无统计学意义(P>0.05);治疗后观察组患儿Caroll手功能评定量表评分高于对照组(P<0.05).治疗前两组患儿ADL评分比较,差异无统计学意义(P>0.05);治疗后观察组患儿ADL评分高于对照组(P<0.05).治疗前两组患儿智力发育量表评分比较,差异无统计学意义(P>0.05);治疗后观察组患儿智力发育量表评分高于对照组(P<0.05).治疗前两组患儿CD4+CD25+Foxp3 high调节性T细胞比例、Foxp3 mRNA相对表达量、CTLA-4 mRNA相对表达量比较,差异无统计学意义(P>0.05);治疗后观察组患儿CD4+CD25+Foxp3 high调节性T细胞比例、Foxp3 mRNA相对表达量、CTLA-4 mRNA相对表达量低于对照组(P<0.05).治疗前两组患儿血清IL-10、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后观察组患儿血清IL-10水平高于对照组,血清TNF-α水平低于对照组(P<0.05).治疗后观察组患儿临床症状发生率低于对照组(P<0.05).结论 益脑增智针法联合Bobath疗法治疗手足徐动型脑瘫患儿的临床疗效确切,可有效改善患儿双上肢精细运动功能、患侧手功能,提高患儿日常生活活动能力,促进患儿智力发育,调节患儿免疫功能,减轻炎性反应,减少临床症状的发生.%Objective To observe the clinical effect of yinao-zengzhi acupuncture therapy combined with Bobath exercise rehabilitation therapy in treating children with athetosic type cerebral palsy.Methods A total of 104 children with athetosic type cerebral palsy were selected in the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from March 2014 to March 2016,and they were divided into control group and observation group according to random number table,each of 52 cases.Children in control group received Bobath exercise rehabilitation therapy,while children in observation group received yinao-zengzhi acupuncture therapy combined with Bobath exercise rehabilitation therapy;both groups continuously treated for 6 months.Clinical effect,FMQ score,Caroll Hand Function Rating Scale score,ADL score, Intelligence Development Scale score,CD4+CD25+Foxp3 high T-regulatory cells ratio,relative expression quantity of Foxp3 mRNA and CTLA-4 mRNA,serum levels of IL-10 and TNF-α before and after treatment were compared between the two groups,and incidence of clinical symptoms was observed after treatment.Results Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).No statistically significant differences of FMQ score was found between the two groups before treatment(P>0.05),while FMQ score in observation group was statistically significantly higher than that in control group after treatment(P<0.05).No statistically significant differences of Caroll Hand Function Rating Scale score was found between the two groups before treatment(P>0.05),while Caroll Hand Function Rating Scale score in observation group was statistically significantly higher than that in control group after treatment(P<0.05).No statistically significant differences of ADL score was found between the two groups before treatment(P>0.05),while ADL score in observation group was statistically significantly higher than that in control group after treatment(P<0.05).No statistically significant differences of Intelligence Development Scale score was found between the two groups before treatment(P>0.05), while Intelligence Development Scale score in observation group was statistically significantly higher than that in control group after treatment(P<0.05).No statistically significant differences of CD4+CD25+Foxp3 high T-regulatory cells ratio,relative expression quantity of Foxp3 mRNA or CTLA-4 mRNA was found between the two groups before treatment(P>0.05),while CD4+CD25+Foxp3 high T-regulatory cells ratio,relative expression quantity of Foxp3 mRNA and CTLA-4 mRNA in observation group were statistically significantly lower than those in control group after treatment(P<0.05).No statistically significant differences of serum level of IL-10 or TNF-α was found between the two groups before treatment(P>0.05);after treatment, serum IL-10 level in observation group was statistically significantly higher than that in control group,while serum TNF-α level was statistically significantly lower than that in control group(P<0.05).Incidence of clinical symptoms in observation group was statistically significantly lower than that in control group after treatment(P<0.05).Conclusion Yinao-zengzhi acupuncture therapy combined with Bobath exercise rehabilitation therapy has certain clinical effect in treating children with athetosic type cerebral palsy,can effectively improve the fine motor function of upper limbs,affected side hand function and activities of daily living,promote the intelligence development,adjust the immunologic function,relieve the inflammatory reaction and reduce the risk of clinical symptoms.