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EFFECT_1

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EFFECT_1

    EFFECT

WorldJ.Acup-Mox.Vo1.11,No.1,March,2001

    ;EFFECToFACUPUNCTUREoNPLASMASTRESSHoRMoNE

    ;LEVELSoFHYPoTHALAMUS.PITUITARY.ADRENAL

    ;AXISINTYPEIIDIABETESWITHCoNCURRENT

    ;ACUTECEREBRALINFARCTIoNPATIENTS

    ;ChenJianfei(谌剑飞)LiangHaorong(梁浩荣)GuanShaoxia(关少

    )MaYaling(马雅玲)

    ;AffiliatedZhuhaiTCMHospitalofGuangzhouUniversityofTCMandPharmacy,

    ;Zhuhai519015,China

    ;ABSTRACTObjective:.

    ;ToobservetheeffectofacupunctureOllthecontentsofstresshormonesofthehypothala?

    ;mILlS?pituitary?adrenalaxis(HPA)intreatmentoftypelIdiabeteswithconcurrentacutecerebralinfarctionpatients.

    ;

    ;Meth

    ;ods:60casesofinpatientswererandomlyandevenlydividedintotreatmentgroup(conventionalmedicationplus

    ;acupuncture)andcontrol(conventionalmediation)group.Plasmacorticotropinreleasinghormone(CRH),adrenocor?

    ;ticotropinhormone(ACTH)andcorticosteroid(cs)contentsbeforeandaftertreatmentweremeasuredusingradioim?

    ;munoassay(RIA)andcomparedwiththeseofhealthysubjectgroup(n=30).

    ;Resu

    ;lts:PlasmaCRH,ACTHandCS

    ;levelsinpatientsofbothtreatmentgroupandcontrolgroupatadmissionweresignificanthigherthanthoseofnormal

    ;subjectgroup(

    <0.05).Aftertreatmentfor15~30days,resultsshewedthatplasmaCRH,ACTHandCSlevelsin

    ;bothtreatmentandcontrolgroupsloweredsignificantlyincomparisonwiththoseofpre-treatment<0.05or0.01);

    ;whilethoseoftreatmentgroupwereevenmorelower(beingclosertothenormalvalues)thantheseofcontrolgroup

    ;(

    <0.05or0.01).Conclusion:AcupuncturetherapycanreducethestressstateofHPAintypelIdiabeteswithcon-

    ;currentacutecerebralinfarctionpatients,i.e.regulatetheneuroendocrineimmunologicalnet,whichmaybeoneofthe

;mechanismsforacupuncturetreatmentofcerebraIstroke.

    ;KEYWORDSAcupuncturetherapyTypelIdiabeteswithconcurrentacutece

    rebralinfarctionCRHACTH

    ;CS

    ;Wehavereportedthetherapeuticeffectof ;acupunctureintreatmentofcerebralcerebrovas

    ;culardiseaseLL2j.Inordertostudythemecha

    ;nismsofacupunctureintreatmentofcerebral ;apoplexy,weobservedtheeffectofacupuncture ;onstresshormonesofthehypothalamus..pitu. ;itary-adrenalaxis(HPA)in60patientssuffering ;fromtypeIIdiabeteswith

    ;bralinfarctionfrom1998

    ;report.

    ;concurrentacutecere

    ;to2000.Hereisthe

    ;1MATERIALSANDMETHoDS

    ;1.1Clinicaldata

    ;A1lthe60casesoftypeIIdiabeteswith ;concurrentacutecerebralinfarctioninthepre

    ;sentstudywereinpatientsofourhospitalwho ;correspondedtothestandardsof”KeyPointsfor

;DiagnosisofVariousCerebrovascularDiseases”

    ;formdatedbytheWHODiabetesSpecialist ;Committeein1985andChineseNeuroscience ;Associationin1995.Thecerebralapoplexywas ;alsoconfirmedbyCTandMRIexaminations. ;beinglessthan72hoursinthedurationofdis. ;ease.Thesepatientshadnoanyseverecomplica

    ;tionsofdiseasesoftheheart.1iverandkidney ;andweresuitabletobetreatedwithfibrinolysin. ;1oweringmethodL.These60casesincluding33 ;malesand27femalesandranginginagefrom41 ;to84years(averaging64.7?8.6years)were ;randomlydividedintotreatmentgroup(n=30) ;andcontrolgroup(n=30).Intreatmentgroup, ;16casesweremaleand14female,’rangingin

    ;agefrom41to84years(mean65.9?9.2

    ;years),andthemeandurationofdiseasewas ;43.6?20.4hr.Multipleinfarctionfocuseswere ;foundin17patientsandsinglefocuswasfound ;in13cases.Amongthem.thebasalganglionic ;areawasinvolvedin18cases.thelobalzonein. ;volvedin10cases,theinternalcapsuleinvolved

    ;in6casesandothercerebralareaswereinvolved ;in7cases.Withrespecttothesizeoffocus.8 ;caseshadalargerinfarctionarea(>4cmindi

    ;ameter),13hadamediuminfarctionarea(1.5 ;

    ;?

    ;10?WorldJ.Acup-Mox.Vo1.11,No.1,March,2001 ;

    ;4cm)and9hadflsmallinfarctionarea(<1. ;5cm).Inaccordancewiththecriteriaofgrading ;fornervefunctionaldefectL,9patientswere ;severecases,14moderatecasesand7lightcas- ;es.Incontrolgroup,17casesweremaleand13 ;female,ranginginagefrom43to82years ;(mean66.1?8.9years),andthemeandura- ;tionofdiseasewas42.5?21.2hr.Multiplein- ;farctionfocusesandsinglefoCUSwerefoundre- ;spectivelyintwo15casesincluding16casesof ;basalganglionicareas,12casesofIobalarea,5 ;internalcapsuleareaand9casesofothercerebral ;areas.Concerningthesizeofthefocus,7cases ;hadfllargerinfarctionarea.12hadflmedium

    ;irdarctionareaand11hadasmallinfarction ;area.Eightpatientswereseverecases,13mod

    ;cratecflsesand9lightcases.Thirtyvolunteer ;healthysubjects(16malesand14females)were ;attributedtothenormalsubjectgroup.Their ;agesrangedfrom40to75years,averaging62.1 ;?8.3years.

    ;1.2Treatmentmethods

    ;Patientsofthecontrolgroupweretreated ;withroutinemedicationmethodincludingad. ;ministrationofWesternmedicinesforlowering ;fibrinolysin(intravenousinfusionofanti.plasmin ;injectio5IU.”braintissueinjectio”812mL

    ;plus250mLnormalsaline,oncedaily,about10 ;

    ;14daysaltogether)andbloodsugar-lowering ;agents(glydiazinarnide510mg,metformin

    ;hydroehloride0.250.5g,3times/day;in-

    ;sulin81U,injectedsubcutaneouslyforseverepa. ;tients,about30minbeforemeals);supporting ;treatment(intravenousinfusionofRinger’sso.

    ;1ution,aminoacid,etc.)andnecessarymea-

    ;suresforloweringintracrianialpressure,anti-in- ;fection,loweringhypertension,etcinthelight ;ofthestateofdisease.Patientsofthetreatment ;groupweretreatedwithacupunctureandthe ;samemeasuresmentionedaboveinthecontrol ;group.ThemainacupointsusedwereBaihui ;(GV20)andRenzhong(GV26),supplement- ;edwithJianyu(LI15),Quchi(LI11),

    ;Waiguan(TE5),Hegu(LI4),Huantiao(GB ;30),Zusanli(ST36),Fenglong(ST40)and ;Taichong(LR3),etc..About68acupoints

    ;wereemployedineverytreatmentandtheabove. ;mentionedacupointsusedalternately.After ;rapidinsertionoftheneedlesandachieving ;needlingsensations,theneedleswereretained ;for20minandtheacupointsadditionallystimu- ;latedelectricallywithaG6805Elec.

    ;troacupunctureTherapeuticApparatus.The ;treatmentwasconductedonceeverydayand ;lastedfor1530days.

    ;1.3Detectionmethods

    ;PlasmaCRH.ACTHandCScontentswere

    ;detectedusingradioimmunoassay(RIA)and ;SN697BAutomaticGammaCounter(double ;probes,madeinShanghai).Thereagentkits ;weresuppliedbytheNeurobiochemicalTeaching ;andResearchSectionoftheSecondMilitary ;MedicalUniversity.AmericanDSLCompany ;andBeijingNorth-ChinaBiologicalTechnique ;Institute.Thecoefficientsamongdifferentkits ;anddifferentbatcheswerewithinthenormal ;rangeandthequalityofthereagentwascon- ;trolledstrictly.Inaddition,plateletaggregation ;rate(PAGR)andfibronogen(FG)contents ;werealsodeterminedsimultaneously. ;1.4Criteriaforevaluatingthetherapeuticeffect ;Thetherapeuticeffectwasevaluatedfie. ;cordingto”StandardsforAssessingClinical

    ;TherapeuticEffectinTreatmentofCerebral ;Apoplexyformulatedby”National4thSession

    ;ofAcademicSymposiumonCerebrovascularDis. ;eases”in1995[4J.

    ;Basicallycured:Aftertreatment,thescore ;ofnerve.functionaldefectdecreasedby91

    ;100%andthemaimedseveritywasgrade0. ;Markedlyeffective:Thescoreoffunctional ;defectdecreasedby4690%andthemaimed

    ;severitywasgrade工??.

    ;Progress:Thescoreoffunctionaldefectde. ;creasedby1845%andthemaimedseverity

    ;wasabovegrade?.

    ;Failed:Thescoreoffunctionaldefectde. ;creasedbyabout17%.

    ;Worsened:Thescoreoffunctionaldefect ;increasedbyabove18%.

    ;1.5Statisticalanalysis

    ;A1lthedatawereexpressedasmeanvalue ;?standarddifference(M?S)andanalyzed ;withStudent’sttest.Thesampleratewasdealt

    ;

    ;WorldJ.Acup-Maz.Vo1.11.No.1,March,2001?11? ;withChisquaretestandbyusingacomputer ;2RESULTS

    ;2.1ChangesofstresshormonecontentsofHPA ;aftertreatment

    ;Beforetreatment.CRH,ArHandCS

    ;contentsinbothtreatmentandcontrolgroups ;weresignificantlyhigherthanthoseofnormal ;subjectgroup(P<0.O1).Aftertreatment,all ;thethreeindexeshadaconsiderableimprove. ;mentincomparisonwithpre-treatment(P< ;0.O5or0.O1).Thedifferencevallies(valuesof ;posttreatmentvaluesofpretreatment)ofcon

    ;tentsofthe3indexesintreatmentgroupwere ;significantlybiggerthanthoseofcontrolgroup ;(P<0.05or0.01,Table1).

    ;TableI.ComparisonofCRH,ACTHandCSContentsamongtheThreeGroup

    s)

    ;*P<0.05**P<0.01***P<0.001vspre-treatment; ;#P<O.05##P<O.01,,scontrolgroup;+++P<0.01vsnormalsubjectg

    roup

    ;2.2Changesofbloodclottingstateaftertreat

    ;ment

    ;Followingtreatment,PAgRandFGcon

    ;tentsintreatmentandcontrolgroupsdecreased ;significantlyincomparisonwithpre.treatment ;(P<0.01or0.001,Table2).Intreatment ;group,PAgRdecreasedby55%[(63.55

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