改良太极操对脑卒中患者平衡功能及碱性磷酸酶、神经肽Y和白细胞介素-6水平的影响

Effect of modified Tai Chi on balance in stroke patients and on serum alkaline phosphatase, neuropeptide Y and interleukin-6 expression

摘要:

目的 探讨改良太极操对脑卒中患者平衡功能及血清碱性磷酸酶(ALP)、神经肽Y(NPY)和白细胞介素-6(IL-6)水平的影响。方法 入选2017年9月至2018年12月徐州市中心医院神经内科收治的86例脑卒中偏瘫患者,随机数表法分为对照组和研究组,每组43例。对照组给予常规康复治疗,研究组患者在对照组基础上增加改良太极操训练,3次/周,连续训练12周。比较2组患者训练前后平衡调节能力指标、足底压力、Berg平衡量表(BBS)和简式Fugly-Meyer运动功能评分(FMA)、起立-行走计时测试(TUGT)、6min步行测试(6MWT),以及ALP、NPY和IL-6水平。应用SPSS 23.0统计软件对数据进行分析。依据数据类型,采用t检验或χ²检验进行组间比较。结果 相比训练前,2组患者训练后健足压力峰值、健足平均压力、包络椭圆面积、包络椭圆面积/压力中心偏移的椭圆轨迹长度比值、TUGT、ALP、NPY和IL-6水平降低,患足压力峰值、患足平均压力、压力中心偏移的椭圆轨迹长度、BBS、FMA、6MWT增加,差异均有统计学意义(P＜0.05)。研究组训练后相比对照组患者健足压力峰值[(207.54±31.20)和(264.87±38.73)N]、健足平均压力[(60.51±12.87)%和(81.20±16.27)%]、患足压力峰值[(180.83±29.20)和(163.52±26.30)N]、患足平均压力[(51.20±8.40)%和(40.58±6.87)%]、包络椭圆面积[(125.42±32.70)和(170.26±38.05)mm²]、压力中心偏移的椭圆轨迹长度[(542.20±68.41)和(425.21±48.23)mm]、包络椭圆面积/压力中心偏移的椭圆轨迹长度比值[(0.23±0.02)和(0.40±0.04)]、TUGT[(13.87±2.62)和(17.52±2.86)s]、ALP[(72.27±6.37)和(77.81±7.05)U/L]、NPY[(128.60±15.79)和(150.24±17.98)μg/L]、IL-6[(6.68±0.87)和(13.20±1.76)pg/ml]、BBS[(28.05±3.41)和(23.08±2.97)分]、FMA[(29.26±3.50)和(23.57±3.02)分]、6MWT[(302.97±58.62)和(256.52±49.67)m]改善明显,差异均有统计学意义(P＜0.05)。结论 改良太极操能够有效改善脑卒中患者平衡、运动及步行功能,其机制可能与下调ALP、NPY和IL-6水平有关。

Abstract:

Objective To investigate the effect of the modified Tai Chi on the balance of stroke patients and on serum alkaline phosphatase (ALP), neuropeptide Y (NPY) and interleukin (IL)-6. Methods A total of 86 patients with stroke and hemiplegia were enrolled in the study, who were admitted to the Department of Neurology of Xuzhou Central Hospital from Sep. 2017 to Dec. 2018. They were randomly divided into two groups with 43 in each group. The control group received routine rehabilitation and the study group received additional training of modified Tai Chi 3 times a week for 12 weeks. The two groups were compared in the balance adjustment ability index, plantar pressure, Berg balance scale (BBS), simplified Fugly-Meyer motor assessment (FMA),timed up and go test (TUGT) and 6-minute walking test (6MWT), and serum ALP, NPY, and IL-6 as measured before treatment and after 12 weeks of treatment. SPSS statistics 23.0 was used for data analysis, and depending on data type, t test or χ² test was used for comparison between groups. Results After training, the peak pressure and average pressure of healthy foot, envelope ellipse area, ratio of envelope ellipse area to pressure center offset, ellipse trajectory length, TUGT, ALP, NPY and IL-6 decreased, while the peak pressure and average pressure of diseased foot, ellipse trajectory length of pressure center offset, BBS, FMA and 6MWT increased in both groups. (P<0.05). After training, the study group improved more significantly than the control group in the peak foot pressure of healthy foot[(207.54±31.20) vs (264.87±38.73) N], the average healthy foot pressure [(60.51±12.87)% vs (81.20±16.27)%], peak diseased foot pressure [(180.83±29.20) vs(163.52±26.30) N], average diseased foot pressure[(51.20±8.40) % vs (40.58±6.87)%], envelope ellipse area[(125.42±32.70) vs (170.26±38.05)mm²], elliptical trajectory length [(542.20±68.41) vs (425.21±48.23)mm], ratio of envelope ellipse area to elliptical trajectory length[(0.23±0.02) vs (0.40±0.04)], TUGT [(13.87±2.62) vs (17.52±2.86)s], ALP[(72.27±6.37) vs (77.81±7.05)U/L], NPY[(128.60±15.79) vs (150.24±17.98)μg/L], IL-6 [(6.68±0.87) vs (13.20±1.76)pg/ml], BBS[(28.05±3.41) vs (23.08±2.97) score], FMA[(29.26±3.50) vs (23.57±3.02) score], and 6MWT[(302.97±58.62) vs (256.52±49.67)m], the differences being statistically significant (P<0.05). Conclusion Modified Tai Chi can effectively improve balance, movement and walking in the stroke patients, and its mechanism may be related to the down-regulation of ALP, NPY and IL-6.