Effect of xingnao kaiqiao acupuncture therapy for patient with acute ischemic stroke and the establishment of prediction model for prognosis: 醒脑开窍针法对急性缺血性脑卒中患者的临床疗效及预后预警模型建立

Abstract

ObjectiveTo explore the clinical effectiveness of xingnao kaiqiao (regaining consciousness and opening orifice) acupuncture therapy for patients with acute ischemic stroke, and establish a prediction model for prognosis for the target population through Logistic regression analysis. MethodsNinety-six patients with acute ischemic stroke were randomly assigned to either an ozone therapy group or an ozone therapy plus xingnao kaiqiao acupuncture group (OA group) with a 1:1 ratio. The patients in the ozone group was treated with ozone therapy, and those in the OA group were treated with acupuncture at Nèiguān (内关PC6), Shuĭgōu (水沟GV26), Sānyīnjiāo (三阴交SP6), lower Jíquán (下极泉Extra, lower HT1), Wĕizhōng (委中BL40) and Chĭzé (尺泽LU5) on the basis of the treatment as the ozone therapy group. The treatment was given once daily for 7 days as a session and 3 consecutive sessions were required. Before treatment and 48 h after treatment, the serological indicators (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α] and hypersensitive C-reactive protein [hs-CRP]) were tested. Using the National Institute of Health stroke scale (NIHSS) score and Montreal cognitive assessment (MoCA) score, the neurological and cognitive functions of patients were assessed. The clinical efficacy was evaluated with the modified Rankin scale, and the incidence of adverse effects was analyzed statistically in two groups. The multivariate Logistic regression analysis was adopted to detect the risk factors of the prognosis in patients and the nomographic prediction model was established. Results(1) clinical therapeutic effect: after treatment, the levels of IL-6, TNF-α and Hs-CRP in the OA group were significantly lower than that in the ozone group (all P < 0.05). After treatment, compared with the ozone therapy group, NIHSS score was lower and the scores of BI and MoCA were significantly higher in the OA group (all P < 0.05). The total effective rate of the OA group was 91.67%, higher than that of the ozone therapy group (62.50%, P < 0.05). The incidence of adverse effects in the OA group was lower when compared with that in the ozone group (P < 0.05); (2) establishment of prediction model for prognosis: age, history of diabetes, cardiogenic cerebral embolism, high density lipoprotein-cholesterol (HDL-C), white blood cell (WBC) and treatment methods were independent risk factors of the unfavorable prognosis for the patients with acute stroke. The established model had sound accuracy for prediction of prognosis. ConclusionXingnao kaiqiao acupuncture was effective on acute ischemic stroke, and the prognosis of this therapy was increased significantly when combined with the ozone therapy. The preventive measures should be set up for patients with risk factors, e.g. advanced age, diabetes, cardiogenic cerebral embolism, low HDL-C and abnormal WBC, in order to further reduce the risk of unfavorable prognosis in patients with acute stroke.