Abstract:

OBJECTIVE: To analyze the effect of Fuyuan Tongluo acupuncture on neurological function, serum chitinase-3-like protein 1 (YKL-40), platelet-activating factor (PAF) and osteopontin (OPN) in patients with acute cerebral infarction and its prognostic factors, so as to provide a scientific basis for clinical judgment of disease condition and optimization of treatment plan.

METHODS: A total of 102 patients with acute cerebral infarction (ACI) who were hospitalized in the Department of Neurology of Hai’an Hospital of Traditional Chinese Medicine between January 2021 and June 2022 and diagnosed by head computed tomography (CT) and/or magnetic resonance imaging (MRI) were selected as the ACI group, and 40 healthy subjects were selected as the healthy control group. According to the treatment methods documented in the medical records, 102 patients with ACI were divided into group A (50 cases, treated with conventional Western Medicine combined with Fuyuan Tongluo acupuncture) and group B (52 cases, treated with conventional Western Medicine). The clinical efficacy, serum levels of YKL-40, PAF, OPN, and carotid intima-media thickness (IMT) were compared, and the correlation between the levels of the above serum indexes and IMT was analyzed. According to the modified Rankin scale score at 90 d after treatment, the combined group was divided into good prognosis group and poor prognosis group. The baseline data, serum YKL-40, PAF and OPN levels were compared between the two groups, the influencing factors of poor prognosis of ACI were explored, and the predictive value of serum YKL-40, PAF and OPN levels for poor short-term prognosis of ACI was evaluated.

RESULTS: The short-term total effective rate of group A was 90.00%, which was significantly higher than that of group B (69.23%) (P <0.05). After treatment, the National Institutes of Health Stroke Scale (NIHSS) score, Mini-Mental State Examination (MMSE) score and Barthel index of the two groups were significantly higher than those before treatment, and the scores in group A were higher than those in group B (P <0.05). After treatment, the serum levels of YKL-40, PAF and OPN in the two groups were significantly lower than those before treatment, and those in group A were lower than those in group B (P <0.05). The levels of serum YKL-40, PAF, OPN and IMT in ACI group were higher than those in healthy control group (P <0.05). Serum YKL-40 (r = 0.426, P <0.001), PAF (r = 0.588, P <0.001), and OPN (r = 0.474, P <0.001) levels were positively correlated with IMT in ACI patients, as determined by Pearson correlation analysis. In the poor prognosis group, the levels of IMT, the proportion of unstable plaques, and the concentrations of YKL-40, PAF, and OPN were significantly higher than those in the good prognosis group (P <0.05). Multivariate logistic regression analysis showed that serum YKL-40 and PAF were independently associated with poor short-term prognosis, whereas IMT and OPN did not reach statistical significance. receiver operating characteristic (ROC) analysis demonstrated that the area under the curve (AUC) values for YKL-40, PAF, and OPN were 0.833, 0.972, and 0.893 respectively. A combined biomarker model showed improved discriminative performance for short-term prognosis.

CONCLUSION: The combination of Fuyuan Tongluo acupuncture and conventional Western Medicine was associated with improvements in the rehabilitation of patients with acute cerebral infarction, as evidenced by reduced serum levels of YKL-40, PAF, and OPN, along with improvements in neurofunctional, cognitive, and daily living abilities. However, these observed changes may not be solely attributable to acupuncture alone and could also be associated with natural disease recovery and standard treatment. Therefore, further validation through large-sample, multi-center studies is warranted.

Key words: platelet activating factor, osteopontin, cerebral infarction, chitinase protein-40, poor prognosis