Serum level changes of insulin-like growth factor-1 and amino acids in children with cerebral palsy following functional exercise plus head acupuncture therapy

Lihua Zhang; Jiaojiao Du; Xiaojie Li; Zhimei Jiang

摘要：BACKGROUND:In the past few years,there were many studies about the pathophysiology of insulin-like growth factor-1(Lgf-1), as well as glutamic acid (GLU) and γ-aminobutydc acid(GABA)in hypoxic-ischemic brain damage (HIBD).IGF-1 plays a protective role in brain damage.The over release of excitatory amino acids (EAA) plays an important role in acute neuronal death,which delays neuronal death.The disproportion of increasing of excitatory and inhibitory amino acids can cause different extent HIBD.However,there is rare report about the change of IGF-1 and neurotransmitter Ievelin serum of cerebral palsy (CP) children.OBJECTIVE:To observe the levels of serum IGF-1.GABA and GLU before and after functional exercise plus head acupuncture therapy and single functional exercise,then study the effective mechanism of IGF-1.GABA and GLU in the occurrence and development of CP,and compare those with normal control group.DESIGN:Case-control study.SETTING:College of Rehabilitation Medicine,Jiamusi University,Prevention and Treatment Center of Child Cerebral Palsy in Heilongjiang Province.PARTICIPANTS:CP group:Sixty CP children came from Prevention and Treatment Center of Child Cerebral Palsy in Heilongjiang Province between April 2005 and March 2006 were selected in this study.All the cases were consistent with the diagnostic criteria and the type of cerebral palsy and finally diagnosed with CT and MRI examinations.There were 35 males and 25 females aged from 8 months to 4 years with the mean age of (2.0±0.5)years.And then,they were randomly divided into two groups.Twenty-six cases were received functional exercise,and the other 34 cases were treated with functional exercise and head acupuncture.Control group: Thirty healthy children were from kindergarten and community for health examination in June 2005.There were 15 males and 15 females aged from 8 month to 4 years with the mean age of(2.0±0.5)years.All guardians agreed with the participation of this experiment.METHODS: ①Bobath and Vojta treatment method were used for twice a day,thirty minutes for each time.Treatment plans were different personally.Functional exercise plus head acupuncture group:Functional exercise was as the same as above.Head acupuncture treatment zone was adopted,30# acupuncture needles.followed fur skin to stab(needle body and skin form 15°-30°),pricked into aponeurosis of occipitofron talis muscle underiayer by means of 200 times per minute twisting needle body,lasted 3 minutes and stayed for 30 minutes.Needles were moved once every 10 minutes and manipulated intermittently.Certain quantity of stimulus was kept once every other day.Fifteen days were regarded as a course,and patients were taken a rest of 3-7 days and received the second course.②Venous blood was collected on the next day of hospitalization and at 3 months after treatment,and venous blood in control group was collected at health examination.The lever of IGF-1 was measured by radio-immunity method.The lever of GABA and GLU were measured by high-performance liquid chromatography.③Specimen mean was compared with t test and analysis of variance.t'test was used in the one of heterogeneity of vadanca.MAIN OUTCOME MEASURES:The changes of serum IGF-1.GABA and GLU in CP children before and after functional exercise plus head acupuncture therapy and single functional exercise therapy, and comparisons With normal control group.RESULTS:All 30 children in the control group and 60 CP children were involved in the final analysis①Before treatment:The levels of IGF-1 and GABA were significantly lower than those in control group(t=28.885,P＜0.01,t'=-46.530,P＜0.05);whereas the levels of GLU were significantly higher than those in control group (t'=35.282,P＜0.05).②After treatment:The levels of serum IGF-1 and GLU were(32.36±12.92)μg/L and (37.47±11.28)mmol/L in functional exercise group,respectively;meanwhile,the levels of them were (38.17±13.84)μg/L and(41.91±11.78)mmol/L in functional exercise plus head acupuncture group,respectively.Both of them in the two groups were lower than those In the control group[(74.90±7.18)μg/L,(92.99±4.52)mmol/L,t'=-13.543 to-23.504,P＜0.05]:however,the level of GLU was higher than that in the control group [(141.25±17.14),(133.03±21.78)mmol/L,t'=17.534,13.765,P＜0.05].The level of serum GLU was lower aftar treatment than before treatment in both functional exercise group and functional exercise plus head acupuncture group[(154.17±13.00),(152.97±15.34)mmol/L,t=3.064,4.364,P＜0.05].In addition,the levels of IGF-1 and GABA were higher after treatment than before treatment [(23.03±9.51), (22.16±7.81) μg/L;(28.72±8.91),(28.02±8.58)mmol/L,t=2.964-5.874.P＜0.05].CONCLUSION:①IGF-1,GLU and GABA may participate in the pathophysiological course of carebral palsy.②Both functional exercise combining head acupuncture therapy and single functional exercise therapy are good for the recovery of cerebral injury.and the former may be even better for it.