Efficacy Evaluation Of Tension Balance Acupuncture Combined With Scalp Acupuncture In Children With Spastic Cerebral Palsy And Its Effect On Serum Metabolomics

Objective:To observe the effects of balanced muscular tension needling method combined with scalp acupuncture and botulinum toxin on lower limb muscle tension,joint range of motion and gross motor function in children with spastic cerebral palsy,and evaluate the clinical efficacy and difference of the two treatments.The differences of serum metabolites and metabolic pathways in children with spastic cerebral palsy treated by balanced muscular tension needling method combined with scalp acupuncture and botulinum toxin type A were studied by metabonomics techniques,and the differences of metabonomics effects of different therapies were explored,and the mechanism was studied from the perspective of metabonomics.Methods:1.In this study,58 children with spastic cerebral palsy were randomly divided into observation group(acupuncture group)and control group(botulinum toxin group).The observation group was treated with balanced muscular tension needling method combined with scalp acupuncture on the basis of routine rehabilitation training,while the control group was treated with botulinum toxin on the basis of routine rehabilitation training.The modified Ashworth scale,joint range of motion(adductive angle,popliteal fossa angle,foot dorsal flexion angle)and gross motor function rating scale were used as the indexes of efficacy evaluation.The clinical efficacy of the two therapies in the treatment of spastic cerebral palsy was evaluated at enrollment and 12 weeks after treatment.2.Serum samples were collected from children with spastic cerebral palsy at enrollment and 12 weeks after treatment,using ultra high performance liquid chromatography-quadrupole exactive-mass spectrometry technology(UHPLC-QE-MS)to detect the balanced muscular tension needling method combined with scalp acupuncture and botulinum toxin in the treatment of children with cerebral palsy serum samples.At the same time,multivariate statistical analysis,such as the principal component analysis(PCA)and orthogonal partial least squares discriminant analysis(OPLS-DA),hierarchical cluster analysis of different metabolites were used to identify the potential differential metabolites before and after treatment through database comparison and analyze their involved metabolic pathways.Results:1.Intra-group comparison showed that the muscle tension of the acupuncture group and the botulinum toxin group decreased at 6th week compared with that before treatment.After 12 weeks of treatment,compared with before treatment,muscle tension,dorsiflexion angle decreased,adduction angle,popliteal angle,GMFM total percentage increased,the differences were statistically significant(p<0.001).2.Comparison between groups showed that the muscle tension of the botulinum toxin group decreased more than that of the acupuncture group at 6th week,and the muscle tension of the acupuncture group decreased more than that of the botulinum toxin group at 12 th week,which the differences were statistically significant(p<0.001,p<0.01).There were no significant differences in adduction angle,popliteal fossa angle,dorsal flexion angle and GMFM percentage between the two groups(p>0.05).3.According to the stratified comparison of the severity of the disease,the muscle tension in the acupuncture group decreased more in grade ? and ? than in grade ?,and the difference was statistically significant(p<0.05).In the acupuncture group,the total percentage of GMFM in grade ? was higher than that in grade ?,and the difference was statistically significant(p<0.05).In the botulinum toxin group,the total percentage of GMFM in grade ? was higher than that in grade? and ?,and the difference was statistically significant(p<0.05).4.After treatment,the concentrations of L-arginine and guanine in the acupuncture group were higher after treatment than before,the concentration of phosphorylcholine,nicotinamide,L-valine and pyruvate acid decreased.The metabolic pathways involved include D-arginine and D-ornithine metabolism;Arginine and proline metabolism;Glycerol phospholipid metabolism;Nicotinate and nicotinamide metabolism;Purine metabolism;Pantothenate and Co A biosynthesis;Valine,leucine and isoleucine biosynthesis;Pyruvate metabolism;Phenylalanine metabolism;Taurine and sub hypotaurine metabolism;Citric cycle;Alanine,aspartate and glutamate metabolism;Glycolysis or gluconeogenesis.5.After treatment,the concentrations of D-Glutamine,Bovinic aci,hydroxyethanesulfonate and cis-Aconitic acid in the botulinum toxin group decreased compared with those before treatment.The metabolic pathways involved include D-Glutamine and D-glutamate metabolism;Linoleic acid metabolism;Taurine and hypotaurine metabolism;Citrate cycle;Glyoxylate and dicarboxylate metabolism.Conclusion:1.Both balanced muscular tension needling method combined with scalp acupuncture and botulinum toxin can improve lower limb muscle tension,joint range of motion and gross motor function in children with spastic cerebral palsy.2.After 6 weeks of treatment,the improvement of lower limb muscle tension was superior to that of the balanced muscular tension needling method combined with scalp acupuncture,and the improvement of lower limb muscle tension was superior to that of botulinum toxin after 12 weeks of treatment.3.The treatment of children with spastic cerebral palsy by balanced muscular tension needling method combined with scalp acupuncture and botulinum toxin may achieve the protective effect on the central nervous system by up-regulating arginine and down-regulating glutamine,and regulating the levels of amino acids in the body.