Acupuncture Regulates the Neurovascular Unit in Poststroke Motor Function Reconstruction: Mechanisms and Clinical Rehabilitation Prospects

Abstract

Objective

To investigate the regulatory effects of acupuncture on the components of the neurovascular unit, clarify the underlying mechanisms of acupuncture intervention for poststroke motor dysfunction, and evaluate the clinical value of acupuncture combined with conventional rehabilitation training for the recovery of limb motor function after stroke.

Methods

A total of 120 patients with motor dysfunction following ischemic stroke were enrolled and randomly allocated using a random number table method into an Acupuncture-Rehabilitation Group and a Conventional Rehabilitation Group, with 60 cases in each group. The Conventional Rehabilitation Group received routine rehabilitation training, whereas the Acupuncture-Rehabilitation Group received additional acupuncture treatment on the basis of conventional rehabilitation. Both groups were intervened continuously for 8 weeks. Before intervention, at 4 weeks of intervention, and at 8 weeks of intervention, the Fugl-Meyer Assessment (FMA) for motor function, the Modified Ashworth Scale (MAS) for spasticity, and the Barthel Index (BI) for activities of daily living were evaluated. The blood flow velocity of the middle cerebral artery on the affected side, and serum levels of brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) were measured. Functional magnetic resonance imaging (fMRI) was used to detect the activation intensity of the bilateral primary motor cortex, supplementary motor area, and other brain regions.

Results

No statistically significant differences in baseline characteristics were observed between the two groups (P > 0.05). After 8 weeks of intervention, the upper-limb FMA score (56.37 ± 4.28 vs. 48.92 ± 5.13, P < 0.001) and lower-limb FMA score (37.09 ± 3.16 vs. 32.15 ± 4.02, P < 0.001) in the Acupuncture-Rehabilitation Group were significantly higher than those in the Conventional Rehabilitation Group. The MAS score in the Acupuncture-Rehabilitation Group was lower than that in the Conventional Rehabilitation Group (0.83 ± 0.41 vs. 1.45 ± 0.52, P < 0.001), while the BI score was higher (78.64 ± 8.12 vs. 65.27 ± 9.15, P < 0.001). The blood flow velocity of the affected middle cerebral artery (56.98 ± 7.09 cm/s vs. 51.15 ± 7.32 cm/s, P < 0.001), serum BDNF (62.38 ± 7.45 ng/L vs. 45.72 ± 6.29 ng/L, P < 0.001), and serum VEGF (487.53 ± 52.37 pg/mL vs. 369.81 ± 48.32 pg/mL, P < 0.001) in the Acupuncture-Rehabilitation Group were all significantly higher than the corresponding values in the Conventional Rehabilitation Group. fMRI showed that the activation intensities of the ipsilesional and contralesional primary motor cortex, supplementary motor area, and premotor cortex were higher in the Acupuncture-Rehabilitation Group than in the Conventional Rehabilitation Group (all P < 0.001). Pearson correlation analysis revealed that BDNF, VEGF, and cerebral blood flow velocity were significantly positively correlated with the total FMA score and the BI (r = 0.623–0.783, all P < 0.001).

Conclusion

Acupuncture can regulate the homeostasis of the neurovascular unit by improving cerebral blood flow perfusion, upregulating the expression of neurotrophic factors, promoting angiogenesis, and modulating functional reorganization of brain regions, thereby facilitating poststroke motor function reconstruction. The combination of acupuncture and conventional rehabilitation training synergistically enhances limb motor ability, alleviates muscle spasticity, and improves activities of daily living, demonstrating broad prospects for clinical application in stroke rehabilitation.