针刺结合认知康复训练对脑卒中后认知障碍患者突触相关miRNAs表达的影响

发布时间：2018-06-08 07:10

本文选题：针刺 + 认知康复训练　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过观察针刺结合认知康复训练对脑卒中后认知障碍患者(Post-stroke Cognitive Impairment,PSCI)临床疗效以及对外周血单个核细胞(Peripheral Blood Mononuclear Cells,PBMCs)中突触相关的 miR-124,miR-132,miR-134 和 miR-138 表达水平的影响,探索针刺结合认知康复训练治疗PSCI可能的机制。方法:在湖北省十堰市太和医院和福建中医药大学附属康复医院住院部选择符合纳入排除标准的PSCI患者62例随机分为治疗组(31例)、对照组(31例),对照组给予基础治疗及认知康复训练,治疗组在基础治疗及认知康复训练基础上进行针刺"百会、神庭"穴;每天治疗30分钟,每周治疗5天,共治疗12周。干预前后采用简易智能精神状态检查量表(Mini-mental State Examination,MMSE)进行认知功能评定及血液样本采集及PBMCs的分离,采用TRIzol法提取PBMCs中的总RNA,逆转录后选用实时荧光定量 PCR(Real-time Quantitative Polymerase Chain Reaction,RT-qPCR)检测miR-124、miR-132、miR-134 和 miR-138 的表达水平。结果:1、两组研究对象的人口学数据(年龄、性别、受教育水平),脑卒中特点(病程、类型、损伤部位)、既往史(高血压病、糖尿病、高脂血症、心脏病)、脑卒中损伤程度(NIHSS评分)均无统计学意义(P0.05),具有可比性。2、组内比较表明治疗组和对照组干预后MMSE量表总分及各个分测验(定向力、即刻记忆力、计算力、回忆力、语言)均较干预前明显提高,具有统计学意义(P0.05);组间比较表明治疗组MMSE量表总分及定向力、计算力较对照组提高,具有统计学意义(P0.05),而即刻记忆力、回忆力及语言与对照组比较无统计学差异(P＞0.05)。3、两组miRNAs相对表达量组内比较表明治疗组和对照组干预后的miR-124、miR-134、miR-138相对表达量与干预前相比呈下调状态,miR-132相对表达量与干预前比较呈上调状态,均具有统计学差异(P0.001)。4、两组miRNAs相对表达量组间比较表明治疗组miR-132相对表达量上调比对照组明显,即治疗组的PBMCs中miR-132表达量更多,具有统计学差异(P0.05);治疗组miR-134相对表达量下调比对照组明显,即治疗组的PBMCs中miR-134表达量更少,具有统计学意义(P0.05),而治疗组miR-124、miR-138相对表达量与对照组比较无统计学意义(P＞0.05)。5、将所有研究对象干预前后MMSE量表总分差值与干预前后miRNAs差异表达的相对表达量进行相关性分析发现:MMSE量表总分差值与miR-132差异表达的相对表达量呈正相关r=0.400(P0.05),与miR-134差异表达的相对表达量呈负相关r=-0.321(P0.05)。结论:1、单纯认知康复训练和针刺结合认知康复训练均能提高PSCI患者的认知功能,但针刺结合认知康复训练改善PSCI患者的认知功能疗效更显著。2、miR-132、miR-134表达水平与认知功能具有相关性,针刺结合认知康复训练治疗PSCI可能通过调控miR-132、miR-134表达水平从而改善认知功能,但仍需进一步研究证明。
[Abstract]:Objective: to observe the effect of acupuncture combined with cognitive rehabilitation training on Post-stroke Cognitive cognitive disorder (PSCI) and the expression of synaptic associated miR-124 miR-132 miR-134 and miR-138 in peripheral blood mononuclear cells (PBMCs) in patients with post-stroke cognitive impairment. To explore the possible mechanism of acupuncture combined with cognitive rehabilitation training in the treatment of PSCI. Methods: 62 PSCI patients were randomly divided into treatment group (n = 31), control group (n = 31) and control group (n = 31). Treatment and cognitive rehabilitation training, On the basis of basic treatment and cognitive rehabilitation training, the treatment group was treated with acupuncture at Baihui and Shenting points for 30 minutes per day for 5 days per week for 12 weeks. Before and after intervention, Mini-Mental State examination scale (MMSE) was used to assess cognitive function, collect blood samples and separate PBMCs. The total RNAs in PBMCs were extracted by TRIzol method, and the expression levels of miR-124 miR-132 miR-134 and miR-138 were detected by real-time quantitative PCR PCR chain Real-time quantitative PCR. Results the demographic data (age, sex, education level, stroke characteristics (course, type, site of injury, history of hypertension, diabetes, hyperlipidemia) of the two groups were compared. No statistical significance was found in the scores of heart disease, stroke injury and NIHSS, which were comparable. The comparison between the treatment group and the control group showed that the total score of MMSE scale and each subtest (orientation, immediate memory, computational power, recall ability) after intervention in the treatment group and the control group. The comparison between groups showed that the total score and orientation of MMSE scale in the treatment group were higher than those in the control group, which had statistical significance (P 0.05), while the immediate memory of the treatment group was significantly higher than that of the control group. There was no significant difference in recall and language between the two groups (P > 0.05). The relative expression of miRNAs in the two groups showed that the relative expression of miR-124 miR-134 and miR-138 was down-regulated in the treatment group and the control group after intervention, and the relative expression of miRNAs in the treatment group and the control group was in a down-regulated state compared with that before the intervention. The former comparison is in an upward state. The relative expression of miRNAs in the treatment group was higher than that in the control group, that is, the expression of miR-132 in the PBMCs of the treatment group was more than that in the control group, and the expression of miR-132 in the PBMCs of the treatment group was higher than that of the control group. The relative expression of miR-134 in the treatment group was significantly lower than that in the control group, that is, the expression of miR-134 in the PBMCs of the treatment group was lower than that in the control group. The relative expression of miR-124 miR-138 in the treatment group was not significantly higher than that in the control group (P > 0.05). The total score difference of MMSE scale before and after intervention was correlated with the relative expression of miRNAs before and after intervention. It was found that the relative expression of miR-132 was positively correlated with the total score difference of MMSE, and negatively correlated with the relative expression of miR-134. Conclusion the cognitive function of PSCI patients can be improved by simple cognitive rehabilitation training and acupuncture combined with cognitive rehabilitation training, but the effect of acupuncture combined with cognitive rehabilitation training on improving cognitive function of PSCI patients is more significant. The expression level of Acupuncture combined with cognitive rehabilitation training is more correlated with cognitive function. Acupuncture combined with cognitive rehabilitation training may improve cognitive function by regulating the expression level of miR-132 miR-134, but further research is needed.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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