加强扬刺百会对中风后抑郁病人MIP-1α和NF-κB/iNOS/NO信号通路的影响

Effects of Intensified Centro-square Needling in Baihui on Recombinant Human Chemokine MIP-1αand NF-κB/iNOS/NO Signaling Pathways in Patients with Post-stroke Depression

目的观察加强扬刺百会联合口服氟西汀治疗中风后抑郁的疗效及对外周巨噬细胞炎性蛋白-1α(MIP-1α)和核因子κB p65(NF-κB p65)/诱导型一氧化氮合成酶(iNOS)/一氧化氮(NO)信号通路的影响。方法选取我院收治的中风后抑郁病人60例,按随机数字表法分为针刺+氟西汀组与氟西汀对照组,每组30例。两组均给予急性缺血性脑卒中常规治疗,氟西汀对照组在常规治疗基础上给予盐酸氟西汀胶囊口服,每次20 mg,每日1次;针刺+氟西汀组在氟西汀对照组治疗基础上给予加强扬刺百会穴治疗,每日行针1次。两组均连续治疗30 d后评价疗效和不良反应,比较两组治疗前后汉密顿抑郁量表(HAMD)评分和Barthel指数,采用酶联免疫吸附法(ELISA)检测血清5-羟色胺(5-HT)、去甲肾上腺素(NE)神经递质水平及MIP-1α、NF-κB p65、iNOS、NO水平。结果治疗后,针刺+氟西汀组总显效率(76.7%)高于氟西汀对照组(50.0%,χ^(2)=4.593,P=0.032);针刺+氟西汀组的总有效率为90.0%,氟西汀对照组为73.3%,组间比较差异无统计学意义(χ^(2)=2.783,P=0.095)。治疗后,两组HAMD评分和MIP-1α、NF-κB p65、iNOS、NO水平均较治疗前降低(P<0.01),且针刺+氟西汀组低于氟西汀对照组(P<0.05);两组Barthel指数较治疗前升高(P<0.01),且针刺+氟西汀组高于氟西汀对照组(P<0.05)。两组治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论加强扬刺百会治疗中风后抑郁疗效显著,能够改善病人抑郁程度和日常生活活动能力,且安全性较高,其抗抑郁机制可能与降低趋化因子MIP-1α水平及调控NF-κB/iNOS/NO信号通路、阻断炎症反应有关。

Objective To observe the efficacy of intensified centro-square needling in Baihui combined with oral fluoxetine in the treatment of post-stroke depression and its effect on the signaling pathway of recombinant human chemokine Ccl3(MIP-1α)and nuclear factorκB p65(NF-κB p65)/inducible nitric oxide synthase(iNOS)/nitric oxide(NO).Methods Sixty patients with post-stroke depression were randomly divided into the acupuncture+fluoxetine group and the fluoxetine control group,with 30 cases in each group.All patients two groups were treated with conventional treatment for acute ischemic stroke.The patients in fluoxetine control group were treated with fluoxetine hydrochloride capsule orally,20 mg each time,once a day,and the patients in acupuncture+fluoxetine group were treated with centro-square needling in Baihui on the basis of the fluoxetine control group,once a day.The efficacy and adverse reactions of both groups were evaluated after 30 days.The scores of Hamilton Depression Scale(HAMD)and Barthel Index were compared between two groups and the levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),MIP-1α,NF-κB p65,iNOS and NO were detected by enzyme linked immunosorbent assay(ELISA).Results After treatment,the efficiency of acupuncture+fluoxetine group was significantly hetter than that of fluoxetine control group(76.7%vs 50.0%,χ^(2)=4.593,P=0.032).The total clinical efficiency of acupuncture+fluoxetine group was 90.0%,and that of fluoxetine control group was 73.3%,there was no significant difference between two groups(χ^(2)=2.783,P=0.095).After treatment,the score of HAMD scale and the levels of MIP-1α,NF-κB p65,iNOS and NO in both groups were lower than those before treatment(P<0.01),and those of acupuncture+fluoxetine group were significantly lower than those of the fluoxetine control group(P<0.05).After treatment the levels of Barthel Index,in both groups were significantly higher than those before treatment(P<0.01),and those of acupuncture+fluoxetine group were significantly higher than those of the fluoxetine control group(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Intensified centro-square needling in Baihui had significant efficacy in the treatment of post-stroke depression,which could significantly improve the degree of depression and the ability of daily living activities of patients with high safety.Its anti-depressant mechanism might be related to the reduction of neurotransmitter release in the brain,the reduction of chemokine MIP-1α,the regulation of NF-κB/iNOS/NO signaling pathway,and the blocking of inflammatory response.