针刺十三鬼穴联合头针丛刺对卒中后认知障碍患者miRNA-335表达的影响

Effect of Puncturing the Thirteen Ghost Points Combined with Cluster Needling at the Scalp Acupoints on the Expression of miRNA-335 in Patients with Post-stroke Cognitive Impairment

目的观察针刺十三鬼穴联合头针丛刺治疗卒中后认知功能障碍(PSCI)的临床疗效及其对miRNA-335表达的影响。方法选取2020年1月至9月在黑龙江中医药大学附属第二医院就诊的90例卒中后认知功能障碍患者,采用随机数字表法分为3组(治疗1组、治疗2组和对照组),每组30例。治疗1组予针刺十三鬼穴联合头针丛刺治疗,治疗2组予头针丛刺联合常规针刺治疗,对照组予口服盐酸多奈哌齐片治疗。分别于治疗前、治疗4周及治疗8周后,观察患者认知功能、日常生活能力及外周血miRNA-335表达水平的变化;比较3组临床疗效。结果治疗1组总有效率高于治疗2组和对照组,差异具有统计学意义(P<0.05)。治疗后,3组蒙特利尔认知量表(MoCA)评分及日常生活活动能力量表(ADL)评分均较同组治疗前升高(P<0.05),且治疗1组均高于治疗2组和对照组(P<0.05)。治疗4周及治疗8周后,3组患者外周血miRNA-335表达水平均较同组治疗前明显升高(P<0.05),且治疗1组明显高于治疗2组和对照组(P<0.05)。结论与头针丛刺联合常规针刺和口服药物比较,针刺十三鬼穴联合头针丛刺治疗卒中后认知功能障碍能更好地改善患者认知功能和日常生活能力,提高临床疗效,上调外周血miRNA-335表达水平。

Objective To observe the clinical efficacy of puncturing the thirteen ghost points plus cluster needling at the scalp acupoints to treat post-stroke cognitive impairment(PSCI)and its effect on the expression of miRNA-335.Method Ninety PSCI patients were recruited from the Second Affiliated Hospital,Heilongjiang University of Chinese Medicine,during January and September of 2020.They were divided into three groups(treatment group 1,treatment group 2,and control group)using the random number table method,with 30 cases in each group.Treatment group 1 was given acupuncture at the thirteen ghost points combined with cluster needling at the scalp acupoints.Treatment group 2 was given cluster needling at the scalp acupoints plus the ordinary acupuncture method.The control group was given oral administration of Donepezil hydrochloride tablets.Prior to treatment,and at treatment weeks 4 and 8,the cognitive function and activities of daily living(ADL)scores,and the expression level of miRNA-335 in peripheral blood were observed.The clinical efficacy was also compared between the two groups.Result The total effective rate was higher in treatment group 1 than in treatment group 2 and the control group,and the differences were statistically significant(P<0.05).After treatment,the Montreal cognitive assessment(MoCA)and ADL scores increased in all three groups(P<0.05),and were higher in treatment group 1 than in treatment group 2 and the control group(P<0.05).At treatment weeks 4 and 8,the expression level of miRNA-335 in peripheral blood increased in all three groups(P<0.05),and was higher in treatment group 1 than in treatment group 2 and the control group(P<0.05).Conclusion Compared with the ordinary acupuncture method or oral medication,puncturing the thirteen ghost points plus cluster needling at the scalp acupoints can better improve the cognitive function and ADL,enhance the clinical efficacy and up-regulate the expression level of miRNA-335 in peripheral blood in treating patients with PSCI.