卒中单元模式下醒神启闭针刺治疗卒中后抑郁疗效观察及对血清Th型细胞因子的影响

Efficacy Observation of Xing Shen Qi Bi Acupuncture for Post-stroke Depression in A Stroke Unit Model and Its Effects on Serum Th Cytokines

目的观察卒中单元模式下醒神启闭针刺治疗卒中后抑郁(PSD)临床疗效及对血清Th型细胞因子的影响。方法将86例PSD患者随机分为对照组和观察组,每组43例。对照组采用常规疗法,观察组在对照组基础上采用卒中单元模式下醒神启闭针刺治疗。比较两组临床疗效、治疗前后汉密尔顿抑郁量表-17(HAMD-17)评分、Th型细胞因子[白细胞介素(IL)-2、IL-10、IL-17a、干扰素(IFN)-γ]水平、神经细胞因子[神经营养因子(NT)-3、脑源性神经因子(BNDF)、酪氨酸激酶B受体(TrkB)]表达、自动思维量表(ATQ)评分、重复性成套神经心理状态测试(RBANS)评分、匹兹堡睡眠质量指数(PSQI)评分。结果观察组总有效率为90.7%(39/43)高于对照组的72.1%(31/43),差异有统计学意义(P<0.05)。治疗后4周和6周,观察组焦虑/躯体化、体质量减轻、日夜变化、抑郁阻滞及绝望感评分低于对照组(P<0.05);观察组血清IL-2水平高于对照组(P<0.05),血清IL-10、IL-17a、IFN-γ水平低于对照组(P<0.05);观察组血清BNDF、TrkB水平高于对照组(P<0.05),血清NT-3水平低于对照组(P<0.05);观察组RBANS评分高于对照组(P<0.05),ATQ评分低于对照组(P<0.05);观察组PSQI评分低于对照组(P<0.05)。结论卒中单元模式下醒神启闭针刺治疗PSD,能够纠正炎性因子水平紊乱,调节神经功能,从而进一步减轻抑郁症状,改善认知功能,缓解睡眠障碍。

Objective To observe the clinical efficacy of Xing Shen Qi Bi(awakening the mind and unblocking the occlusion)in treating post-stroke depression(PSD)in a stroke unit model and its effects on serum Th cytokines.Method Eighty-six PSD patients were randomized into a control group and an observation group,with 43 cases in each group.The control group was intervened by conventional therapy,while the observation group was given additional Xing Shen Qi Bi acupuncture in the stroke unit model.The clinical efficacy was compared between the two groups,as well as the score of Hamilton depression scale(HAMD)-17,the levels of Th cytokines[interleukin(IL)-2,IL-10,IL-17a and interferon(IFN)-γ],the expressions of neurocytokines[neurotrophin-3(NT-3),brain-derived neurotrophic factor(BDNF)and tyrosine kinase receptor B(TrkB)],and the scores of automatic thoughts questionnaire(ATQ),repeatable battery for the assessment of neuropsychological status(RBANS)and Pittsburgh sleep quality index(PSQI)before and after treatment.Result The total effective rate was 90.70%(39/43)in the observation group,higher than 72.1%(31/43)in the control group,and the difference was statistically significant(P<0.05).At treatment weeks 4 and 6,the scores of anxiety/somatization,decrease in body mass,diurnal variation,depression block and feeling of despair were lower in the observation group than in the control group(P<0.05);the serum IL-2 level was higher and the levels of serum IL-10,IL-17a and IFN-γwere lower in the observation group than in the control group(P<0.05);the levels of serum BDNF and TrkB were higher(P<0.05)and the level of serum NT-3 was lower(P<0.05)in the observation group than in the control group;the RBANS score was higher in the observation group than in the control group(P<0.05),and the ATQ score was lower in the observation group than in the control group(P<0.05);the PSQI score in the observation group was lower than that in the control group(P<0.05).Conclusion In the stroke unit model,Xing Shen Qi Bi acupuncture can correct the inflammatory factor disorders and regulate neural function,so as to further reduce depression symptoms,improve cognitive function and mitigate sleep disturbance in the treatment of PSD.