醒脑开窍针法联合乌灵胶囊治疗卒中后抑郁对自噬相关蛋白水平的影响

Xing Nao Kai Qiao acupuncture plus Wu Ling capsules for treating post-stroke depression and its effect on autophagy-related protein levels

目的观察醒脑开窍针法联合乌灵胶囊治疗卒中后抑郁的临床疗效及对患者自噬相关蛋白水平的影响。方法将132例卒中后抑郁患者按随机数字表法分为对照组(66例)和联合组(66例)。两组均接受常规治疗,对照组另予口服乌灵胶囊治疗,联合组另予醒脑开窍针法联合口服乌灵胶囊治疗。比较两组临床疗效和不良反应发生率。观察治疗前后两组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、汉密顿抑郁量表(Hamilton depression scale,HAMD)和日常生活能力量表(activity of daily living,ADL)的评分变化。比较两组治疗前后血清炎症因子[白介素-1β(interleukin-1β,IL-1β)、白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和核因子-κB(nuclear factor kappa-B,NF-κB)]的水平以及自噬相关蛋白[微管相关蛋白1轻链3-Ⅱ(microtubule-associated protein light chain 3-Ⅱ,LC3-Ⅱ)、自噬底物蛋白(autophagy substrate protein,p62)和自噬相关蛋白1(autophagy related protein 1,Beclin1)]的水平。结果联合组总有效率高于对照组(P<0.05)。与治疗前比较,两组治疗后HAMD和NIHSS评分均降低(P<0.05),ADL评分均升高(P<0.05);联合组治疗后HAMD和NIHSS评分低于对照组(P<0.05),ADL评分高于对照组(P<0.05)。与治疗前比较,两组治疗后血清IL-1β、IL-6、TNF-α和NF-κB水平均降低(P<0.05);联合组治疗后上述血清炎症因子水平均低于对照组(P<0.05)。与治疗前比较,两组治疗后血清Beclin1和LC3-Ⅱ水平均降低(P<0.05),血清p62水平均升高(P<0.05);联合组治疗后血清Beclin1和LC3-Ⅱ水平低于对照组(P<0.05),血清p62水平高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在常规治疗基础上,醒脑开窍针法联合乌灵胶囊治疗卒中后抑郁可以改善患者抑郁程度和神经功能、提高日常生活能力、降低炎症反应及减轻自噬程度,疗效优于单纯乌灵胶囊治疗。

Objective To observe the clinical efficacy of Xing Nao Kai Qiao acupuncture plus Wu Ling capsules for treating post-stroke depression and its effect on autophagy-related protein levels.Method One hundred and thirty-two patients with post-stroke depression were allocated,using a random number table,to a control group(66 cases)and a combination group(66 cases).Both groups received conventional treatment.Additionally,the control group received oral administration of Wu Ling capsules and the combination group received Xing Nao Kai Qiao acupuncture plus oral administration of Wu Ling capsules.The clinical therapeutic effects and the incidences of adverse reactions were compared between the two groups.The National Institute of Health stroke scale(NIHSS),the Hamilton depression scale(HAMD)and the activities of daily living(ADL)scores were recorded in the two groups before and after treatment.Pre-treatment and post-treatment interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and nuclear factor kappa-B(NF-κB)levels,and autophagy-related proteins[microtubule-associated protein light chain 3-Ⅱ(LC3-Ⅱ),autophagy substrate protein(p62)and autophagy related protein 1(Beclin1)]levels were compared between the two groups.Result The total efficacy rate was higher in the combination group than that in the control group(P<0.05).After treatment,the HAMD and the NIHSS scores decreased(P<0.05)and the ADL score increased(P<0.05)in the two groups compared with those before treatment.After treatment,the HAMD and the NIHSS scores were lower(P<0.05)and the ADL score was higher(P<0.05)in the combination group than those in the control group.After treatment,IL-1β,IL-6,TNF-αand NF-κB levels decreased in the two groups compared with those before treatment(P<0.05)and the levels of the above inflammatory factors were lower in the combination group than those in the control group(P<0.05).After treatment,Beclin1 and LC3-Ⅱlevels decreased(P<0.05)and p62 levels increased(P<0.05)in the two groups compared with those before treatment;Beclin1 and LC3-Ⅱlevels were lower(P<0.05)and p62 level was higher(P<0.05)in the combination group than those in the control group.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P<0.05).Conclusion On the basis of conventional treatment,Xing Nao Kai Qiao acupuncture plus Wu Ling capsules can relieve depression,improve neural functions,ameliorate the activities of daily living,diminish inflammatory reactions and decrease the degree of autophagy in treating patients with post-stroke depression.It is more effective than Wu Ling capsules alone.