经颅直流电刺激联合益生菌对脑卒中后认知功能障碍患者的作用

Effects of transcranial direct current stimulation combined with probiotics on patients with cognitive impairment after stroke

目的 探讨经颅直流电刺激(t DCS)联合益生菌对脑卒中后认知功能障碍(PSCI)患者认知功能和肠道菌群的影响。方法 按随机数字表法将2020年6月至2021年6月我院收治的150例PSCI患者分为对照组和观察组,各75例。对照组患者给予t DCS治疗,观察组患者给予tDCS联合益生菌治疗。采用蒙特利尔认知功能评估量表(MoCA)和简易智力状态检查量表(MMSE)评估患者治疗前后的认知功能。采用荧光定量PCR法检测患者治疗前后肠道菌群数量变化。比较两组患者认知功能、肠道菌群、临床疗效以及不良反应发生情况。结果 治疗后,观察组患者肠道双歧杆菌和乳杆菌数量较治疗前显著升高,且双歧杆菌和乳杆菌数量显著高于对照组;而大肠埃希菌和肠球菌数量较治疗前显著降低,且大肠埃希菌和肠球菌数量显著低于对照组(均P<0.05)。治疗后,两组患者MoCA和MMSE评分均升高,且观察组高于对照组(均P<0.05)。观察组患者临床总有效率显著高于对照组(90.67%vs 78.67%,χ^(2)=12.482,P<0.001)。对照组和观察组患者的不良反应发生情况比较差异无统计学意义(χ^(2)=0.150,P=0.699)。结论 tDCS联合益生菌治疗能够有效改善PSCI患者的认知功能和肠道菌群状态,且不良反应少,安全系数高,值得临床推广。

Objective To explore the effect of transcranial direct current stimulation(tDCS) combined with probiotics on the cognitive function and intestinal flora of patients with cognitive dysfunction after stroke(PSCI). Methods A total of150 patients with PSCI admitted to our hospital from June 2020 to June 2021 were divided into control group and observation group randomly, with 75 cases in each group. The control group was treated with tDCS, and the observation group was treated with tDCS combined with probiotics. The Montreal Cognitive Function Assessment Scale(MoCA) and Simple Mental State Examination Scale(MMSE) were used to assess the cognitive function of patients before and after treatment,and quantitative PCR method was used to detect the changes in the counts of intestinal flora. The cognitive function, intestinal flora, clinical efficacy and adverse reactions in the two groups were compared. Results After treatment, the counts of intestinal Bifidobacteria and Lactobacillus in the observation group were significantly higher than those before treatment,and those of Bifidobacteria and Lactobacillus were significantly higher compared with control group;the counts of Escherichia coli and Enterococcus were significantly lower than those before treatment, and those of Escherichia coli and Enterococcus were significantly lower than in control group(all P<0.05). After treatment, the MoCA and MMSE scores of the two groups increased, and those in observation group were higher compared with control group(all P<0.05). After treatment, the total clinical efficiency rates in the control group vs observation group were 78.67% vs 90.67%, and the rate in observation group was higher compared with control group(χ^(2) = 12.482, P<0.001). The difference in occurrence of adverse reactions between the control group and observation group was not significant(χ^(2) = 0.150, P = 0.699).Conclusion The treatment of tDCS combined with probiotics can effectively improve the cognitive function and intestinal flora of PSCI patients, with few adverse reactions and high safety, which is worthy of clinical promotion.