丰富康复训练联合rTMS对卒中后认知障碍患者认知功能及血浆miR-146a-5p TNF-α水平的影响

Effects of enriched rehabilitation training combined with rTMS on cognitive function,plasma miR-146a-5p and TNF-αin patients with post-stroke cognitive impairment

目的探讨丰富康复训练联合重复经颅磁刺激(rTMS)对卒中后认知障碍(PSCI)患者的认知功能和血浆miR-146a-5p、肿瘤坏死因子-α(TNF-α)水平的影响。方法选取2018-11—2020-09西安交通大学医学院附属三二〇一医院收治的PSCI患者132例,随机分为常规组、联合组,每组66例,常规组采取丰富康复训练,联合组采取丰富康复训练联合rTMS干预,比较2组患者干预前后认知功能变化和生活活动能力,使用实时定量PCR(RT-PCR)检测PSCI患者治疗前后血浆miR-146a-5p表达水平,酶联免疫吸附法检测血浆TNF-α、白细胞介素(IL)-6、IL-1β水平和血清神经递质、神经损伤标志物水平。结果治疗8周后,常规组、联合组PSCI患者的MMSE、MoCA、MBI、FIM评分和血浆miR-146a-5p表达均高于治疗前(P<0.05),血清Ach、DA、NE水平均高于治疗前(P<0.05),血清NSE、VILIP-1、MBP水平均低于治疗前(P<0.05),血浆TNF-α、IL-6、IL-1β水平低于治疗前(P<0.05);联合组PSCI患者的MMSE、MoCA、MBI、FIM评分和血浆miR-146a-5p表达均高于常规组(P<0.001),血清Ach、DA、NE水平均高于常规组(P<0.001),血清NSE、VILIP-1、MBP水平均低于常规组(P<0.001),血浆TNF-α、IL-6、IL-1β水平低于常规组(P<0.001)。结论丰富康复训练联合rTMS可改善PSCI患者认知功能、生活活动能力,改善神经损伤,可能与提高miR-146a-5p表达、降低促炎因子水平有关。

Objective To explore the effect of enriched rehabilitation training combined with repetitive tran⁃scranial magnetic stimulation(rTMS)on cognitive function,plasma miR-146a-5p and tumor necrosis factor-α(TNF-α)in patients with post-stroke cognitive impairment(PSCI).Methods A total of 132 patients with PSCI ad⁃mitted to the 3201 Hospital Affiliated to Xi’an Jiaotong University School of Medicine were enrolled between Novem⁃ber 2018 and September 2020.They were randomly divided into routine group and combination group,66 cases in each group.The routine group was given enriched rehabilitation training,while combination group was additionally given rTMS intervention.The changes in cognitive function and activities of daily life before and after intervention were compared between the two groups.The expression level of plasma miR-146a-5p was detected by real-time quan⁃titative PCR(RT-PCR).The changes in levels of plasma TNF-α,interleukin(IL)-6,IL-1β,serum neurotransmitters and nerve injury markers were detected by enzyme-linked immunosorbent assay.Results After 8 weeks of treat⁃ment,the scores of MMSE,MoCA,MBI and FIM,and the expression of plasma miR-146a-5p were increased in both groups(P<0.05),the levels of serum Ach,DA and NE were increased(P<0.05),the levels of serum NSE,VILIP-1 and MBP were decreased(P<0.05),and the levels of plasma TNF-α,IL-6 and IL-1βwere decreased(P<0.05).The scores of MMSE,MoCA,MBI and FIM,and the expression of plasma miR-146a-5p in combination group were higher than those in routine group(P<0.001),the levels of serum Ach,DA and NE were higher than those in routine group(P<0.001),the levels of serum NSE,VILIP-1 and MBP were lower than those in routine group(P<0.001),and the levels of plasma TNF-α,IL-6 and IL-1βwere lower than those in routine group(P<0.001).Conclusion Enriched rehabilitation training combined with rTMS can improve cognitive function,activities of daily life and nerve injury in PSCI patients,which may be related to increasing the expression of miR-146a-5p and decreasing the levels of proinflammatory factors.