艾灸督脉对阿尔茨海默病患者认知功能及血浆外泌体中Aβ_(1-42)和lncRNA H19的影响

Effects of moxibustion on Du meridian in cognitive function and plasma exosomes Aβ_(1-42) and lncRNA H19 in Alzheimer’s patients

[目的]观察艾灸督脉治疗阿尔茨海默病(AD)的临床疗效,探究艾灸督脉治疗AD影响人血浆外泌体的可能作用机制。[方法]纳入AD患者和健康受试者各30例。AD组取百会、大椎、风府、命门4穴,百会隔附子饼实按灸,其余3穴温和灸,每日20 min,共治疗8周。在治疗前后采用蒙特利尔认知评估量表(MoCA)和阿尔茨海默病评定量表-认知(ADAS-Cog)对AD患者进行认知评估,收集两组清晨空腹静脉血样本,采用酶联免疫吸附测定法(ELISA)检测Aβ_(1-42)蛋白浓度,实时荧光定量聚合酶链反应(qRT-PCR)检测lncRNA H19相对表达量,并做双变量的Pearson线性相关分析。[结果]与治疗前相比,AD组艾灸后MoCA量表评分有显著提高(P<0.05),ADAS-cog量表评分显著降低(P<0.05)。与健康受试组相比,AD组治疗前血浆外泌体Aβ1-42及lncRNA H19表达水平均较高(P<0.05);与治疗前相比,AD组血浆外泌体中Aβ_(1-42)浓度及lncRNA H19表达水平均有所降低(P<0.05)。Pearson线性相关分析显示ADAS-cog评分与Aβ_(1-42)浓度水平、lncRNA H19相对表达量存在正相关性(P<0.05);MoCA评分与Aβ_(1-42)浓度水平、lncRNA H19相对表达量存在负相关性(P<0.05);MoCA评分与ADAS-cog评分存在较强的负相关性(P<0.05)。[结论]艾灸督脉组穴疗效确切,能够降低AD患者血浆外泌体中Aβ_(1-42)和lncRNA H19的表达水平,进而推测艾灸督脉改善认知功能可能与下调lncRNA H19的表达,促进Aβ_(1-42)的清除有关。

[Objective]To observe the clinical efficacy of moxibustion on Du meridian in the treatment of Alzheimer’s disease(AD),and to explore the possible mechanism of action of moxibustion on Du meridian in the treatment of AD on human plasma exosomes.[Methods]Thirty patients with AD and 30 healthy subjects were included.In the AD group,four acupoints of baihui(DU 20),dazhui(DU 14),fengfu(DU 16),mingmen(DU 4),baihui(DU 20).Aconite cake were moxibustion,and the remaining three acupoints were treated mildly,20 min/d,for a total of 8 weeks.The Montreal Cognitive Assessment Scale(MoCA)and the Alzheimer’s Disease Rating Scale-Cognition(ADAS-Cog)were used to assess the cognitive function of AD patients before and after treatment.Two sets of fasting venous blood samples were collected in the morning,Aβ_(1-42)protein concentration was detected by ELISA method,the relative expression of lncRNA H19 was detected by real-time real-time quantitative(qRT-PCR),and bivariate Pearson linear correlation analysis was performed.[Results]Compared with before treatment,the MoCA scale score after moxibustion in the AD group was significantly improved(P<0.05)and the ADAS-cog scale score was significantly reduced(P<0.05).Compared with the healthy test group,the expression levels of plasma exosome Aβ_(1-42) and lncRNA H19 were higher in the AD group before treatment(P<0.05),and the concentration of Aβ_(1-42) and lncRNA H19 expression in plasma exosomes in the AD group were reduced(P<0.05)compared with before treatment.Pearson linear correlation analysis showed that there was a positive correlation between ADAS-cog score and Aβ_(1-42) concentration level and lncRNA H19 expression level(P<0.05).There was a negative correlation between MoCA score and Aβ_(1-42) concentration level and lncRNA H19 expression(P<0.05).There was a strong negative correlation between MoCA score and ADAS-cog score(P<0.05).[Conclusion]Moxibustion on Du meridian has a definite effect and can reduce the expression levels of Aβ_(1-42) and lncRNA H19 in plasma exosomes of AD patients,and then speculate that the improvement of cognitive function by moxibustion on Du meridian may be related to downregulating the expression of lncRNA H19 and promoting the clearance of Aβ_(1-42).