针灸联合rTMS用于脑卒中后焦虑抑郁共病的疗效及对患者血清5-HT、Hcy水平的影响

Effect of Acupuncture Combined with rTMS on Post-stroke Comorbid Anxiety and Depression and its Impact on Patients' Serum 5-HT and Hcy Levels

【目的】探讨针灸联合重复经颅磁刺激(rTMS)治疗脑卒中后焦虑抑郁共病(PSCAD)的疗效及对患者血清5-羟色胺(5-HT)、同型半胱氨酸(Hcy)水平的影响。【方法】PSCAD患者76例,随机分为观察组和对照组,每组38例。两组患者在常规对症治疗的基础上,对照组同时予以针灸治疗,观察组予以针灸联合rTMS治疗,均在门诊治疗8周。比较两组治疗前及治疗8周后汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分,炎症因子[白细胞介素(IL)-2、IL-6、肿瘤坏死因子-α(TNF-α)]、神经损伤指标[神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)和神经肽Y(NPY)]及血清5-HT和Hcy水平。【结果】两组治疗后HAMA评分、HAMD评分较治疗前均降低(P<0.05),且观察组两项评分低于对照组(P<0.05)。两组治疗后IL-2、IL-6、TNF-α及NSE、Hcy水平较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。两组治疗8周后BDNF、NPY、5-HT水平较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。【结论】针灸联合rTMS治疗可有效改善PSCAD患者不良情绪,抑制炎症反应,缓解神经损伤,调节血清5-HT和Hcy水平。

【Objective】To investigate the therapeutic effect of acupuncture combined with rTMS on post-stroke comorbid anxiety and depression(PSCAD),and its impact on patients'serum 5-hydroxytryptamine(5-HT)and homocysteine(Hcy)levels.【Methods】A total of 76 PSCAD patients were randomly divided into the observation group and the control group,with 38 cases in each.Based on the routine symptomatic treatment,the control group was given acupuncture treatment,while the observation group was given acupuncture combined with rTMS treatment.Both groups were treated for 8 weeks on an outpatient basis.The scores of Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA),inflammatory factors[interleukin(IL)-2,IL-6,tumor necrosis factor-α(TNF-α)],neuro-damage indicators[neuron-specific enolase(NSE),brain-derived neurotrophic factor(BDNF),and neuropeptide Y(NPY)],and serum 5-HT and Hcy levels were compared before treatment and 8 weeks after treatment in both groups.【Results】After treatment,the HAMA and HAMD scores in both groups were reduced compared to pre-treatment(P<0.05),and the scores in the observation group were lower than that in the control group(P<0.05).After treatment,the levels of IL-2,IL-6,TNF-α,NSE,and Hcy were decreased compared to pre-treatment(P<0.05),and their levels in the observation group were lower than those in the control group(P<0.05).After 8 weeks of treatment,the levels of BDNF,NPY,and 5-HT were increased compared to pre-treatment(P<0.05),and the levels in the observation group were higher than those in the control group(P<0.05).【Conclusion】The combined treatment of acupuncture and rTMS can effectively improve the negative emotions of PSCAD patients,inhibit the inflammatory response,alleviate neuro-damage,and regulate serum 5-HT and Hcy levels.