發(fā)布時間：2018-06-08 07:10

  本文選題：針刺 + 認知康復(fù)訓(xùn)練　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察針刺結(jié)合認知康復(fù)訓(xùn)練對腦卒中后認知障礙患者(Post-stroke Cognitive Impairment,PSCI)臨床療效以及對外周血單個核細胞(Peripheral Blood Mononuclear Cells,PBMCs)中突觸相關(guān)的 miR-124,miR-132,miR-134 和 miR-138 表達水平的影響,探索針刺結(jié)合認知康復(fù)訓(xùn)練治療PSCI可能的機制。方法:在湖北省十堰市太和醫(yī)院和福建中醫(yī)藥大學(xué)附屬康復(fù)醫(yī)院住院部選擇符合納入排除標(biāo)準(zhǔn)的PSCI患者62例隨機分為治療組(31例)、對照組(31例),對照組給予基礎(chǔ)治療及認知康復(fù)訓(xùn)練,治療組在基礎(chǔ)治療及認知康復(fù)訓(xùn)練基礎(chǔ)上進行針刺"百會、神庭"穴;每天治療30分鐘,每周治療5天,共治療12周。干預(yù)前后采用簡易智能精神狀態(tài)檢查量表(Mini-mental State Examination,MMSE)進行認知功能評定及血液樣本采集及PBMCs的分離,采用TRIzol法提取PBMCs中的總RNA,逆轉(zhuǎn)錄后選用實時熒光定量 PCR(Real-time Quantitative Polymerase Chain Reaction,RT-qPCR)檢測miR-124、miR-132、miR-134 和 miR-138 的表達水平。結(jié)果:1、兩組研究對象的人口學(xué)數(shù)據(jù)(年齡、性別、受教育水平),腦卒中特點(病程、類型、損傷部位)、既往史(高血壓病、糖尿病、高脂血癥、心臟病)、腦卒中損傷程度(NIHSS評分)均無統(tǒng)計學(xué)意義(P0.05),具有可比性。2、組內(nèi)比較表明治療組和對照組干預(yù)后MMSE量表總分及各個分測驗(定向力、即刻記憶力、計算力、回憶力、語言)均較干預(yù)前明顯提高,具有統(tǒng)計學(xué)意義(P0.05);組間比較表明治療組MMSE量表總分及定向力、計算力較對照組提高,具有統(tǒng)計學(xué)意義(P0.05),而即刻記憶力、回憶力及語言與對照組比較無統(tǒng)計學(xué)差異(P＞0.05)。3、兩組miRNAs相對表達量組內(nèi)比較表明治療組和對照組干預(yù)后的miR-124、miR-134、miR-138相對表達量與干預(yù)前相比呈下調(diào)狀態(tài),miR-132相對表達量與干預(yù)前比較呈上調(diào)狀態(tài),均具有統(tǒng)計學(xué)差異(P0.001)。4、兩組miRNAs相對表達量組間比較表明治療組miR-132相對表達量上調(diào)比對照組明顯,即治療組的PBMCs中miR-132表達量更多,具有統(tǒng)計學(xué)差異(P0.05);治療組miR-134相對表達量下調(diào)比對照組明顯,即治療組的PBMCs中miR-134表達量更少,具有統(tǒng)計學(xué)意義(P0.05),而治療組miR-124、miR-138相對表達量與對照組比較無統(tǒng)計學(xué)意義(P＞0.05)。5、將所有研究對象干預(yù)前后MMSE量表總分差值與干預(yù)前后miRNAs差異表達的相對表達量進行相關(guān)性分析發(fā)現(xiàn):MMSE量表總分差值與miR-132差異表達的相對表達量呈正相關(guān)r=0.400(P0.05),與miR-134差異表達的相對表達量呈負相關(guān)r=-0.321(P0.05)。結(jié)論:1、單純認知康復(fù)訓(xùn)練和針刺結(jié)合認知康復(fù)訓(xùn)練均能提高PSCI患者的認知功能,但針刺結(jié)合認知康復(fù)訓(xùn)練改善PSCI患者的認知功能療效更顯著。2、miR-132、miR-134表達水平與認知功能具有相關(guān)性,針刺結(jié)合認知康復(fù)訓(xùn)練治療PSCI可能通過調(diào)控miR-132、miR-134表達水平從而改善認知功能,但仍需進一步研究證明。
[Abstract]:Objective: to observe the effect of acupuncture combined with cognitive rehabilitation training on Post-stroke Cognitive cognitive disorder (PSCI) and the expression of synaptic associated miR-124 miR-132 miR-134 and miR-138 in peripheral blood mononuclear cells (PBMCs) in patients with post-stroke cognitive impairment. To explore the possible mechanism of acupuncture combined with cognitive rehabilitation training in the treatment of PSCI. Methods: 62 PSCI patients were randomly divided into treatment group (n = 31), control group (n = 31) and control group (n = 31). Treatment and cognitive rehabilitation training, On the basis of basic treatment and cognitive rehabilitation training, the treatment group was treated with acupuncture at Baihui and Shenting points for 30 minutes per day for 5 days per week for 12 weeks. Before and after intervention, Mini-Mental State examination scale (MMSE) was used to assess cognitive function, collect blood samples and separate PBMCs. The total RNAs in PBMCs were extracted by TRIzol method, and the expression levels of miR-124 miR-132 miR-134 and miR-138 were detected by real-time quantitative PCR PCR chain Real-time quantitative PCR. Results the demographic data (age, sex, education level, stroke characteristics (course, type, site of injury, history of hypertension, diabetes, hyperlipidemia) of the two groups were compared. No statistical significance was found in the scores of heart disease, stroke injury and NIHSS, which were comparable. The comparison between the treatment group and the control group showed that the total score of MMSE scale and each subtest (orientation, immediate memory, computational power, recall ability) after intervention in the treatment group and the control group. The comparison between groups showed that the total score and orientation of MMSE scale in the treatment group were higher than those in the control group, which had statistical significance (P 0.05), while the immediate memory of the treatment group was significantly higher than that of the control group. There was no significant difference in recall and language between the two groups (P > 0.05). The relative expression of miRNAs in the two groups showed that the relative expression of miR-124 miR-134 and miR-138 was down-regulated in the treatment group and the control group after intervention, and the relative expression of miRNAs in the treatment group and the control group was in a down-regulated state compared with that before the intervention. The former comparison is in an upward state. The relative expression of miRNAs in the treatment group was higher than that in the control group, that is, the expression of miR-132 in the PBMCs of the treatment group was more than that in the control group, and the expression of miR-132 in the PBMCs of the treatment group was higher than that of the control group. The relative expression of miR-134 in the treatment group was significantly lower than that in the control group, that is, the expression of miR-134 in the PBMCs of the treatment group was lower than that in the control group. The relative expression of miR-124 miR-138 in the treatment group was not significantly higher than that in the control group (P > 0.05). The total score difference of MMSE scale before and after intervention was correlated with the relative expression of miRNAs before and after intervention. It was found that the relative expression of miR-132 was positively correlated with the total score difference of MMSE, and negatively correlated with the relative expression of miR-134. Conclusion the cognitive function of PSCI patients can be improved by simple cognitive rehabilitation training and acupuncture combined with cognitive rehabilitation training, but the effect of acupuncture combined with cognitive rehabilitation training on improving cognitive function of PSCI patients is more significant. The expression level of Acupuncture combined with cognitive rehabilitation training is more correlated with cognitive function. Acupuncture combined with cognitive rehabilitation training may improve cognitive function by regulating the expression level of miR-132 miR-134, but further research is needed.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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