丰富康复训练改善卒中后认知障碍患者认知功能中miR-146a-5p的作用及机制探讨  

The role of miR-146a-5p in enriched rehabilitation training′s ability to improve the cognition of stroke survi-vors

作　　者：周洪雨 孟兆祥 金星 刘佳雨 牛萌 严萍 王鑫 Zhou Hongyu;Meng Zhaoxiang;Jin Xing;Liu Jiayu;Niu Meng;Yan Ping;Wang Xin(Department of Rehabilitation Medicine,Northern Jiangsu People′s Hospital Affiliated to Yangzhou University,Yang-zhou 225001,China;School of Nursing,Yangzhou University,Yangzhou 225009,China;Dalian Medical Universi-ty,Dalian 116044,China)

机构地区：[1]扬州大学附属苏北人民医院康复医学科,扬州225001 [2]扬州大学护理学院,扬州225009 [3]大连医科大学,大连116044

出　　处：《中华物理医学与康复杂志》2021年第4期316-321,共6页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：江苏省青年医学人才项目(QNRC2016339);中国博士后科学基金资助项目(2017M621675)。

摘　　要：目的观察丰富康复训练对卒中后认知障碍(PSCI)患者认知功能及血浆miR-146a-5p、炎性因子的影响。方法采用随机数字表法将58例PSCI患者分为观察组及对照组,观察组患者给予丰富康复训练,对照组患者给予常规认识康复训练。于治疗前、治疗8周后分别采用蒙特利尔认知评估量表(MoCA)、数字广度测试(DST)、连线测试A-B(TMT A-B)、改良Barthel指数(MBI)量表对2组患者认知功能及日常生活活动(ADL)能力进行评定,同时检测治疗前、后2组患者血浆miR-146a-5p、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)表达量。结果治疗后2组患者MoCA评分、DST评分、TMT A-B计时、MBI评分均较治疗前明显改善(P<0.05);并且观察组MoCA评分[(25.34±2.45)分]、TMT A-B计时[分别为(65.36±24.45)s和(153.76±36.17)s]、MBI评分[(82.38±9.88)分]亦显著优于对照组水平(P<0.05);治疗后观察组、对照组DST评分组间差异仍无统计学意义(P>0.05)。治疗后2组患者血浆miR-146a-5p表达量均较治疗前明显上调(P<0.05),血浆IL-6、TNF-α含量均较治疗前明显下调(P<0.05);并且观察组miR-146a-5p表达量[0.79(0.41-3.41)]亦显著高于对照组水平(P<0.05),血浆TNF-α含量[17.82(10.95-24.55)pg/ml]则明显低于对照组水平(P<0.05),血浆IL-6含量虽较对照组有下降趋势,但组间差异仍无统计学意义(P>0.05)。结论丰富康复训练较常规认识康复训练能更有效改善PSCI患者认知功能,其治疗机制可能与上调脑内miR-146a-5p水平、减弱神经炎症反应有关。Objective To observe the effect of enriched rehabilitation training on cognitive function,plasma mir-146a-5p microRNA precursor levels and inflammatory factors in persons with post-stroke cognitive impairment(PSCI).Methods Fifty-eight persons with PSCI were randomly divided into an observation group and a control group,each of 29.The observation group was given enriched rehabilitation training,while the control group was provided with conventional cognitive rehabilitation training.The Montreal Cognitive Assessment Scale(MoCA),the Digit Span Test(DST),parts A and B of the Trail Making Test(TMT A-B)and the Modified Barthel Index(MBI)were used to assess the subjects′cognitive functioning and their ability in the activities of daily living(ADL).Plasma levels of mir-146a-5p,IL-6 and TNF-αwere detected before and after the treatment.Results After treatment,the average MOCA,DST and MBI scores,as well as the average TMT A-B times had improved significantly for both groups.However,the observation group′s averages were significantly better than those of the control group on all three tests.After the treatment,the average plasma expression of miR-146a-5p had increased significantly in both groups,but the increase in the observation group was significantly greater.Plasma IL-6 and TNF-αlevels were significantly lower than before the treatment,with the average TNF-αlevel in the observation group significantly lower than that of the control group.Conclusions Enriched rehabilitation training can improve the cognition of stroke survivors more effectively than conventional cognitive rehabilitation training.That may be related to the up-regulation of plasma miR-146a-5p and reducing inflammation.

关 键 词：丰富康复训练 卒中后认知障碍 miR-146a-5p 炎症反应 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]