调神运枢法治疗卒中后抑郁对肠道菌群和其代谢物与相关神经递质的影响:随机对照试验  

Effect of Tiaoshen Yunshu Acupuncture on Intestinal Flora and Its Metabolites and Related Neurotransmitters in Treatment of Post-Stroke Depression:A Randomized Control Trial

作　　者：孙妍 高扬[2] 王润泽 孙颖哲[1] SUN Yan;GAO Yang;WANG Runze;SUN Yingzhe(The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150001,China;Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学附属第二医院,黑龙江哈尔滨150001 [2]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《针灸临床杂志》2024年第1期33-38,共6页Journal of Clinical Acupuncture and Moxibustion

基　　金：黑龙江省博士后资助面上项目,编号:LBH-Z21031;黑龙江省博士后科研启动金,编号:LBH-Q21183;孙申田青年人才基金,编号:2021KY-01;黑龙江中医药大学校科研基金,编号:2019MS21。

摘　　要：目的:观察调神运枢法治疗卒中后抑郁的临床疗效及对肠道菌群和其代谢产物、相关神经递质的影响。方法:将符合标准的62例患者随机分为调神运枢组及常规西药组,观察两组患者治疗前及治疗6周后汉密尔顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、肠道菌群、粪便中短链脂肪酸(SCFAs)水平以及5-羟色胺(5-HT)和去甲肾上腺素(NE)的变化。结果:两组患者在治疗6周后HAMD、NIHSS评分均较治疗前降低,BI评分较治疗前升高,差异具有统计学意义(P<0.05),且调神运枢组的HAMD、NIHSS评分低于常规西药组(P<0.05),而BI评分高于常规西药组(P<0.05)。调神运枢组肠道菌群中的乳酸菌、双歧杆菌菌落数量在治疗6周后均较本组治疗前增加,肠球菌、大肠杆菌则减少,差异具有统计学意义(P<0.05),而常规西药组治疗前后差异无统计学意义(P>0.05);组间比较调神运枢组患者肠道菌群的改善较常规西药组显著(P<0.05)。治疗6周后两组粪便中的SCFAs水平均有增高,但只有调神运枢组的差异具有统计学意义(P<0.05);组间比较调神运枢组丁酸以及总SCFAs水平明显低于常规西药组(P<0.05)。两组患者的血清5-HT、NE水平均低于治疗前(P<0.05)。组间比较调神运枢组血清5-HT、NE水平均低于常规西药组(P<0.05)。结论:调神运枢法对卒中后抑郁患者的抑郁情绪、神经功能、日常生活活动能力、肠道菌群、代谢物SCFAs水平、血清5-HT及NE的疗效优于单纯西药常规治疗。Objective:To observe the clinical efficacy of Tiaoshen Yunshu acupuncture in treatment of post-stroke depression and its effects on intestinal flora and its metabolites and related neurotransmitters.Methods:62 patients who met the inclusion criteria were randomly divided into the Tiaoshen Yunshu group and the conventional western medication group.The scores of Hamilton Depression Scale(HAMD),National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI),as well as the levels of intestinal flora,fecal short-chain fatty acids(SCFAs),5-hydroxytryptamine(5-HT)and norepinephrine(NE)were observed before the treatment and after 6 weeks of the treatment.Results:The scores of HAMD and NIHSS were lower,and the scores of BI were higher after 6 weeks of the treatment than those before the treatment in the two groups(P<0.05);the scores of HAMD and NIHSS were lower(P<0.05),whereas the score of BI was higher in the Tiaoshen Yunshu group than those in the conventional western medication group after the treatment(P<0.05).The number of Lactobacillus and Bifidobacterium colonies in the intestinal flora increased,whereas Enterococcus and E.coli decreased after 6 weeks of the treatment compared with those before the treatment in the Tiaoshen Yunshu group(P<0.05);there were no statistical differences in intestinal flora between before the treatment and after the treatment in the conventional western medication group(P>0.05);Tiaoshen Yunshu group was superior to the conventional western medication group in terms of the improvements in intestinal flora(P<0.05).The level of SCFAs in the stool of both groups increased after 6 weeks of the treatment,but the difference was statistically significant only in Tiaoshen Yunshu group(P<0.05);the levels of butyric acid and total SCFAs were significantly lower in the Tiaoshen Yunshu group than those in the conventional western medication group after the treatment(P<0.05).The serum levels of 5-HT and NE were lower after the treatment than those before the treatment in the two groups(P<0.05);

关 键 词：调神运枢法 肠道菌群 短链脂肪酸 5-HT NE 卒中 抑郁 

分 类 号：R246.6[医药卫生—针灸推拿学]