通督醒神针刺调节肠道微生物改善缺血性脑卒中后认知障碍的临床机制研究  

The Clinical Mechanism of Improvement of Cognitive Impairment After Ischemic Stroke through Tongdu Xingshen Acupuncture by Regulating Gut Microbes

作　　者：吕转 陈玉龙[2] 王亚敏 刘瑞东 苏凯奇 印帅 高静 李瑞青[1] 吴明莉[1] 张铭[1] 冯晓东[1] LYU Zhuan;CHEN Yulong;WANG Yamin;LIU Ruidong;SU Kaiqi;YIN Shuai;GAO Jing;LIRuiqing;WU Mingli;ZHANG Ming;FENG Xiaodong(The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China;Zhongjing College of Henan University of Traditional Chinese Medicine,Zhengzhou 450046,China;College of Rehabilitation Medicine,Henan University of Traditional Chinese Medicine,Zhengzhou 450046,China)

机构地区：[1]河南中医药大学第一附属医院,郑州450000 [2]河南中医药大学仲景学院,郑州450046 [3]河南中医药大学康复医学院,郑州450046

出　　处：《世界科学技术-中医药现代化》2025年第2期545-555,共11页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金委员会面上项目(82174473):基于NCOA4介导的铁蛋白自噬/铁死亡途径探讨通督醒神针刺改善MCAO学习记忆障碍的机制研究,负责人:冯晓东;中国博士后科学基金委员会面上项目(2024M760847):基于HDAC3/mtDNA/cGAS轴调控小胶质细胞极化探讨通督醒神针刺改善MCAO/R学习记忆障碍的机制,负责人:吕转;河南省卫生健康委员会专项课题(2022JDZX028):基于肠道微生态调节探讨通督醒神针刺治疗缺血性脑卒中后认知障碍的临床机制研究,负责人:吕转。

摘　　要：目的探究通督醒神针刺对缺血性脑卒中(Ischemic stroke,IS)后认知障碍患者的临床疗效、全身炎症反应、血脑屏障及肠道菌群的影响及其作用机制。方法30例(脱落3例)IS后认知障碍患者为疾病组,其中治疗前的患者作为疾病组,通督醒神针刺治疗后的患者作为电针组,同时30例(脱落3例)健康对照者为健康组。电针组为在基础治疗基础上,行通督醒神针刺干预,每天干预1次,每次30 min,共干预14天。分别观察三组MMSE、MoCA和MBI评分;收集所有研究对象的粪便样本和血清样本,使用16S rDNA测序技术和ELISA法检测粪便中的肠道菌群变化及血清中促炎因子IL-6、IL-1β、TNF-α和血脑屏障功能破坏的相关因子S100β的含量变化。结果与健康组比较,疾病组患者的MMSE、MoCA、MBI评分显著降低(P<0.05),血清中促炎因子及S100β蛋白含量显著升高(P<0.05),Shannon指数(P<0.01)和Simpson指数(P<0.001)显著升高;而与疾病组比较,电针组患者的MMSE、MoCA、MBI评分显著升高(P<0.05),血清中促炎因子及S100β含量显著降低(P<0.05),Shannon指数和Simpson指数均有所下降(P>0.05)。健康组中的优势菌群主要包括拟杆菌门、双歧杆菌属、拟杆菌属、粪杆菌属、双歧杆菌科、瘤胃球菌科、拟杆菌科等有益菌(P<0.05),疾病组患者中的优势菌群包括变形菌门、肠杆菌科、埃希氏杆菌属、克雷伯杆菌属等条件致病菌(P<0.05),而电针组患者体内优势菌群与健康组一致,有益菌相对丰度水平显著升高(P<0.05),条件致病菌相对丰度显著降低(P<0.05)。Spearman相关性分析发现有益菌相对丰度水平与临床疗效相关指标呈正相关,而与血清中促炎因子及S100β含量呈负相关。结论通督醒神针刺可通过调节肠道菌群多样性提升拟杆菌属、双歧杆菌属、粪杆菌属等有益菌丰度水平,调控肠道微生态平衡,从而调控全身炎症及血脑屏障功能,进而发挥改善认知功能的�Objective To explore the mechanism of Tongdu Xingshen acupuncture,the clinical efficacy,systemic inflammatory response,blood-brain barrier and intestinal flora in patients with cognitive impairment after ischemic stroke(IS)were studied.Methods Thirty patients(3 cases shedding)with cognitive impairment after IS were included as the disease group,including patients before treatment as the disease group,patients after Tongdu Xingshen acupuncture treatment as the electroacupuncture group,and 30 healthy controls(3 cases shedding)were included as the healthy group.In the electroacupuncture group,on the basis of the basic treatment,Tongdu Xingshen acupuncture was applied,which was 30 min each time,once a day for 14 days.The MMSE,MoCA and MBI scores of the three groups were observed.The fecal and serum samples from all study subjects were collected,and 16S rDNA sequencing technology and ELISA were used to detect the changes of proinflammatory factors IL-6,IL-1β,TNF-αand S100βin serum in intestinal flora and feces.Results Compared with the healthy group,the MMSE,MoCA,and MBI score of patients in the disease group decreased significantly(P<0.05),serum proinflammatory factors and S100βprotein content increased significantly(P<0.05),and the Shannon index(P<0.01)and Simpson index(P<0.001)increased significantly.Compared with the disease group,the MMSE,MoCA,and MBI score of the EA group increased significantly(P<0.05),the serum levels of proinflammatory factors and S100βdecreased significantly(P<0.05),Shannon index and Simpson index decreased(P>0.05).The dominant bacterial flora in the healthy group mainly included Bacteroides,Bifidobacterium,Bacteroides,Faecalibacterium,Bifidobacteriaceae,Ruminococcaceae,and Bacteroides and other beneficial bacteria(P<0.05).The dominant flora in the disease group included Proteobacteria,Enterobacteriaceae,Escherichia,Klebsiella and other opportunistic bacteria(P<0.05),while the dominant flora in the EA group was consistent with the healthy group,the relative abundance of beneficial bacte

关 键 词：缺血性脑卒中 认知障碍 通督醒神针刺 肠道菌群 炎症 血脑屏障 

分 类 号：R246.6[医药卫生—针灸推拿学]