针药并用治疗卒中后抑郁的疗效观察及对血清CX3CL1和CX3CR1水平的影响  

Observation on the efficacy of combined acupuncture and medicine for post-stroke depression and its effect on serum CX3CL1 and CX3CR1 levels

作　　者：刘海燕 李伟 宗兴燕 LIU Haiyan;LI Wei;ZONG Xingyan(Hebei Hengshui Seventh People's Hospital,Hengshui 053000,China)

机构地区：[1]河北省衡水市第七人民医院,衡水053000

出　　处：《上海针灸杂志》2025年第4期418-423,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：国家自然科学基金项目(81904193)。

摘　　要：目的 观察针刺联合氟西汀胶囊治疗卒中后抑郁的临床疗效及对患者血清CX3C趋化因子配体1(CX3C chemokine ligand 1, CX3CL1)和CX3C趋化因子受体1(CX3C chemokine receptor 1, CX3CR1)水平的影响。方法将130例卒中后抑郁患者按随机数字表法分为观察组和对照组,每组65例。对照组予口服氟西汀胶囊治疗,观察组在对照组基础上联合针刺百会和印堂穴治疗。比较两组临床疗效,观察两组治疗前后中医证候积分、汉密尔顿抑郁量表-17(Hamilton depression scale-17, HAMD-17)评分和美国国立卫生研究院卒中量表(National Institutes of Health stroke scale, NIHSS)评分以及血清CX3CL1、CX3CR1、5-羟色胺(5-hydroxytryptamine,5-HT)和胶质细胞源性神经营养因子(glial cell derived neurotrophic factor, GDNF)水平的变化。结果 观察组总有效率为95.4%,高于对照组的78.5%(P<0.05)。治疗后,两组嗳气太息、胸胁胀闷、精神不振、易怒善哭的中医证候积分均降低(P<0.05),且观察组均低于对照组(P<0.05)。治疗后,两组HAMD-17和NIHSS评分均降低(P<0.05),且观察组均低于对照组(P<0.05)。治疗后,两组血清CX3CL1和CX3CR1水平均降低(P<0.05),且观察组均低于对照组(P<0.05)。治疗后,两组血清5-HT和GDNF水平均升高(P<0.05),且观察组均高于对照组(P<0.05)。结论 针药并用治疗卒中后抑郁可改善患者的抑郁症状,提高神经功能,降低血清CX3CL1和CX3CR1水平,提高血清5-HT和GDNF水平,疗效优于单纯药物治疗。Objective To observe the clinical efficacy of acupuncture plus fluoxetine capsules for post-stroke depression and its effect on serum CX3C chemokine ligand 1(CX3CL1)and CX3C chemokine receptor 1(CX3CR1)levels.Method One hundred and thirty patients with post-stroke depression were randomized to observation and control groups,with 65 cases in each group.The control group received oral administration of fluoxetine capsules and the observation group,acupuncture at points Baihui(GV20)and Yintang(GV29)in addition.The clinical therapeutic effects were compared between the two groups.The TCM symptom score,the Hamilton depression scale-17(HAMD-17)score and the National Institutes of Health stroke scale(NIHSS)score were recorded and serum CX3CL1,CX3CR1,5-hydroxytryptamine(5-HT)and glial cell derived neurotrophic factor(GDNF)levels were measured in the two groups before and after treatment.Result The total efficacy rate was 95.4%in the observation group,which was higher than 78.5%in the control group(P<0.05).After treatment,the HAMD-17 and NIHSS scores decreased in the two groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).After treatment,serum CX3CL1 and CX3CR1 levels decreased in the two groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).After treatment,serum 5-HT and GDNF levels increased in the two groups(P<0.05)and were higher in the observation group than in the control group(P<0.05).Conclusion Combined use of acupuncture and medicine can relieve depression symptoms,improve nervous function,reduce serum CX3CL1 and CX3CR1 levels and increase serum 5-HT and GDNF levels in treating patients with post-stroke depression.Its therapeutic effect is better than that of medication alone.

关 键 词：针刺疗法 针药并用 穴 百会(GV20) 穴 印堂(GV29) 中风 并发症 抑郁 CX3C趋化因子 

分 类 号：R246.6[医药卫生—针灸推拿学]