本文選題：針刺 + 認(rèn)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(guò)觀(guān)察針刺結(jié)合認(rèn)知康復(fù)訓(xùn)練對(duì)腦卒中后認(rèn)知障礙患者(Post-stroke Cognitive Impairment,PSCI)臨床療效以及對(duì)外周血單個(gè)核細(xì)胞(Peripheral Blood Mononuclear Cells,PBMCs)中突觸相關(guān)的 miR-124,miR-132,miR-134 和 miR-138 表達(dá)水平的影響,探索針刺結(jié)合認(rèn)知康復(fù)訓(xùn)練治療PSCI可能的機(jī)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(jī)分為治療組(31例)、對(duì)照組(31例),對(duì)照組給予基礎(chǔ)治療及認(rèn)知康復(fù)訓(xùn)練,治療組在基礎(chǔ)治療及認(rèn)知康復(fù)訓(xùn)練基礎(chǔ)上進(jìn)行針刺"百會(huì)、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(jiǎn)易智能精神狀態(tài)檢查量表(Mini-mental State Examination,MMSE)進(jìn)行認(rèn)知功能評(píng)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(shí)時(shí)熒光定量 PCR(Real-time Quantitative Polymerase Chain Reaction,RT-qPCR)檢測(cè)miR-124、miR-132、miR-134 和 miR-138 的表達(dá)水平。結(jié)果:1、兩組研究對(duì)象的人口學(xué)數(shù)據(jù)(年齡、性別、受教育水平),腦卒中特點(diǎn)(病程、類(lèi)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(píng)分)均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2、組內(nèi)比較表明治療組和對(duì)照組干預(yù)后MMSE量表總分及各個(gè)分測(cè)驗(yàn)(定向力、即刻記憶力、計(jì)算力、回憶力、語(yǔ)言)均較干預(yù)前明顯提高,具有統(tǒng)計(jì)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(jì)算力較對(duì)照組提高,具有統(tǒng)計(jì)學(xué)意義(P0.05),而即刻記憶力、回憶力及語(yǔ)言與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)差異(P＞0.05)。3、兩組miRNAs相對(duì)表達(dá)量組內(nèi)比較表明治療組和對(duì)照組干預(yù)后的miR-124、miR-134、miR-138相對(duì)表達(dá)量與干預(yù)前相比呈下調(diào)狀態(tài),miR-132相對(duì)表達(dá)量與干預(yù)前比較呈上調(diào)狀態(tài),均具有統(tǒng)計(jì)學(xué)差異(P0.001)。4、兩組miRNAs相對(duì)表達(dá)量組間比較表明治療組miR-132相對(duì)表達(dá)量上調(diào)比對(duì)照組明顯,即治療組的PBMCs中miR-132表達(dá)量更多,具有統(tǒng)計(jì)學(xué)差異(P0.05);治療組miR-134相對(duì)表達(dá)量下調(diào)比對(duì)照組明顯,即治療組的PBMCs中miR-134表達(dá)量更少,具有統(tǒng)計(jì)學(xué)意義(P0.05),而治療組miR-124、miR-138相對(duì)表達(dá)量與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。5、將所有研究對(duì)象干預(yù)前后MMSE量表總分差值與干預(yù)前后miRNAs差異表達(dá)的相對(duì)表達(dá)量進(jìn)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(dá)的相對(duì)表達(dá)量呈正相關(guān)r=0.400(P0.05),與miR-134差異表達(dá)的相對(duì)表達(dá)量呈負(fù)相關(guān)r=-0.321(P0.05)。結(jié)論:1、單純認(rèn)知康復(fù)訓(xùn)練和針刺結(jié)合認(rèn)知康復(fù)訓(xùn)練均能提高PSCI患者的認(rèn)知功能,但針刺結(jié)合認(rèn)知康復(fù)訓(xùn)練改善PSCI患者的認(rèn)知功能療效更顯著。2、miR-132、miR-134表達(dá)水平與認(rèn)知功能具有相關(guān)性,針刺結(jié)合認(rèn)知康復(fù)訓(xùn)練治療PSCI可能通過(guò)調(diào)控miR-132、miR-134表達(dá)水平從而改善認(rèn)知功能,但仍需進(jìn)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(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.3

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