耳穴电针治疗2型糖尿病合并脑卒中后抑郁症状临床效果及血清MMP-9、sICAM-1、ROS表达水平与抑郁程度相关性研究

邵洪伟

文章摘要

耳穴电针治疗2型糖尿病合并脑卒中后抑郁症状临床效果及血清MMP-9、sICAM-1、ROS表达水平与抑郁程度相关性研究

Clinical effect of auricular electro-acupuncture on type 2 diabetes mellitus complicated with post-stroke depressive symptoms and correlation between serum levels of MMP-9， sICAM-1 and ROS and depressive degree

投稿时间：2019-08-05 录用日期：2019-09-30

DOI：

中文关键词: 耳穴电针 2型糖尿病脑卒中基质金属蛋白酶-9（MMP-9）可溶性细胞间黏附分子（sICAM-1）活性氧（ROS）

英文关键词: auricular electro-acupuncture type 2 diabetes mellitus stroke matrix metalloproteinase-9(MMP-9) solubleintercellularadhesionmolecule(sICAM-1) reactive oxygen species(ROS)

基金项目:第六批全国老中医药专家学术经验继承人项目[2017]29号

作者	单位	邮编
邵洪伟^*	辽宁中医药大学附属第四医院门诊辽宁沈阳 110000	110000

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中文摘要:

目的：观察耳穴电针治疗2型糖尿病合并脑卒中后抑郁(PSD)的临床疗效及血清基质金属蛋白酶-9(MMP-9)、可溶性细胞间黏附分子(sICAM-1)、活性氧(ROS)表达水平与抑郁程度、日常活动能力相关性研究,并探讨其治疗机制。方法：收集临床治疗的80例2型糖尿病合并PSD患者作为研究对象,随机分为两组,对照组予以氟西汀药物口服治疗,观察组在此治疗基础上联合耳穴电针。观察两组患者治疗前后日常生活活动能力评分(MBI)、抗抑郁药副反应量表(SERS)评分、汉密尔顿抑郁量表(HAMD)评分改善及临床疗效情况,比较两组治疗前后血清MMP-9、sICAM-1、ROS水平变化情况,并进行相关性分析。结果：经治疗,观察组治疗有效率(90%)明显高于对照组(75%)(P＜0.05)；治疗前比较两组患者HAMD评分结果无统计学差异(P＞0.05),治疗3、6周后,观察组较治疗前HAMD评分均显著降低(P＜0.05),对照组治疗6周后的HAMD评分较治疗前降低显著(P＜0.017),治疗3、6周后两组间比较,观察组HAMD评分、SERS评分结果均降低显著(P＜0.05)；治疗前比较MBI评分无差异(P＞0.05),与治疗前比较两组治疗3、6周时MBI评分均显著提高,两组间比较观察组升高明显(P＜0.05)；两组治疗后血清MMP-9、sICAM-1、ROS水平均明显降低(P＜0.05),但观察组改善更明显(P＜0.05)；两组MMP-9、sICAM-1、ROS表达水平与MBI评分情况呈负相关变化(P＜0.05)；两组MMP-9、sICAM-1、ROS表达水平与HAMD评分情况呈正相关变化(P＜0.05)。结论：耳穴电针配合抗抑郁药物治疗在改善2型糖尿病合并PSD患者日常活动能力方面优势明显,加快抗抑郁作用,提高疗效改善生活质量,同时减轻氟西汀治疗产生的不良反应。机制可能为通过耳穴电针治疗,干预体内相关疾病因子调节,下调MMP-9、sICAM-1、ROS等有害性因子表达水平,进而改善脑组织中单胺类神经递质多巴胺、去甲肾上腺素、5-羟色胺的异常表达,有效改善抑郁症状,促进日常生活能力恢复。

英文摘要:

Objective:To observe the clinical effect of auricular point electro-acupuncture on type 2 diabetes mellitus complicated with post-stroke depression (PSD),and to study the correlation between the expression levels of matrix metalloproteinase-9(MMP-9),soluble intercellular adhesion molecule (sICAM-1),reactive oxygen species(ROS)and the degree of depression and daily activity, and to explore its therapeutic mechanism. System.Methods:80 patients with type 2 diabetes mellitus complicated with PSD were randomly divided into two groups. The control group was treated with fluoxetine orally.The observation group was treated with auricular electroacupuncture on the basis of this treatment.The activities of daily living (MBI),antidepressant side effects scale (SERS),Hamilton Depression Scale(HAMD)and clinical efficacy of the two groups were observed before and after treatment.The changes of serum MMP-9,sICAM-1 and ROS levels were compared between the two groups before and after treatment,and the correlation was analyzed.Results:After treatment,the effective rate of the observation group (90%) was significantly higher than that of the control group(75%)(P<0.05);there was no significant difference in HAMD score between the two groups before treatment(P> 0.05).After 3 and 6 weeks of treatment,the HAMD score of the observation group was significantly lower than that of the control group(P<0.05).After 6 weeks of treatment,the HAMD score of the control group was significantly lower than that before treatment(P<0.05).The results of HAMD score and SERS score in the observation group were significantly lower than those before treatment(P<0.017).There was no difference in MBI score before treatment(P>0.05).Compared with before treatment, MBI score in the two groups at 3 and 6 weeks of treatment was significantly higher, and there was a significant increase in the observation group(P<0.05).After treatment,the levels of serum MMP-9,sICAM-1 and ROS decreased significantly in both groups(P<0.05),but the improvement was more obvious in the observation group (P<0.05);the levels of MMP-9,sICAM-1 and ROS in the two groups were negatively correlated with the MBI score(P<0.05);the levels of MMP-9,sICAM-1 and ROS in the two groups were positively correlated with the HAMD score(P<0.05). <0.05).Conclusion:auricular electro-acupuncture combined with antidepressant therapy has obvious advantages in improving the daily activities of patients with type 2 diabetes mellitus complicated with PSD,accelerating the antidepressant effect,improving the curative effect,improving the quality of life,and alleviating the adverse reactions caused by fluoxetine therapy.The mechanism may be that electro-acupuncture at auricular points can intervene in the regulation of related disease factors in vivo,down-regulate the expression levels of harmful factors such as MMP-9,sICAM-1 and ROS,thereby improving the abnormal expression of monoamine neurotransmitters dopamine,norepinephrine and 5-hydroxytryptamine in brain tissue, effectively improving depressive symptoms and promoting the recovery of daily living ability.

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