目的观察电针百会、风府穴对焦虑模型大鼠行为学及脑源性神经营养因子(Brain-derived neuro⁃trophic factor,BDNF)、促肾上腺皮质释放激素(Corticotropin releasing hormone,CRH)、皮质醇(Cortisol,CORT)表达的影响,探讨针刺治疗焦虑障碍效应及作用机制。方法将30只SPF级SD雄性大鼠按随机数字表法分为正常组、模型组、电针组,每组各10只。采用慢性不可预见性应激刺激法制备焦虑大鼠模型。电针组取“百会”“风府”穴进行电针操作,隔日1次,20 min/次,造模与干预共计15 d。15 d后,采用高架十字迷宫实验(Elevated plus maze,EPM)和自发活动旷场实验(Open field test,OFT)测试大鼠行为学变化,HE染色法观察大鼠海马形态,免疫组化法观察海马组织内BDNF蛋白表达,酶联免疫吸附法检测血清BDNF、CRH与CORT的含量。结果与正常组比较,模型组大鼠进入开臂次数百分比(The percentage of open arm entry,OE%)、开臂停留时间百分比(The per⁃centage of open arm time,OT%)明显降低,差异有统计学意义(P<0.05),水平得分、垂直得分明显下降,差异有统计学意义(P<0.01),血清BDNF、CRH、CORT含量明显升高,差异有统计学意义(P<0.01),海马神经元数量和BDNF蛋白阳性明显减少,差异有统计学意义(P<0.05);与模型组比较,电针组OE%、OT%值明显升高,差异有统计学意义(P<0.01),水平得分、垂直得分明显升高,差异有统计学意义(P<0.01),海马神经元数量和BDNF蛋白阳性含量明显增加,差异有统计学意义(P<0.05),血清BDNF、CRH、CORT含量明显降低,差异有统计学意义(P<0.01)。结论电针可改善焦虑大鼠的焦虑样行为症状,其抗焦虑的机制可能与上调海马BDNF水平,抑制血清中BDNF、CORT、CRH的表达,使下丘脑-垂体-肾上腺(Hypothalamic–pituitary–adrenal,HPA)轴亢进受抑有关。
Introduction:Obstructive sleep apnea syndrome(OSAS) is considered a major public health issue due to its high prevalence and severe consequences.Several published studies have revealed that electroacupuncture may relieve OSAS symptoms.However,the mechanism of electro-acupuncture in the treatment of patients with OSAS remains unclear.Methods and analysis:We evaluated the efficacy and mechanism of electro-acupuncture in the treatment of patients with OSAS.This was a two-group parallel randomized controlled trial.Sixty patients with OSAS will be randomly divided into an electro-acupuncture or shallow acupuncture group in a proportion of 1:1,and the patients will be administered 36 sessions of electro/shallow acupuncture treatment(three times a week for 12 weeks,20 min for each session).The Epworth Sleepiness Scale(ESS) will be used as the primary outcome.Secondary outcomes will include polysomnography(PSG),sleep quality,emotional state,and cognitive function.In addition,patients will receive neuroimaging scanning before and after the entire acupuncture treatment to evaluate neuroplasticity changes,including gray matter density,white matter integrity,and functional connections.Expected outcomes:We believe that the use of electro-acupuncture will be more effective in patients with mild to moderate OSAS and that the cognitive and emotional status of patients will improve after acupuncture treatment.In addition,we aim to clarify which brain areas can be altered by acupuncture in patients with OSAS.Discussion:This randomized clinical trial aims to explore the curative effect and central mechanism of acupuncture treatment for OSAS.We will explore gray matter density,white matter integrity,and functional connections of the brain using fMRI technology.The results of this study will be significant to the guidelines for clinical OSAS treatment.
目的观察慢性肾脏病(CKD)患者认知功能水平与脑功能的改变。方法选择2018年1月至2020年1月在东直门医院被诊断为CKD 3~4期的10例患者为观察组,同时纳入19例肾功能正常的受试者作为对照组。分别进行简明精神状态量表(MMSE)、听觉词语学习测验量表(AVLT)、数字广度(DST)、动物词语流畅性量表(AFT)、形状连线测试A和B(TMT A and B)和高山量表评价2组受试者的认知功能和对记忆的满意程度,并进行静息态功能磁共振扫描观察2组受试者脑功能的差异。临床数据采用SPSS 20.0统计软件处理。结果在认知功能方面,与对照组相比,观察组AVLT的即刻回忆、短延时回忆和长延时回忆得分均显著下降(P<0.005),高山量表评分显著降低(P=0.024)。在脑功能方面,观察组左侧海马度中心度值(DC)较对照组显著增加(P<0.01);左侧海马与额中回和中央前回的功能连接减弱(P<0.01),并且这种功能连接减弱与听觉短延时回忆和长延时回忆呈显著负相关(P<0.05)。结论CKD患者较肾功能正常的受试者认知功能水平有所下降,尤其是情景记忆功能;在脑功能方面,CKD患者的海马DC值增加,海马与额中回和中央前回的功能连接减弱,且这种功能连接减弱与情景记忆功能呈显著负相关。
