“通督治郁”针法上调miR-223-3p抑制NLRP3炎症小体改善脑卒中后抑郁的临床研究^*

Tongdu Zhiyu Acupuncture Improves Post-Stroke Depression by Upregulating miR-223-3p and Inhibiting NLRP3 Inflammasome: A Clinical Study

摘要

目的 探讨“通督治郁”针法治疗脑卒中后抑郁（post-stroke depression, PSD）的可能作用机制。方法 采用随机对照试验，纳入安徽中医药大学第二附属医院脑病六科PSD患者62例，按就诊顺序编号后随机1∶1分为对照组（31例）和试验组（31例）。两组均接受基础治疗，对照组予普通针刺，试验组予普通针刺联合“通督治郁”针法，治疗8周。主要结局指标为24项汉密尔顿抑郁量表（HAMD-24）总分；次要指标包括美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数、外周血单个核细胞miR-223-3p表达量及血清NLRP3、IL-1β、IL-18水平。结果 治疗后，试验组各项指标较治疗前均改善（均P<0.05），且改善幅度均优于对照组（均P<0.05）：HAMD-24总分由（17.87±3.90）分降至（13.04±3.55）分；NIHSS评分由（23.29±6.74）分降至（9.97±5.81）分；Barthel指数由（32.29±5.37）分升至（87.13±6.82）分；miR-223-3p表达由0.29±0.07升至0.98±0.21；NLRP3由（65.84±7.16） ng/L降至（49.56±4.89） ng/L；IL-1β由（43.92±7.25） pg/mL降至（22.24±4.76） pg/mL；IL-18由（30.70±4.13） pg/mL降至（15.40±3.09） pg/mL。结论 “通督治郁”针法可改善PSD患者神经功能，其机制可能与上调miR-223-3p表达、抑制NLRP3炎症小体活化、减少IL-1β和IL-18等炎症因子释放有关，从而缓解抑郁症状。

Abstract

Objective To investigate the mechanism of Tongdu Zhiyu acupuncture in the treatment of post-stroke depression (PSD). Methods A randomized controlled trial was conducted. Sixty-two PSD patients from the Department of Brain Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine were enrolled and randomly assigned in a 1∶1 ratio to a control group (n = 31) or an experimental group (n = 31). All patients received basic treatment. The control group received ordinary acupuncture, while the experimental group received ordinary acupuncture combined with Tongdu Zhiyu acupuncture. The treatment period was 8 weeks. The primary outcome was the total score on the 24-item Hamilton Depression Scale (HAMD-24). Secondary outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index, peripheral blood mononuclear cell miR-223-3p expression, and serum levels of NLRP3, IL-1β, and IL-18. Results After treatment, all indicators in the experimental group improved significantly compared with baseline (all P < 0.05), and the improvements were significantly greater than those in the control group (all P < 0.05). The HAMD-24 score decreased from 17.87 ± 3.90 to 13.04 ± 3.55; the NIHSS score decreased from 23.29 ± 6.74 to 9.97 ± 5.81; the Barthel index increased from 32.29 ± 5.37 to 87.13 ± 6.82; miR-223-3p expression increased from 0.29 ± 0.07 to 0.98 ± 0.21; serum NLRP3 decreased from (65.84 ± 7.16) ng/L to (49.56 ± 4.89) ng/L; IL-1β decreased from (43.92 ± 7.25) pg/mL to (22.24 ± 4.76) pg/mL; and IL-18 decreased from (30.70 ± 4.13) pg/mL to (15.40 ± 3.09) pg/mL. Conclusion Tongdu Zhiyu acupuncture can improve neurological function in PSD patients. Its mechanism may involve upregulating miR-223-3p expression, inhibiting NLRP3 inflammasome activation, and reducing the release of pro-inflammatory cytokines such as IL-1β and IL-18, thereby alleviating depressive symptoms.

关键词

miR-223-3p / NLRP3 / IL-1β / 卒中后抑郁 / “通督治郁”针法

Key words

miR-223-3p / NLRP3 / IL-1β / Post-stroke depression / Tongdu Zhiyu acupuncture

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基金资助

*安徽省高等学校科学研究项目(2024AH050999)

安徽省长三角名医工作室(皖中医药发展秘〔2023〕16号)