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| 基于BDNF基因多态性探讨脑卒中患者腿部功能障碍经颅直流电刺激治疗的效果 |
| Exploring the effect of transcranial direct current stimulation therapy on lower limb dysfunction in stroke patients based on BDNF gene polymorphism |
| 投稿时间：2024-06-05 修订日期：2024-06-05 |
| DOI： |
| 中文关键词: 脑源性神经营养因子 Val66Met多态性 脑卒中 腿部功能障碍 经颅直流电刺激 |
| 英文关键词: Brain derived neurotrophic factor Val66Met polymorphism Stroke Lower limb dysfunction Transcranial direct current stimulation |
| 基金项目:西省卫生健康委科研课题计划（2021031B） |
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| 中文摘要: |
| 目的：探讨脑源性神经营养因子（BDNF）Val66Met多态性与脑卒中腿部功能障碍患者经颅直流电刺激（tDCS）治疗效果的联系。方法：研究受试者为2021年2月至2023年3月期间因卒中后偏瘫康复治疗而入住本院的住院患者。所有患者接受相同疗程的tDCS治疗。在三个不同阶段采用腿部Fugl-Meyer评估(FMA)、改良Barthel指数对患者的腿部运动功能进行评估：治疗前、治疗后4周和治疗后8周。收集血样用于分析BDNF多态性和测量BDNF、proBDNF水平。结果：在纳入分析的47例患者中，16例具有met等位基因的患者，纳入Val66Met组，其余31例患者纳入Val66Val组。在治疗4周和8周后，Val66Val组的FMA评分、Barthel指数明显高于Val66Met组（P＜0.05）。两组FMA评分、Barthel指数在治疗4周后显著高于治疗前（P＜0.05），并且在治疗8周后高于治疗4周后（P＜0.05）。两组的血清成熟BDNF水平和成熟BDNF水平与总BDNF水平比率显示了显著的组-时间交互作用（F(组x时间)=4.62、7.43，P=0.037、0.009）。此外，Val66Val组在tDCS治疗后的血清成熟BDNF水平和成熟BDNF水平与总BDNF水平比率显著高于Val66Met组（P < 0.05）。在Val66Val组中，观察到tDCS治疗前后患者血清成熟BDNF水平变化与Barthel指数、FMA评分呈显著正相关（r=0.539、0.585，均P＜0.001）。结论：tDCS可显著促进卒中后偏瘫患者腿部运动功能的恢复，且在卒中恢复阶段tDCS对纯合Val66Val携带者的治疗效果优于Val66Met多态性携带者。 |
| 英文摘要: |
| Objective To explore the relationship between the polymorphism of brain-derived neurotrophic factor (BDNF)Val66Met and the therapeutic effect of transcranial direct current stimulation (tDCS) in stroke patients with lower limb dysfunction. Methods The research subjects were inpatients admitted to our hospital from February 2021 to March 2023 for rehabilitation treatment of hemiplegia after stroke. All patients received the same course of tDCS treatment. The lower limb Fugl-Meyer assessment (FMA) and modified Barthel index were used to assess the patients at three different stages: prior to treatment, 4 weeks after treatment, and 8 weeks after treatment. Blood samples were collected for analysis of BDNF polymorphism and measurement of BDNF and proBDNF levels. Results Among the 47 patients included in the analysis, 16 patients with met allele were included in the Val66Met group, and the remaining 31 patients were included in the Val66Val group. After 4 and 8 weeks of treatment, the FMA score and Barthel index of Val66Val group were significantly higher than those of Val66Met group (P < 0.05). The FMA score and Barthel index of both groups were significantly higher after 4 weeks of treatment than that before treatment (P < 0.05), and the scores after 8 weeks of treatment were significantly higher than those after 4 weeks after treatment (P < 0.05). Serum mature BDNF level and the ratio of mature BDNF level to total BDNF level showed significant group-time interaction (f (group x time) =4.62, 7.43, P=0.037, 0.009). In addition, the serum mature BDNF level and the ratio of mature BDNF level to total BDNF level in Val66Val group after tDCS treatment were significantly higher than those in Val66Met group (P < 0.05). In Val66Val group, it was observed that the changes of serum mature BDNF level were positively correlated with Barthel index and FMA score before and after tDCS treatment (r=0.539, 0.585, all P < 0.001). Conclusions tDCS can significantly promote the recovery of lower limb motor function in hemiplegic patients after stroke, and its therapeutic effect on homozygous Val66Val carriers is better than that of Val66Met polymorphic carriers during the stroke recovery stage. |
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