| Objective:1.A meta-analysis was conducted on the study of acupuncture combined with rehabilitation training in the treatment of post-stroke depression to find the evidence-based medical basis of acupuncture combined with rehabilitation training in the treatment of post-stroke depression.2.A randomized controlled trial was conducted to set up an soothing-liver and regulating-mentality acupuncture integrated plan group and a placebo control group.The efficacy and safety of soothing-liver and regulating-mentality acupuncture integrated plan in the treatment of post-stroke depressive disorder will be evaluated by HAMD-24,NIHSS,MBI and other indicators.3.Based on the hypothesis of cholinergic imbalance in depression,magnetic resonance spectroscopy(MRS)was used to explore the effect of soothing-liver and regulating-mentality acupuncture integrated planon post-stroke depressive disorder by regulating choline levels.Methods:1.Literature researchRandomized controls on acupuncture combined with rehabilitation training in the treatment of post-stroke depressive disorder were searched from cnKI,Wanfang Database,China Biomedical Literature CD-ROM database,VIP Chinese Scientific and technical journal database,Pubmed,Embase,Cochrane Clinical Controlled Trial Center,and other databases from the establishment of the database to August 2021.Quality evaluation and meta-analysis were conducted to evaluate the clinical efficacy of acupuncture combined with rehabilitation training in treating post-stroke depressive disorder.(1)Retrieval strategies:The Chinese retrieval formulas were(acupuncture or acupuncture)and(rehabilitation training or rehabilitation treatment)and(post-stroke depression or post-stroke depression);The English search criteria were(Acupuncture or needling)and(Rehabilitation)and(Post-stroke depression or depression after stroke),which were adjusted according to different databases.(2)Literature screening,quality evaluation,and statistical analysis:Two researchers independently conducted literature screening,risk assessment using Cochrane HandBook 5.2.0 risk assessment tool,meta-analysis using Review Managers 5.2 software package.Disputes arising in literature processing shall be decided through consultation with a third researcher.2.Clinical trials2.1 Magnetic resonance spectrum analysis of post-stroke depressive disorder and post-stroke non-depression(1)Grouping and observation index collection:14 patients with post-stroke depressive disorder and 14 patients with post-stroke non-depression were enrolled,and indicators were collected by Philips Ingenia 3.0T MAGNETIC resonance head device:Cho/Cr and NAA/Cr.(2)Statistical analysisSPSS 20.0 software was used to complete the statistical analysis.Measurement data are expressed.A two-sided test was used for the statistical test,and P<0.05 was considered statistically significant.2.2 Clinical study on soothing-liver and regulating-mentality acupuncture integrated plan in the treatment of post-stroke depression.(1)Grouping and blind method:60 patients with post-stroke depression disorder who met the inclusion criteria were divided into two groups according to the ratio of 1:1 and the random numbers produced by SPSS20.0 software:soothing-liver and regulating-mentality acupuncture integrated plan group and placebo control group,with 30 patients in each group.Blind patients and evaluators of curative effect.(2)Intervention measures①Basic treatment:All subjects received routine treatment for underlying stroke diseases and standardized rehabilitation intervention.②soothing-liver and regulating-mentality acupuncture integrated plan group:Acupoint selection:Body acupuncture:Baihui,Yintang,Hegu(double),Taichong(double),Zhongwan,Xiawan,Qihai,Guan Yuan,Shenmen(double);Intradermal needle:Xinshu,Ganshu,Jueyinshu(alternating left and right).Operation method:body acupuncture:the doctor will first finger and acupoint skin disinfection,stick the needle seat sleeve,needle into the needle seat sleeve,Pierce the skin,twist,lift and intervene method to acupuncture local acid hemp pain as degree,after the completion of the needle,ask the patient to breathe deeply through the nose.First,Hegu,Taichong,and Shenmen were needled,then Baihui and Yintang were needled,and Zhong wan,Xiawan,Qihai,and Guanyuan were needled for 30 minutes,once a day,five times a week.Intradermal needle:the doctor first disinfected the skin on the finger and acupoint,then pricked the granular intradermal needle flat into the acupoint,pricked it towards the spine,and covered it with adhesive tape.The needle was retained for three days,twice a week.③Placebo control groupAcupoint selection:acupoint selection and soothing-liver and regulating-mentality acupuncture integrated plan group.Operation method:body acupuncture,the doctor will first finger and acupoints in skin disinfection,glue needle casing,after the needle into the needle seat cover tube,shi pin on the subjects on the skin,but not to Pierce the skin.First,Hegu,Taichong,and Shenmen were needled,then Baihui and Yintang were needled,and Zhong wan,Xiawan,Qihai,and Guanyuan were needled for 30 minutes,once a day,five times a week.Comfort intradermal needle:the doctor first disinfected the fingers and the skin on the acupoint,put the tadpole-type intradermal needle on the acupoint part,pricked it to the spine,and then covered it with adhesive tape.The needle was retained for three days,twice a week.④Treatment course:8 weeks.(3)Observe time points and indicatorsObservation points:0,8,and 12 weeksOutcome measures:HAMD-24,NIHSS,MBI,Cho/Cr,NAA/Cr.(4)Statistical analysisSPSS 20.0 software was used to complete the statistical analysis.The measurement data were expressed.Two independent samples t-test or rank-sum tests were used for pial comparison between groups.Matched T-test was used for intra-group comparison before and after treatment.Repeated measures ANOVA was used to measure data at multiple time points.The counting data were represented by composition ratio,ratio,chi-square test(or Fisher’s exact probability method).Cho/Cr and NAA/Cr were analyzed with HAND,respectively.A two-sided test was used for the statistical test,and P<0.05 was considered statistically significant.Results:1.Literature researchTwo hundred seventy-one related studies were retrieved,including 262 Chinese and 9 English studies.Finally,nine studies were included for analysis,involving 811 cases.Meta-analysis results showed that:The results showed statistical homogeneity(X~2=2.68,P=0.61,I~2=0%).The fixed-effect model was used for analysis,OR=3.08,95%CI[1.86,5.03],Z=4.51,P<0.001.Therefore,acupuncture combined with rehabilitation training is superior to 5-HT reuptake inhibition antidepressant combined with rehabilitation training in improving 24-HAMD reduction rates in stroke patients.(2)HAMD reduction rate of 17 items in 3 studies,17-HAMD reduction rates were used,and the results were statistically homogeneity(X~2=2.24,P=0.69,P=0%).Fixed effect model analysis showed that OR=1.69,95%CI[,0.76,3.65],Z=1.28.P=0.20.Therefore,acupuncture combined with rehabilitation training is comparable to 5-HT reuptake inhibition antidepressant combined with rehabilitation training in improving the HAMD reduction rate of 17 items in stroke patients.(3)Evaluation of the degree of neurological impairment In the two studies,the scores of clinical neurological impairment in stroke patients were statistically heterogeneous(X~2=2.95,P=0.09,I~2=66%),and the random effect model,MD=-1.93,conducted a meta-analysis.95%C I-2.93,0.94],Z=3.80,P<0.001).Therefore,acupuncture combined with rehabilitation training is superior to 5-HT reuptake inhibition antidepressant and rehabilitation training in improving neurological impairment of patients with post-stroke depression.2.Clinical research2.1 Magnetic resonance spectrum analysis of changes in cerebral metabolites in post-stroke depressive disorder and non-depressed patientsA total of 28 patients were included in this study,including 14 patients with post-stroke depression and 14 patients without post-stroke depression.(1)Comparison of baseline dataT-test or Chi-square comparison of general information,such as the age of onset,course of the disease,gender,and nature of stroke,showed no statistical difference between the two groups(P>0.05).(2)The HAMD score of the poststroke depression group was higher than that of the non-depressed group,with a statistical difference(P<0.001).(3)Cho/Cr comparison between the two groupsThe Cho/Cr on the left side of the PTSD group was higher than that of the non-DEPRESSION group,with a statistical difference(P=0.001).The right Cho/Cr of the PTSD group was higher than that of the non-depression group,and the difference was statistically significant(P<0.001).(3)NAA/Cr comparison between the two groupsNAA/Cr on the left side of the PTSD group was lower than that of the non-depression group,with no statistical difference(P=0.069).The right NAA/Cr of the PTSD group was lower than that of the non-depression group,and there was no statistical difference(P=0.059).2.2 Clinical study on the treatment of poststroke depression with soothing-liver and regulating-mentality acupuncture integrated planA total of 58 effective cases were included in this study,including 2 patients in the soothing-liver and regulating-mentality acupuncture integrated plan group and 29 patients in the placebo control group.There were no statistical differences between the two groups in age,nature,stroke nature,and disease course(P>0.05).(1)Comparison of HAMD scores between the two groups before and after treatmentComparison between groups:Before treatment,there was no statistical difference in HAMD score between the soothing-liver and regulating-mentality acupuncture integrated plan and placebo groups(P=0.900),indicating comparability.At eight weeks,the HAMD score in both groups was lower than that before treatment,but the HAMD score in the soothing-liver and regulating-mentality acupuncture integrated plan group was more significant than that in the placebo group(P<0.001).At 12 weeks,THE HAMD scores of the two groups were further reduced,and those of the soothing-liver and regulating-mentality acupuncture integrated plan group were more significant than those of the placebo group(P<0.001).Intra-group comparison:HAMD score of the soothing-liver and regulating-mentality acupuncture integrated plan group at eight weeks was significantly lower than that before treatment(P<0.001);the HAMD score at 12 weeks was significantly lower than that at eight weeks P<0.05).The HAMD score of the placebo group at eight weeks was considerably lower than that before treatment(P<0.001).HAMD score at week 12 was significantly lower than that at week 8(P<0.001).(2)Comparison of NIHSS scores between the two groups before and after treatmentComparison between groups:Before treatment,there was no statistical difference in NIHSS score between the soothing-liver and regulating-mentality acupuncture integrated plan and placebo groups(P=0.431),indicating comparability.At eight weeks,NIHSS scores in both groups were lower than before treatment,and there was no statistical difference between the two groups(P=0.438).At 12 weeks,the two groups showed a downward trend compared with eight weeks,and there was no statistical difference between the two groups(P=0.178).Intra-group comparison:NIHSS score of the soothing-liver and regulating-mentality acupuncture integrated plan group at eight weeks was significantly lower than that before treatment(P<0.001);the NIHSS score at 12 weeks was significantly lower than that at eight weeks(P<0.001).The HAMD score of the placebo group at eight weeks was considerably lower than that before treatment(P<0.001).HAMD score at 12 weeks was significantly lower than that at eight weeks(P<0.05).(3)Comparison of MBI scores between the two groups before and after treatmentRepeated measurement ANOVA was used to compare the two groups at 3-time points.Spherical test results showed Mauchly W=0.503,significance P<0.001.which did not conform to the spherical test.The calibration results in the univariate ANOVA"greenhouse-Geisser" were taken as the criterion,and the results showed:A.The main effect of group F=9.013,P=0,004,η 2=0.139 was significant.The MBI score of the soothing-liver and regulating-mentality acupuncture integrated plan group was higher than that of the comfort acupuncture group.B.The main effect of measuring time was significant,F=289.117,P<0.001,η2=0.838;The difference in MBI score at the three-time points was statistically significant.C.The interaction effect between time and group was not significant(F=1.286,P=0.272,η2=0.0224),indicating that the interaction effect between time and group was not statistically significant.D.MBI scores in both groups showed a significant upward trend at 8 weeks and 12 weeks.(4)Comparison of Cho/Cr and NAA/Cr between the two groupsBefore treatment,there was no significant difference in Cho/Cr on the left side between the soothing-liver and regulating-mentality acupuncture integrated plan group and the placebo group(P=0.402).After treatment,Cho/Cr on both sides of the soothing-liver and regulating-mentality acupuncture integrated plan group and the placebo control group were lower than before treatment.The Cho/Cr in the soothing-liver and regulating-mentality acupuncture integrated plan group was lower than that in the placebo group.The difference was statistically significant(P=0.015).Before treatment,there was no significant difference in Cho/Cr on the right side between the soothing-liver and regulating-mentality acupuncture integrated plan group and the placebo group(P=0.504).After treatment,Cho/Cr on both sides of the soothing-liver and regulating-mentality acupuncture integrated plan and moxibustion group was lower than before treatment.The Cho/Cr in the soothing-liver and regulating-mentality acupuncture integrated plan and moxibustion group was lower than in the placebo group.The difference was statistically significant(P=0.038).Before treatment,NAA/Cr on the left side of the soothing-liver and regulating-mentality acupuncture integrated plan group and the placebo group had no statistical significance(P=0.437).After treatment,NAA/Cr on both sides of the soothing-liver and regulating-mentality acupuncture integrated plan and placebo groups increased compared with before treatment.Still,there was no statistical significance between the two groups(P=0.733).Before treatment,there was no significant difference in NAA/Cr between the soothing-liver and regulating-mentality acupuncture integrated plan group and the placebo group(P=0.200).NAA/Cr on both sides of the soothing-liver and regulating-mentality acupuncture integrated plan and placebo groups increased after treatment,but there was no statistical significance between the two groups(P=0.669).(5)Correlation between Cho/Cr、Naa/Cr and HAMD scoreThe correlation between Cho/Cr,Naa/Cr,and HAMD in 12 patients with soothing-liver and regulating-mentality acupuncture integrated plan was analyzed.The correlation coefficient between the difference before and after Cho/Cr treatment and the difference before and after HAMD treatment was 0.603,P=0.038,indicating a correlation between the two.The correlation coefficient between the difference before and after Cho/Cr treatment and the difference before and after HAMD treatment was 0.608,P=0.036,indicating a correlation between the two.The correlation coefficient between the difference of left Naa/Cr before and after treatment and that of HAMD before and after treatment was-0.095,P=0.768,indicating no correlation between the two.The correlation coefficient between the difference of left Naa/Cr before and after treatment and that of HAMD before and after treatment was 0.306,P=0.333,indicating no correlation between the two.(5)Safety observation:No obvious adverse reactions.Conclusion:1.Through a systematic evaluation study,it is suggested that acupuncture combined with rehabilitation therapy has good efficacy in the treatment of stroke depression;2.soothing-liver and regulating-mentality acupuncture integrated plan treatment for post-stroke depressive disorder has good efficacy and safety;3.soothing-liver and regulating-mentality acupuncture integrated plan and moxibustion can achieve anti-stroke depressive disorder by down-regulating choline levels. |
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