摘要
目的基于脑源性神经营养因子(BDNF)-环磷腺苷效应元件结合蛋白(CREB)信号通路,探讨中医推拿联合常规康复训练治疗儿童孤独症的临床疗效及潜在作用机制。方法选取2022年5月—2024年8月郑州大学第五附属医院收治的100例儿童孤独症患者,采用随机数字表法分为对照组(n=50,常规康复训练)和观察组(n=50,常规康复训练+中医推拿)。推拿方案依据“心主神明”“肾藏精”理论,选取头面部(百会、四神聪)、上肢(脾经、肝经)、胸腹部(中脘)、下肢(涌泉、足三里)等穴位进行干预。采用孤独症行为量表(ABC)和儿童孤独症评定量表(CARS)评估临床症状改善情况,酶联免疫吸附试验(ELISA)检测血清BDNF、CREB及磷酸化CREB(p-CREB)蛋白表达水平。结果观察组总有效率(94.0%)显著优于对照组(76.0%),(P<0.05)。治疗后,两组ABC、CARS评分均显著降低(P<0.05),且观察组下降幅度大于对照组(P<0.05)。ELISA检测显示,观察组血清BDNF(156.87±18.35)pg/mL vs.(89.63±12.47)pg/mL、CREB(215.76±20.42)pg/mL vs.(126.54±15.73)pg/mL及p-CREB(197.68±31.45)pg/mL vs.(113.56±25.12)pg/mL表达水平均显著优于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论中医推拿联合常规康复训练可显著改善儿童孤独症患者的临床症状,其机制可能与上调BDNF-CREB信号通路关键蛋白表达、促进神经可塑性调节有关。本研究为中医外治法治疗孤独症提供了理论依据和临床参考。
Objective To investigate the clinical efficacy and potential mechanism of traditional Chinese medicine(TCM)massage combined with conventional rehabilitation training in the treatment of childhood autism based on the brain-derived neurotrophic factor(BDNF)-cAMP response element-binding protein(CREB)signaling pathway.Methods A total of 100 children with autism admitted to the Fifth Affiliated Hospital of Zhengzhou University from May 2022 to August 2024 were randomly divided into a control group(n=50,conventional rehabilitation training)and an observation group(n=50,conventional rehabilitation training+TCM massage).The massage protocol was designed based on TCM theories such as"the heart governs the mind"and"the kidney stores essence,"targeting specific acupoints including Baihui(GV20),Sishencong(EX-HN1)on the head and face,spleen and liver meridians on the upper limbs,Zhongwan(CV12)on the chest and abdomen,and Yongquan(KI1)and Zusanli(ST36)on the lower limbs.The Autism Behavior Checklist(ABC)and Childhood Autism Rating Scale(CARS)were used to assess clinical symptom improvement,while serum levels of BDNF,CREB,and phosphorylated CREB(p-CREB)were measured using enzyme-linked immunosorbent assay(ELISA).Results The total effective rate in the observation group(94.0%)was significantly higher than that in the control group(76.0%),(P<0.05).After treatment,both groups showed significant reductions in ABC and CARS scores(P<0.05),with a greater decrease in the observation group(P<0.05).ELISA results demonstrated that serum levels of BDNF(156.87±18.35 pg/mL vs.89.63±12.47 pg/mL),CREB(215.76±20.42 pg/mL vs.126.54±15.73 pg/mL),and p-CREB(197.68±31.45 pg/mL vs.113.56±25.12 pg/mL)were significantly higher in the observation group(P<0.05).No significant difference in adverse reaction rates was observed between the two groups(P>0.05).Conclusion TCM massage combined with conventional rehabilitation training significantly improves clinical symptoms in children with autism,potentially through upregulation of key proteins in the BDNF-CREB signaling pathway and promotion of neural plasticity.This study provides theoretical and clinical evidence for the application of TCM external therapies in autism treatment.
作者
盛自勉
张丽娜
SHENG Zimian;ZHANG Lina(The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 50000,Henan,China)
出处
《实用中医内科杂志》
2025年第8期136-140,共5页
Journal of Practical Traditional Chinese Internal Medicine
基金
河南省医学科技攻关计划项目(LHGJ20220977)。
关键词
中医外治法
推拿
BDNF-CREB信号通路
儿童孤独症
临床疗效
Traditional Chinese medicine external therapy
Massage
BDNF-CREB signaling pathway
Childhood autism
Clinical efficacy
