Essa H, Vasant D H, Raginis-Zborowska A, Payton A, Michou E, Hamdy S
University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
School of Health Sciences, Division of Human Communication, Development & Hearing, The University of Manchester, Manchester, UK.
Neurogastroenterol Motil. 2017 Aug;29(8). doi: 10.1111/nmo.13062. Epub 2017 Mar 20.
The aim of this study was to explore the effect of brain-derived neurotrophic factor (BDNF) polymorphism rs6265 (Val66Met) in both "natural" and treatment induced recovery of swallowing after dysphagic stroke.
Sixteen dysphagic stroke patients that completed a single-blind randomized sham controlled trial of pharyngeal electrical stimulation (PES) within 6 weeks of their stroke (N=38), were genotyped for the BDNF SNP Val66Met (rs6265) from saliva samples. These patients received active or sham PES according to randomized allocation. PES was delivered at a set frequency (5 Hz), intensity (75% of maximal tolerated), and duration (10 minutes) once a day for three consecutive days. Clinical measurements were taken from patients at baseline, 2 weeks and 3 months post entering the study. Changes in swallowing ability based on the dysphagia severity rating scale (DSRS) were compared between active and sham groups and associated with BDNF SNP status.
In the active stimulation group, patients with the Met BDNF allele demonstrated significantly greater improvements in DSRS at 3 months compared to patients homozygous for the Val allele (P=.009). By comparison, there were no significant associations at the 2 week stage in either the active or sham group, or at 3 month in the sham group. Functional scores including the Barthel Index and modified Rankin scale were also unaffected by BDNF status.
CONCLUSIONS & INFERENCES: Our findings suggest an association between BDNF and stimulation induced swallowing recovery. Further work will be required to validate these observations and demonstrate clinical utility in patients.
本研究旨在探讨脑源性神经营养因子（BDNF）基因多态性rs6265（Val66Met）在吞咽困难性中风“自然”恢复及治疗诱导恢复过程中的作用。
16例吞咽困难性中风患者在中风后6周内完成了一项关于咽部电刺激（PES）的单盲随机假对照试验（N = 38），从唾液样本中对BDNF单核苷酸多态性Val66Met（rs6265）进行基因分型。这些患者根据随机分配接受主动或假PES治疗。PES以设定频率（5Hz）、强度（最大耐受量的75%）和持续时间（10分钟）每天进行一次，连续三天。在患者进入研究的基线、2周和3个月时进行临床测量。比较主动组和假手术组基于吞咽困难严重程度评分量表（DSRS）的吞咽能力变化，并与BDNF单核苷酸多态性状态相关联。
在主动刺激组中，与Val等位基因纯合子患者相比，携带Met BDNF等位基因的患者在3个月时DSRS改善更为显著（P = 0.009）。相比之下，在主动组或假手术组的2周阶段以及假手术组的3个月时均无显著关联。包括Barthel指数和改良Rankin量表在内的功能评分也不受BDNF状态的影响。
我们的研究结果表明BDNF与刺激诱导的吞咽恢复之间存在关联。需要进一步开展工作来验证这些观察结果并证明其在患者中的临床实用性。
