The effects and potential molecular mechanisms of acupuncture combined with hyperbaric oxygen in the treatment of dysphagia after stroke

Hehe Chen, Meifei Xu, Feihong Zhu, Yali Pan, Jing Yu, Xiajun Zhang^*

Department of Rehabilitation, Jinhua Central Hospital, Zhejiang Province, Jinhua 321000, Zhejiang, China

Objective: Dysphagia is common after stroke and in relation to increased risk of prolonged hospital stay, poor clinical prognosis, and increased mortality. This study aimed to observe the therapeutic effects and molecular mechanisms of acupuncture combined with hyperbaric oxygen on dysphagia after stroke.

Methods: Dysphagia patients after stroke were randomly divided into control, acupuncture and acupuncture combined with hyperbaric oxygen groups (n=30 each group). After 4 weeks of treatment, swallowing function was assessed by video fluorography (VFG), swallowing-related quality of life (SWAL-QOL) scale and Watian drinking water tests. The rat models of dysphagia after stroke were constructed. Thirty rats were separated into sham operation, model, acupuncture, hyperbaric oxygen, acupuncture combined with hyperbaric oxygen groups (n=6 each group). After treatment for 8 and 16 days, the number of swallows and swallowing response time were examined. Tryptophan hydroxylase (TPH) in brain homogenate and serum substance P (SP) levels were detected via ELISA. After 16 days, cerebral infarct volume was detected via TTC staining and the expression of 5-HT and its subtypes 5-HT1A and 5-HT3 was detected by immunohistochemistry and western blot.

Results: Acupuncture combined with hyperbaric oxygen treatment significantly increased VFG scores and decreased SWAL-QOL scores for dysphagia patients. Furthermore, total effective rate was up to 93.3% in combination treatment group. This combination treatment distinctly increased the number of swallows and lowered swallowing response time for model rats on the 8th and 16th day. The lower infarct volume and higher TPH and SP levels were found in combination group. Also, the combination treatment elevated the expression of 5-HT, 5-HT1A and 5-HT3 in the nucleus of the solitary tract of model rats.

Conclusion: Our data demonstrated that acupuncture combined with hyperbaric oxygen exhibited a good therapeutic effect on dysphagia after stroke, which may be related to the activation of 5-HT pathway.