针药结合治疗抑郁症的临床疗效观察及对P300的影响
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摘要
研究目的：本研究旨在探讨观察抑郁症患者服用5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)的同时,进行针刺督脉经穴为主的针药结合治疗与单纯西药治疗进行比较,寻找治疗抑郁症的有效方法及提高其治疗效果,探讨督脉调神法在抑郁症治疗中的作用,针药结合治疗抑郁症的疗效及优势。同时从认知及内分泌学的角度来探讨针药结合治疗抑郁症的疗效,以期拓宽针药结合治病的临床应用范围。
研究方法：将60例患者随机编码分成单纯西药组(30例)和针药结合组(30例)两组。单纯西药组(对照组)：口服选择性5-HT再摄取抑制剂(SSRIs)类抗抑郁症药物,共服6周。针药结合组(治疗组)：在对照组治疗的基础上针刺百会、印堂、风府、大椎、风池(双侧)、内关(双侧)、三阴交(双侧),隔日针刺1次,1周治疗3次,共针刺治疗6周。随证配穴：肝气郁结加太冲；肝郁痰阻加丰隆、太冲；心脾两虚加足三里、脾俞；肝肾阴虚加太溪、肝俞、肾俞。治疗组和对照组都治疗6周,6周后总结、统计并比较二组的疗效。
目前,抑郁症治疗以西药抗抑郁为主,抗抑郁症药能改善患者的症状,但不能预防其复发,并有较多的毒副作用,如眩晕、头痛、失眠、紧张、激动、焦虑、恶心、呕吐、口干、消化不良和腹泻；也可见有厌食、体重减轻、倦怠、失眠、颤抖、惊厥和性欲减退及性功能障碍等,长期服用可能会损害肠胃功能及肝肾功能,致患者难以坚持服药,服药时间长还有一定的依赖性。
(1)治疗组痊愈、显效率优于对照组(p<0.05)。治疗组愈、显率比对照组高26.75%。
(2)治疗组疗效优于对照组。治疗6周后,汉密尔顿量表(HAMD)评分比较有统计意义(p<0.05)。其中对焦虑/躯体症状、睡眠情况改善优于单纯西药治疗。
(3)针药结合治疗抑郁症患者的自觉症状及睡眠情况均优于单纯西药治疗。抑郁自评量表(SDS)、匹兹堡睡眠质量指数评定量表(PSQI)评定结果显示,治疗后针药结合组较单纯西药组有显著性差异(p<0.05)。
(4)针刺具有减轻西药治疗抑郁症的毒副反应的作用。Asberg副作用量表(SERS)评定结果显示,5-羟色胺再摄取抑制剂药物的副作用在治疗6周后,两组有明显差异(p<0.05)。
(5)针药结合能改善抑郁症患者的认知功能P3波。事件相关电位P300在治疗后,两组同期P3潜伏期及波幅有统计意义(p<0.05)。
(6)针药结合治疗能提高甲状腺功能TSH水平。甲状腺功能检测在治疗后,两组同期的TSH有统计意义(p<0.05)。
1、针药结合治疗抑郁症的疗效优于单纯西药治疗。
2、针药结合能更好的改善焦虑和躯体等症状且起效早,优于单纯西药治疗。
3、针药结合既是一种能提高治疗抑郁症疗效、又可减轻西药副作用的理想方法。
4、针药结合能改善患者认知功能波P3的作用。
5、针药结合能改善甲状腺功能TSH水平。
This research's aim was to observe and discuss the effects on depression patients, who was administrated Selective Serotonin Reuptake Inhibitors (SSRIs antidepressants), while simultaneously being treated with acupuncture. To search for and further improve treatment for depression syndrome, combined conventional medicinal treatment and acupuncture, mainly to points of the Governor Vessel (GV/Dumai), was compared to singular medicinal treatment. Analysis and discussions of data was made to clarify the mental regulating effects of Governor Vessel to depression patients, considering possibly beneficial tendencies of combined medicinal and acupuncture treatment to depression patients. To expand the clinical value of this combined treatment and its therapeutic range, discussions from established knowledge and endocrinological viewpoints was added to its analysis.
60 included patients were randomly divided into groups of singular medicinal treatment (30 patients) and combined acupuncture and medicinal treatment group (30 patients). Patients in the singular conventional medicinal (control group) was orally administrated SSRIs antidepressants, over a 6 weeks period. Patients in the group of combined acupuncture and medicinal treatment (treatment group), was given acupuncture to Baihui/GV20, Yintang/EX-HN3, Fengfu/GV16, Fengchi/GB20 (bilaterally), Dazhui/GV14, Neiguan/PC6 (bilaterally), Sanyinjiao/SP6 (bilaterally). This formula was punctured 1 time/2 days,3times/week, treatment was given for 6 weeks. In addition, the treatment group was given acupuncture according to Chinese Medicine patterns with following standard:Heart & Spleen deficiency,+Zusanli/ST36; Liver Qi stagnation,+Taichong/LR3; Disturbance of toxic phlegm-heat,+Fenglong/ST40+Taichong/LR3; Yin deficiency with flaring up of fire,+Taixi/KI3+Ganshu/BL19+Shenshu/BL23. Each group was treated for 6 weeks, then summarizing both groups'results and statistically analyse them.
Presently, depression syndrome is mainly treated with conventional western medicine, where as antidepressants can positively change these patients symptoms. But still this media does not prevent reoccurrence and multiple side-effects like, dizziness, headache, insomnia, nervousness, overexcitement, pensiveness, nausea, vomiting, dry mouth, impaired digestion and diarrhoea; also reported are:anorexia, weight loss, fatigue, trembling, faint from fear, decreased libido and sexual dysfunction, etc. Long term administration might injure and impair the functions of GI-tractus, Live and Kidney, making administration of medicine difficult. Patients can also develop dependence upon antidepressants, from long-term usage.
a. Complete recovery rate in the treatment group of combined acupuncture and medication group, is distinctively higher than in the control group of singular medication (P<0.05). The number of completely recovered patients in the treatment group, exceeded the control group with 26.7%.
b. A comparison of scores, according to Hamilton Depression Scale (HAMD), expressed superior treatment results in the treatment group, reaching statistical significance (P<0.05)
c. Symptoms of disturbed sleep showed superior improvements in the treatment group compared to the control group. Quantifying treatment results according to Self-rating Depression Scale (SDS) & Pittsburgh Sleep Quality Index (PSQI) showed statistically significant differences (P<0.05), suggesting combined medicinal and acupuncture treatment express better results than singular medicinal treatment.
d. Acupuncture can relieve and minimize the side-effects of antidepressants in treatment of depression syndrome. According to measurements made with the Asberg Rating Scale for Side Effects (SERS), there was a statistically significant difference between the two groups in side-effects from Selective Serotonin Reuptake Inhibitors, after 6 weeks treatment (P<0.05).
e. Combined acupuncture and medication, can improve the cognitive functions of depression patients. Post treatment testing of patients in both groups using Event-Related Electrical Potential P300,show statistically significant treatment results with amplitude and latency period P3 (P<0.05).
f. Combined acupuncture and medicinal treatment can elevate a hypo-condition of TSH. Thyroid gland functional tests before and after treatment, showed statistical significance for both treatment and control group testing TSH (P<0.05).
1. Combined treatment with acupuncture and antidepressant medication is superior to singular antidepressant medical treatment.
2. Treatment with combined antidepressant administration and acupuncture, can further improve conditions of anxiety and organic symptoms, while further promote or substitute, what western medical antidepressants are deficient in.
3. Combined acupuncture and medical treatment can further improve treatment of depression syndrome, while it's an ideal method for reducing western medicine's side-effects.
4. Combined acupuncture and medical treatment has the positive effect of the P3 cognitive functions of depression patients.
5. Combined acupuncture and medical treatment can elevate a hypo-condition of TSH.
研究方法：将60例患者随机编码分成单纯西药组(30例)和针药结合组(30例)两组。单纯西药组(对照组)：口服选择性5-HT再摄取抑制剂(SSRIs)类抗抑郁症药物,共服6周。针药结合组(治疗组)：在对照组治疗的基础上针刺百会、印堂、风府、大椎、风池(双侧)、内关(双侧)、三阴交(双侧),隔日针刺1次,1周治疗3次,共针刺治疗6周。随证配穴：肝气郁结加太冲；肝郁痰阻加丰隆、太冲；心脾两虚加足三里、脾俞；肝肾阴虚加太溪、肝俞、肾俞。治疗组和对照组都治疗6周,6周后总结、统计并比较二组的疗效。
目前,抑郁症治疗以西药抗抑郁为主,抗抑郁症药能改善患者的症状,但不能预防其复发,并有较多的毒副作用,如眩晕、头痛、失眠、紧张、激动、焦虑、恶心、呕吐、口干、消化不良和腹泻；也可见有厌食、体重减轻、倦怠、失眠、颤抖、惊厥和性欲减退及性功能障碍等,长期服用可能会损害肠胃功能及肝肾功能,致患者难以坚持服药,服药时间长还有一定的依赖性。
(1)治疗组痊愈、显效率优于对照组(p<0.05)。治疗组愈、显率比对照组高26.75%。
(2)治疗组疗效优于对照组。治疗6周后,汉密尔顿量表(HAMD)评分比较有统计意义(p<0.05)。其中对焦虑/躯体症状、睡眠情况改善优于单纯西药治疗。
(3)针药结合治疗抑郁症患者的自觉症状及睡眠情况均优于单纯西药治疗。抑郁自评量表(SDS)、匹兹堡睡眠质量指数评定量表(PSQI)评定结果显示,治疗后针药结合组较单纯西药组有显著性差异(p<0.05)。
(4)针刺具有减轻西药治疗抑郁症的毒副反应的作用。Asberg副作用量表(SERS)评定结果显示,5-羟色胺再摄取抑制剂药物的副作用在治疗6周后,两组有明显差异(p<0.05)。
(5)针药结合能改善抑郁症患者的认知功能P3波。事件相关电位P300在治疗后,两组同期P3潜伏期及波幅有统计意义(p<0.05)。
(6)针药结合治疗能提高甲状腺功能TSH水平。甲状腺功能检测在治疗后,两组同期的TSH有统计意义(p<0.05)。
1、针药结合治疗抑郁症的疗效优于单纯西药治疗。
2、针药结合能更好的改善焦虑和躯体等症状且起效早,优于单纯西药治疗。
3、针药结合既是一种能提高治疗抑郁症疗效、又可减轻西药副作用的理想方法。
4、针药结合能改善患者认知功能波P3的作用。
5、针药结合能改善甲状腺功能TSH水平。
This research's aim was to observe and discuss the effects on depression patients, who was administrated Selective Serotonin Reuptake Inhibitors (SSRIs antidepressants), while simultaneously being treated with acupuncture. To search for and further improve treatment for depression syndrome, combined conventional medicinal treatment and acupuncture, mainly to points of the Governor Vessel (GV/Dumai), was compared to singular medicinal treatment. Analysis and discussions of data was made to clarify the mental regulating effects of Governor Vessel to depression patients, considering possibly beneficial tendencies of combined medicinal and acupuncture treatment to depression patients. To expand the clinical value of this combined treatment and its therapeutic range, discussions from established knowledge and endocrinological viewpoints was added to its analysis.
60 included patients were randomly divided into groups of singular medicinal treatment (30 patients) and combined acupuncture and medicinal treatment group (30 patients). Patients in the singular conventional medicinal (control group) was orally administrated SSRIs antidepressants, over a 6 weeks period. Patients in the group of combined acupuncture and medicinal treatment (treatment group), was given acupuncture to Baihui/GV20, Yintang/EX-HN3, Fengfu/GV16, Fengchi/GB20 (bilaterally), Dazhui/GV14, Neiguan/PC6 (bilaterally), Sanyinjiao/SP6 (bilaterally). This formula was punctured 1 time/2 days,3times/week, treatment was given for 6 weeks. In addition, the treatment group was given acupuncture according to Chinese Medicine patterns with following standard:Heart & Spleen deficiency,+Zusanli/ST36; Liver Qi stagnation,+Taichong/LR3; Disturbance of toxic phlegm-heat,+Fenglong/ST40+Taichong/LR3; Yin deficiency with flaring up of fire,+Taixi/KI3+Ganshu/BL19+Shenshu/BL23. Each group was treated for 6 weeks, then summarizing both groups'results and statistically analyse them.
Presently, depression syndrome is mainly treated with conventional western medicine, where as antidepressants can positively change these patients symptoms. But still this media does not prevent reoccurrence and multiple side-effects like, dizziness, headache, insomnia, nervousness, overexcitement, pensiveness, nausea, vomiting, dry mouth, impaired digestion and diarrhoea; also reported are:anorexia, weight loss, fatigue, trembling, faint from fear, decreased libido and sexual dysfunction, etc. Long term administration might injure and impair the functions of GI-tractus, Live and Kidney, making administration of medicine difficult. Patients can also develop dependence upon antidepressants, from long-term usage.
a. Complete recovery rate in the treatment group of combined acupuncture and medication group, is distinctively higher than in the control group of singular medication (P<0.05). The number of completely recovered patients in the treatment group, exceeded the control group with 26.7%.
b. A comparison of scores, according to Hamilton Depression Scale (HAMD), expressed superior treatment results in the treatment group, reaching statistical significance (P<0.05)
c. Symptoms of disturbed sleep showed superior improvements in the treatment group compared to the control group. Quantifying treatment results according to Self-rating Depression Scale (SDS) & Pittsburgh Sleep Quality Index (PSQI) showed statistically significant differences (P<0.05), suggesting combined medicinal and acupuncture treatment express better results than singular medicinal treatment.
d. Acupuncture can relieve and minimize the side-effects of antidepressants in treatment of depression syndrome. According to measurements made with the Asberg Rating Scale for Side Effects (SERS), there was a statistically significant difference between the two groups in side-effects from Selective Serotonin Reuptake Inhibitors, after 6 weeks treatment (P<0.05).
e. Combined acupuncture and medication, can improve the cognitive functions of depression patients. Post treatment testing of patients in both groups using Event-Related Electrical Potential P300,show statistically significant treatment results with amplitude and latency period P3 (P<0.05).
f. Combined acupuncture and medicinal treatment can elevate a hypo-condition of TSH. Thyroid gland functional tests before and after treatment, showed statistical significance for both treatment and control group testing TSH (P<0.05).
1. Combined treatment with acupuncture and antidepressant medication is superior to singular antidepressant medical treatment.
2. Treatment with combined antidepressant administration and acupuncture, can further improve conditions of anxiety and organic symptoms, while further promote or substitute, what western medical antidepressants are deficient in.
3. Combined acupuncture and medical treatment can further improve treatment of depression syndrome, while it's an ideal method for reducing western medicine's side-effects.
4. Combined acupuncture and medical treatment has the positive effect of the P3 cognitive functions of depression patients.
5. Combined acupuncture and medical treatment can elevate a hypo-condition of TSH.
引文
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