团体归因治疗与选择性5-羟色胺回收抑制剂对血浆脑源性神经营养因子的作用  

Attributable retraining group therapy versus selective serotonin reuptake inhibitors:effect on plasma brain-derived neurotrophic factor

作　　者：王纯[1,2] 马辉[1] 张宁[1] 张亚林[2] 张婕[1,3] 杨华[1] 武欣[1] 李箕君[1] 

机构地区：[1]南京医科大学附属脑科医院医学心理科,210029 [2]中南大学湘雅二医院精神卫生研究所 [3]山东科技大学心理咨询中心

出　　处：《临床精神医学杂志》2011年第3期152-155,共4页Journal of Clinical Psychiatry

基　　金：江苏省自然科学基金(BK2008083);南京市医学科技发展青年基金项目(QYK09184);南京医科大学科技发展基金面上项目(09NJMUM127)

摘　　要：目的:比较团体归因治疗(ARGT)与选择性5-羟色胺回收抑制剂(SSRI)对抑郁症、焦虑症、强迫症患者血浆脑源性神经营养因子(BDNF)的作用。方法:采用ARGT与SSRI对照的前瞻性干预研究设计,根据就诊顺序将129例门诊患者(其中抑郁症45例、焦虑症45例、强迫症39例)分至ARGT组63例(其中抑郁症21例、焦虑症23例、强迫症19例)和SSRI组66例(其中抑郁症24例、焦虑症22例、强迫症20例)。ARGT组有54例、SSRI组有55例完成研究。于治疗前和治疗8周后通过24项汉密尔顿抑郁量表、汉密尔顿焦虑量表和Yale-Brown强迫症量表分别对抑郁症、焦虑症、强迫症患者进行症状的评定;同时所有被试者在治疗前、后采用酶联免疫法测定血浆BDNF水平。结果:ARGT组和SS-RI组治疗前后的所有症状学指标的减分均达到统计学意义(P<0.001)。治疗后SSRI组患者血浆BD-NF水平升高有统计学意义(Z值=-2.636,P=0.008),ARGT组血浆BDNF水平降低无统计学意义(Z值=-0.182,P=0.855),两组间比较,治疗前后血浆BDNF减分的差异无统计学意义(P>0.05)。结论:SSRI可上调血浆BDNF水平,可能通过作用于神经可塑性起效。本研究结果不支持ARGT通过BDNF作用于神经可塑性起效的假设。Objective： To compare the effect of attributable retraining group therapy （ARGT） and selective serotonin reuptake inhibitors （SSRI） on plasma brain-derived neurotrophic factor （BDNF） in patients with major depressive disorder （MDD）, anxiety disorder （AD） and obsessive-compulsive disorder （OCD）. Method ： Comparison study between ARGT and SSRI was designed by a prospective intervention. 129 outpatients （45 MDD,45 AD and 39 OCD） were divided into ARGT group （n =63,including 21 MDD,23 AD and 19 OCD ） and SSRI group （n = 66,including 24 MDD,22 AD and 20 OCD） according to the sequence of entering the study. 54 outpatients in ARGT group and 55 outpatients in SSRI group completed the study at the end of the point. The symptoms were evaluated with Hamilton depression scale-24 items, Hamilton anxiety scale and Yale- Brown obsessive compulsive scale before and after 8 weeks treatment. The plasma level of BDNF was measured by enzyme-linked immunosorbent assay （ELISA） in all subjects before and after treatment. Results ： There was a significant score reduction in all symptoms in both ARGT group and SSRI group between before and after treatment （P 〈 0. 001 ）. The plasma level of BDNF increased significantly in patients of SSRI group （ Z = - 2. 636, P = 0. 008 ） and reduced non statistically in patients of ARGT group （ Z = - 0. 182, P = 0. 855 ） after treatment. There was no significant difference in the change of plasma level of BDNF between before and after treatment when compared the two groups. Conclusion ： SSRI can upregulate the plasma level of BDNF, which may have an effect on neural plasticity（ However, our study did not support the hypothesis that ARGT had an effect on neural, plasticity by regulating BDNF.

关 键 词：团体归因治疗 选择性5-羟色胺回收抑制剂 脑源性神经营养因子 神经可塑性 

分 类 号：R395[哲学宗教—心理学]