基于感觉门控理论的电针疗法在持续性躯体形式疼痛障碍中的应用效果  

Effect of Electroacupuncture Therapy Based on Sensory Gating Theory on Persistent Somatoform Pain Disorder

作　　者：孙伟铭[1] 李士林 董香丽 赵娜 于国华[1] 帅浪[1] 袁也丰[3] SUN Wei-ming;LI Shi-lin;DONG Xiang-li;ZHAO Na;YU Guo-hua;SHUAI Lang;YUAN Ye-feng(Department of Rehabilitation Medicine,the First Affiliated Hospital of Nanchang University;Department of Psychosomatic Medicine,the Second Affiliated Hospital of Nanchang University;Department of Psychosomatic Medicine,the First Affiliated Hospital of Nanchang University;Department of Rehabilitation Medicine,Jiangxi Provincial People’s Hospital,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院康复医学科 [2]南昌大学第二附属医院心身医学科 [3]南昌大学第一附属医院心身医学科 [4]江西省人民医院康复医学科,南昌330006

出　　处：《南昌大学学报（医学版）》2021年第3期44-48,66,共6页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生计生委中医药科研课题(2018A146)。

摘　　要：目的探讨基于感觉门控(SG)理论的电针疗法在持续性躯体形式疼痛障碍(PSPD)治疗中的应用效果及可能机制。方法将60例PSPD患者随机分为对照组和观察组,每组30例,对照组采用度洛西汀药物治疗,观察组采用度洛西汀联合电针治疗。比较2组治疗前及治疗2、4、6周后疼痛、抑郁及焦虑状况变化情况,治疗前及治疗6周后感觉门控电位(SGP/P50)水平。疼痛程度采用数字评分法(NRS)评估,抑郁状况采用汉密尔顿抑郁量表(HAMD-24)评估,焦虑状况采用汉密尔顿焦虑量表(HAMA-14)评估。SGP/P50水平检测使用MEB-920肌电图/诱发电位仪,对受试者进行条件(S1)-测试(S2)短声听觉成对刺激模式测试,记录S1-P50波幅、S2-P50波幅、S1-P50波幅与S2-P50波幅差值(S1-S2)、P50抑制率(S2/S1)及P50抑制异常率。结果2组治疗后NRS、HAMD-24、HAMA-14评分均呈下降趋势;与对照组比较,观察组治疗2、4、6周后NRS评分显著下降(P<0.05),治疗4、6周后HAMD-24、HAMA-14评分显著下降(P<0.05)。对照组治疗前后SGP/P50各参数比较差异无统计学意义(P>0.05);观察组S1-P50波幅、S1-S2值治疗前后比较差异无统计学意义(P>0.05),S2-P50波幅、S2/S1、P50抑制异常率治疗后较治疗前明显降低(P<0.05);与对照组比较,观察组治疗后S2-P50波幅、S2/S1及P50抑制异常率显著降低(P<0.05)。结论电针可能通过调控PSPD患者的感觉门控功能,缓解PSPD患者的疼痛,改善抑郁及焦虑症状。Objective To investigate the effect of electroacupuncture therapy based on sensory gating theory on persistent somatoform pain disorder(PSPD)and its mechanism of action.Methods Sixty patients with PSPD were randomly treated with duloxetine alone(control group,n=30)or in combination with electroacupuncture therapy(observation group,n=30).Pain severity was measured by the numerical rating scale(NRS),depression status was assessed by the Hamilton depression scale(HAMD-24),and anxiety status was evaluated by the Hamilton anxiety scale(HAMA-14)before and after treatment for 2,4 and 6 weeks.In addition,P50 sensory gating potential(SGP/P50)was determined using the MEB-920 EMG/evoked potentiometer before and after treatment for 6 weeks.The patients were subjected to(S1)-(S2)paired short-tone stimuli to record S1-P50 amplitude,S2-P50 amplitude,difference between S1-P50 amplitude and S2-P50 amplitude(S1-S2),P50 suppression rate(S2/S1),and abnormal P50 suppression rate.Results There was a downward trend in NRS,HAMD-24 and HAMA-14 scores after treatment in both groups.Compared with the control group,NRS scores at 2,4 and 6 weeks after treatment and HAMD-24 and HAMA-14 scores at 4 and 6 weeks after treatment significantly decreased in the observation group(P<0.05).No obvious changes were found after treatment in SGP/P50 parameters in control group,as well as in S1-P50 amplitude and S1-S2 in observation group(P>0.05).However,S2-P50 amplitude,S2/S1 and abnormal P50 suppression rate decreased after treatment(P<0.05).Furthermore,compared with the control group,these parameters significantly reduced in the observation group(P<0.05).Conclusion Electroacupuncture may alleviate the pain and improve the symptoms of depression and anxiety in PSPD patients by regulating the sensory gating function.

关 键 词：持续性躯体形式疼痛障碍 电针治疗 感觉门控理论 临床效果 

分 类 号：R741[医药卫生—神经病学与精神病学]