针刺联合低频rTMS治疗轻中度抑郁障碍共病失眠:随机对照试验  

Effect of acupuncture combined with low frequency rTMS on comorbid mild-to-moderate depressive disorder and insomnia:a randomized controlled trial

作　　者：阎路达 周鹏[2,3] 赖美琪 吴苗 张瑜 唐润东 孙锐 罗依 李美 孙继岭[2,3] 符文彬 YAN Lu-da;ZHOU Peng;LAI Mei-qi;WU Miao;ZHANG Yu;TANG Run-dong;SUN Rui;LUO Yi;LI Mei;SUN Ji-ling;FU Wen-bin(Second Clinical College,Guangzhou University of CM,Guangzhou 510405,Guangdong Province,China;Department of Acupuncture and Moxibustion,Bao'an TCM Hospital,Shenzhen 518100,Guangdong Province;Shenzhen Bao'an Research Center for Acupuncture and Moxibustion,Shenzhen 518100,Guangdong Province;Department of Acupuncture and Moxibustion,Guangdong Provincial Hospital of TCM,Guangzhou 510120;Department of Treatment and Prevention of Disease,Bao'an TCM Hospital)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]深圳市宝安区中医院针灸科,广东深圳518100 [3]深圳市宝安区针灸临床研究中心,广东深圳518100 [4]广东省中医院针灸科,广州510120 [5]深圳市宝安区中医院治未病中心,广东深圳518100

出　　处：《中国针灸》2023年第4期374-378,400,共6页Chinese Acupuncture & Moxibustion

基　　金：深圳市人民政府“医疗卫生三名工程”项目:SZSM201806077;深圳市宝安区医疗卫生基础研究项目:2019JD347;深圳市宝安区中医药发展基金项目:2020KJCX-KTYJ-10。

摘　　要：目的:观察针刺对轻中度抑郁障碍共病失眠患者抑郁情绪和睡眠质量的影响,探讨其作用机制.方法:将60例轻中度抑郁障碍共病失眠患者随机分为观察组(30例,脱落1例)和对照组(30例,脱落2例).观察组予针刺联合低频重复经颅磁刺激(rTMS)治疗,针刺穴取百会、印堂、内关、阳陵泉等,留针30 min,揿针穴取心俞、胆俞,留针2 d;针刺后于右侧前额叶背外侧皮质区(R-DLPFC)行1 Hz、80%运动阈值(MT)rTMS刺激,每次30 min.对照组予假针刺联合低频rTMS治疗,取穴、操作同观察组.两组针刺均隔日1次,每周3次;rTMS每日1次,每周连续5次,均治疗4周.观察两组患者治疗前后及治疗结束后1个月(随访时)汉密尔顿抑郁量表(HAMD-17)、匹兹堡睡眠质量指数(PSQI)评分,并检测治疗前后血清神经生长因子(BDNF)、γ-氨基丁酸(GABA)含量.结果:治疗后及随访时,两组患者HAMD-17评分均较治疗前降低(P<0.05),且观察组均低于对照组(P<0.05).治疗后,除对照组睡眠效率评分外,两组患者PSQI总分和各因子评分均较治疗前降低(P<0.05),观察组PSQI总分及睡眠质量、入睡时间、睡眠效率、日间功能障碍评分均低于对照组(P<0.05);随访时,除对照组睡眠时间和睡眠效率评分外,两组患者PSQI总分和各因子评分均较治疗前降低(P<0.05),且观察组PSQI总分及睡眠质量、入睡时间、睡眠时间、睡眠效率、日间功能障碍评分均低于对照组(P<0.05).治疗后,观察组血清BDNF、GABA含量较治疗前升高(P<0.05);观察组血清BDNF含量高于对照组(P<0.05).结论:针刺可改善轻中度抑郁障碍共病失眠患者抑郁情绪、睡眠质量,其机制可能与调节BDNF、GABA含量,促进脑神经功能恢复有关.Objective To observe the impacts of acupuncture on depressive mood and sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia,and explore its effect mechanism.Methods A total of 60 patients with comorbid mild-to-moderate depressive disorder and insomnia were randomly divided into an observation group(30 cases,1 case dropped off)and a control group(30 cases,2 cases dropped off).In the observation group,acupuncture and low frequency repeated transcranial magnetic stimulation(rTMS)were combined for the intervention.Acupuncture was applied to Baihui(GV 20),Yintang(GV 24'),Neiguan(PC 6)and Yanglingquan(GB 34),etc.,the needles were retained for 30 min;and the intradermal needles were embedded at Xinshu(BL 15)and Danshu(BL 19)for 2 days.After acupuncture,the rTMS was delivered at the right dorsolateral prefrontal cortex(R-DLPFC),with 1 Hz and 80%of movement threshold,lasting 30 min in each treatment.In the control group,the sham-acupuncture was adopted,combined with low frequency rTMS.The acupoint selection and manipulation were the same as the observation group.In the two groups,acupuncture was given once every two days,3 times weekly;while,rTMS was operated once daily,for consecutive 5 days a week.The duration of treatment consisted of 4 weeks.Hamilton depression scale-17(HAMD-17)and Pittsburgh sleep quality index(PSQI)scores were observed before and after treatment,as well as 1 month after the treatment completion(follow-up period)separately.Besides,the levels of nerve growth factor(BDNF)and-aminobutyric acid(GABA)in the serum were detected before and after treatment in the two groups.Results After treatment and in follow-up,the HAMD-17 scores were lower than those before treatment in the two groups(P<0.05),and the scores in the observation group were lower than the control group(P<0.05).After treatment,the total scores and the scores of each factor of PSQI were reduced in the two groups in comparison with those before treatment except for the score of sleep efficiency in the contro

关 键 词：轻中度抑郁障碍 失眠 针刺 重复经颅磁刺激 心胆论治 

分 类 号：R246.6[医药卫生—针灸推拿学]