基于临床症状和生物学特征预测电针抗抑郁临床疗效的探索性分析  

Clinical Effect Prediction of Electroacupuncture on Depression Based on Clinical Symptoms and Biological Indicators:A Pilot Study

作　　者：胡凌娟[1] 赵冰骢 李晶 图娅[4] 杨昕婧 郭卓[6] HU Lingjuan;ZHAO Bingcong;LI Jing;TU Ya;YANG Xinjing;GUO Zhuo(Management College,Beijing University of Chinese Medicine,Beijing 100029,China;Department of Acupuncture and Moxibustion,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Institute of Aging Health,China Research Center on Aging,Beijing 100088,China;Acupuncture Tuina Institute,Beijing University of Chinese Medicine,Beijing 100029,China;Shenzhen Hospital(Futian)of Guangzhou University of Chiaese Medicine,Shenzhen 518000,Guangdong,China;Department of Basic Traditional Chinese Medicine,Institute of Integrative Traditional Chinese and Western medicine,Hebei Medical University,Shijiazhuang 050031,Hebei,China)

机构地区：[1]北京中医药大学管理学院,北京100029 [2]首都医科大学附属北京中医医院针灸中心,北京100010 [3]中国老龄科学研究中心老龄健康研究所,北京100088 [4]北京中医药大学针灸推拿学院,北京100029 [5]广州中医药大学深圳医院(福田),广东深圳518000 [6]河北医科大学中西医结合学院中医基础教研室,河北石家庄050031

出　　处：《辽宁中医杂志》2024年第11期1-5,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81574070)。

摘　　要：目的探索影响轻中度抑郁症患者对电针、药物和针药联合3种不同干预措施应答的关键因素。方法将61例轻中度抑郁症患者随机分为电针组(20例,脱落1例)、药物组(20例,脱落4例)和针药联合组(21例,脱落1例)。电针治疗选取主穴百会、印堂并接电,每次30 min,每周3次;药物治疗口服草酸艾司西酞普兰,5~10 mg/d;针药联合组的患者同时接受电针和药物治疗,治疗均持续6周。观察患者抑郁严重程度、生活质量等临床表现,ELISA法检测3组患者血清相关指标表达水平。结果治疗后,3组患者,24项汉密尔顿抑郁量在(24-item Hamilton depression scale,HAMD-24)评分均显著下降(P<0.05),3组患者,健康状况调查问卷(short form 36 health survey,SF-36)评分均显著提高(P<0.05)。3组患者的HAMD-24应答率、缓解率、SSRS、SF-36评分差异无统计学意义(P>0.05)。结合临床症状和分子生物学指标模拟的模型较为可靠。结论适合不同干预措施的轻、中度抑郁症患者人群基本特征有所不同。对伴随较严重睡眠障碍的抑郁症患者,选择针药联合治疗更有可能取得较好的临床疗效。Objective To explore the key factors influence the response rate of different interventions for patients with mild and moderate depression.Methods Sixty-one patients with mild and moderate depression were randomly divided into electroacupuncture(EA)group(20 cases,1 case dropped out),antidepressant group(20 cases,4 cases dropped out)and EA+antidepressant group(21 cases,1 case dropped out).The main acupoints of EA were Baihui(GV20)and Yintang(GV29)(connected to EA apparatus).Each EA session lasted for 30 minutes,three times a week.In the antidepressant group,escitalopram oxalate tablets were taken orally 5~10 mg/d.The patients in the EA+antidepressant group received both EA and antidepressant treatment.The treatment lasted for 6 weeks in all three groups.The changes of 24-item Hamilton depression scale(HAMD-24),16-item quick inventory of depressive symptomatology-self report(QIDS-SR16),short form 36 health survey(SF-36)and social support rating scale(SSRS)were observed before and after treatment.The serum levels of corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),Toll-like receptor 4(TLR4),nucleotide-binding oligomerization domain,leucine-rich repeat and pyrin domain-containing 3(NLRP3),interleukin-6(IL-6),interleukin-1β(IL-1β),interleukin-18(IL-18)and tumor necrosis factor-α(TNF-α)were determined by ELISA.Results After treatment,HAMD-24 scores were significantly decreased in three groups(P<0.05)and SF-36 scores were significantly increased in three groups(P<0.05).There were no significant differences in HAMD-24 response rate,remission rate,SSRS or SF-36 scores among the three groups(P>0.05).The model simulated by combining clinical symptoms and molecular biology indicators was relatively reliable.Conclusion The characteristics of patients with mild-to-moderate depression suitable for different interventions are different.For depression patients with more serious sleep disorders,The combination therapy of EA and antidepressant is more likely to achieve better clinical efficacy.

关 键 词：电针 草酸艾司西酞普兰 抑郁症 疗效预测 睡眠障碍 

分 类 号：R246.6[医药卫生—针灸推拿学]