抑郁症中医辨证分型与认知功能、代谢指标的关联及疗效研究  

Relationship among TCM syndrome differentiation and cognitive function,metabolic index of depression

作　　者：张丽鸿 恵海宾 闵海瑛 施美丽 严佳佩 顾莲莹 ZHANG Lihong;HUI Haibin;MIN Haiying(Tongji University Affiliated Mental Health Center(Shanghai Pudong New Area Mental Health Center),Shanghai 200124,China)

机构地区：[1]同济大学附属精神卫生中心(上海浦东新区精神卫生中心),上海市200124

出　　处：《精神医学杂志》2024年第5期487-491,共5页Journal of Psychiatry

摘　　要：目的探讨抑郁症中医辨证分型与认知功能、代谢指标的关联,观察耳穴埋针联合早期心理康复疗法的疗效。方法选取107例抑郁症患者为研究对象,依据中医辨证分型分为肝郁气滞型、心脾两虚型、肝郁脾虚型、肝肾阴虚型、痰气郁结型,采用蒙特利尔认知功能评估量表(MoCA)评估患者认知功能,比较不同证型抑郁症患者代谢指标,分析抑郁症患者MoCA评分、代谢指标与中医证候积分的关系。依据随机数字表法将入组患者分为对照组和观察组,分别给予早期心理康复疗法干预和耳穴埋针联合早期心理康复疗法干预,采用中医证候积分量表评价治疗前后临床疗效,采用汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质量指数(PSQI)、MoCA、生活质量综合评定问卷-74(GQOL-74)比较治疗前后精神状况、生活质量。结果107例抑郁症患者证型分布由高到低依次为肝郁气滞型26.17%、肝肾阴虚型22.43%、心脾两虚型19.63%、肝郁脾虚型16.82%、痰气郁结型14.95%。不同证型抑郁症患者MoCA评分及甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)水平差异有统计学意义(P<0.05)。肝郁脾虚型、肝肾阴虚型患者MoCA评分均低于肝郁气滞型(P<0.05),肝肾阴虚型患者总胆汁酸(TBA)水平低于肝郁气滞型(P<0.05);肝郁脾虚型抑郁症患者TG水平低于肝肾阴虚型(P<0.05),肝郁脾虚型、痰气郁结型患者糖化白蛋白(GA)水平均低于肝肾阴虚型(P<0.05),肝肾阴虚型患者肌酐(CRE)水平低于心脾两虚型(P<0.05)。抑郁症患者中医证候积分与MoCA量表评分、TG水平均呈负相关(P<0.05)。临床干预后,观察组临床有效率高于对照组(P<0.05),两组治疗后HAMA、PSQI评分均较治疗前均降低(P<0.05),MoCA、GQOL-74评分均较治疗前均升高(P<0.05);观察组HAMA、PSQI评分均低于对照组(P<0.001),MoCA、GQOL-74评分高于对照组(P<0.001)。结论抑郁症不同证型患者认知�Objective To explore the relationship among TCM syndrome differentiation of depression and cognitive function and metabolic index,and to observe the curative effect of auricular acupuncture combined with early psychological rehabilitation therapy.Methods A total of 107 patients with depression were selected and divided into liver-qi stagnation type,heart-spleen deficiency type,liver-spleen deficiency type,liver-kidney Yin deficiency type and spittoon stagnation type according to TCM syndrome differentiation.Their cognitive function was assessed with Montreal Cognitive Assessment(MoCA),and their metabolic indexes were compared,to analyze the relationship among MoCA score,metabolic indexes and TCM syndrome score in patients with depression.According to the random number table method,the enrolled patients were divided into control group treated with early psychological rehabilitation therapy and observation group treated with auricular acupuncture combined with early psychological rehabilitation therapy,to compared the clinical efficacy,mental status[scores of Hamilton Anxiety Scale(HAMA),Pittsburgh Sleep Quality Index(PSQI),MoCA]and quality of life[score of Generic Quality of Life Inventory-74(GQOL-74)]before and after treatment.Results The distribution of syndrome types in 107 patients with depression from high to low was liver-qi stagnation 26.17%(28/107),liver and kidney Yin deficiency 22.43%(24/107),heart-spleen deficiency 19.63%(21/107),liver-spleen deficiency 16.82%(18/107),spittoon stagnation 14.95%(16/107).There were significant differences in MoCA scores and levels of triglyceride(TG),low density lipoprotein cholesterol(LDL)and high density lipoprotein cholesterol(HDL)among patients with different syndrome types(P<0.05).Liver-spleen deficiency and liver-kidney Yin deficiency showed lower MoCA scores than liver-qi stagnation(P<0.05),liver-kidney Yin deficiency showed lower total bile acid(TBA)than liver-qi stagnation(P<0.05);liver-spleen deficiency showed lower TG than liver-kidney Yin deficiency(P<0.05);li

关 键 词：抑郁症 辨证分型 认知功能 代谢指标 耳穴埋针 早期心理康复疗法 

分 类 号：R749.4[医药卫生—神经病学与精神病学]