经颅磁刺激及心理基础治疗下园艺疗法联合皮内针治疗肝郁化火型广泛性焦虑障碍患者60例临床观察  

Horticultural Therapy Combined with Intradermal Needling for Patients with Generalized Anxiety Disorder of Liver Depression Transforming into Fire Syndrome Under Transcranial Magnetic Stimulation and Psychological Therapy:Clinical Observation of 60 Cases

作　　者：张琬云 颜嘉怡 邱晴宜 彭玉梅[2] 钟小玲[2] 张金文 唐润东 吴苗 胡丹[2] 苏广[2] ZHANG Wanyun;YAN Jiayi;QIU Qingyi;PENG Yumei;ZHONG Xiaoling;ZHANG Jinwen;TANG Rundong;WU Miao;HU Dan;SU Guang(The Seventh Clinical Medical College of Guangzhou University of Chinese Medicine,Shenzhen,518101;Traditional Chinese Medicine Hospital of Shenzhen Bao′an District,Guangdong Province)

机构地区：[1]广州中医药大学第七临床医学院,广东深圳518101 [2]深圳市宝安区中医院

出　　处：《中医杂志》2025年第1期50-58,共9页Journal of Traditional Chinese Medicine

基　　金：深圳市科技创新委员会科技计划项目(JCYJ202205-30141402005)。

摘　　要：目的观察经颅磁刺激及心理基础治疗下种植中草药薄荷、百合盆栽的园艺疗法联合皮内针治疗肝郁化火型广泛性焦虑障碍的临床疗效,并探讨其可能作用机制。方法将180例肝郁化火型广泛性焦虑障碍患者随机分为园艺疗法组、皮内针组和园艺+皮内针组各60例。各组均给予基础治疗(包括基础心理治疗及经颅磁刺激治疗),园艺疗法组加用园艺治疗;皮内针组加用皮内针治疗,每周1次,共8周;园艺+皮内针组加用园艺疗法及皮内针治疗,操作方法及疗程同上。分别于治疗前及治疗2、4、6、8周后比较各组患者汉密尔顿焦虑量表(HAMA)评分、焦虑自评量表(SAS)评分、匹兹堡睡眠质量指数量表(PSQI)评分。治疗前及治疗8周后检测各组血清促肾上腺皮质激素(ACTH)、血清皮质酮(CORT)水平。治疗前记录运动诱发电位(MEP)基线水平,并于治疗1、8周后比较各组患者经颅磁刺激治疗时MEP波幅比。治疗8周后评估各组患者临床疗效,并采用皮尔逊相关性分析方法分析患者血清ACTH、CORT水平和MEP波幅比与焦虑的相关性。结果与治疗前比较,园艺疗法组和皮内针组在治疗4、6、8周后HAMA、SAS、PSQI评分均明显降低,园艺+皮内针组从治疗2周后起至治疗8周后均明显下降(P<0.05);园艺+皮内针组在治疗2、4、6、8周后HAMA、SAS、PSQI评分均低于同时间点其他两组(P<0.05)。治疗8周后园艺+皮内针组血清CORT、ACTH水平均较本组治疗前下降(P<0.05),且均低于同时间点其他两组(P<0.01)。各组治疗8周后与治疗1周后比较,PAS10刺激下,皮内针组在30 min时MEP波幅比降低,园艺+皮内针组各时间点MEP波幅比降低(P<0.05或P<0.001);PAS25刺激下,园艺疗法组在20 min时MEP波幅比升高,皮内针组在10 min时MEP波幅比升高(P<0.05),园艺+皮内针组各时间点治疗后MEP波幅比均升高(P<0.001)。园艺+皮内针组治疗后治愈率(74.14%,43/58)高于园艺疗法组(30.00%Objective To observe the clinical effectiveness of horticultural therapy involving the planting of Chinese medicinal herbs(mint and lily potted plants)combined with intradermal needling therapy for generalized anxiety disorder(GAD)of liver depression transforming into fire syndrome under transcranial magnetic stimulation and basic psychological therapy,and to explore the possible mechanisms of action.Methods A total of 180 patients with GAD of liver depression transforming into fire syndrome were randomly divided into three groups,horticultural therapy group,intradermal needling group,and horticultural therapy+intradermal needling group,with 60 patients in each.All groups received basic treatment including basic psychological therapy and transcranial magnetic stimulation.The horticultural therapy group received horticultural therapy in addition to the basic treatment;the intradermal needling group received intradermal needling therapy once a week for 8 weeks in addition to the basic treatment;the horticultural therapy+intradermal needling group received both horticultural therapy and intradermal needling therapy,following the same procedures and duration.Hamilton Anxiety Rating Scale(HAMA),Self-Rating Anxiety Scale(SAS),and Pittsburgh Sleep Quality Index(PSQI)scores were assessed at baseline and after 2,4,6,and 8 weeks of treatment.Serum levels of adrenocorticotropic hormone(ACTH)and corticosterone(CORT)were measured before treatment and after 8 weeks of treatment.Motor-evoked potential(MEP)baseline levels were recorded before treatment,and MEP amplitude ratios were compared after 1 week and 8 weeks of treatment.Clinical effectiveness and safety were evaluated after 8 weeks of treatment.Pearson correlation analysis was used to examine the relationships between serum ACTH and CORT levels,MEP amplitude,and anxiety.Results In the horticultural therapy group and intradermal needling group,HAMA,SAS and PSQI scores after 4,6,and 8 weeks treatment were lower than baseline scores(P<0.05).In the horticultural therapy+intr

关 键 词：广泛性焦虑障碍 肝郁化火型 皮内针 园艺疗法 皮质酮 经颅磁刺激 

分 类 号：R749.72[医药卫生—神经病学与精神病学]