电针结合音乐疗法对卒中后抑郁患者磁共振波谱脑神经代谢物变化的影响

Effect of Electroacupuncture Combined with Music Therapy on Cerebral Neurometabolites in Patients with Post-stroke Depression: A Magnetic Resonance Spectroscopy Study

目的观察电针结合音乐疗法对卒中后抑郁患者磁共振波谱前额叶白质神经生化代谢物的影响。方法 2013年1月至2017年12月,将60例脑卒中后抑郁患者随机分为药物治疗组(n=30)和电针音乐治疗组(n=30),同时招募20例正常对照组。三组在治疗前、后分别采用磁共振波谱检测双侧前额叶白质氮-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)变化。治疗后采用汉密尔顿抑郁量表(HAMD)评分减分率进行临床疗效评定。结果电针音乐治疗组和药物治疗组显效率无显著性差异(Z=-0.145,P>0.05)。治疗前电针音乐治疗组和药物治疗组双侧前额叶白质Cho/Cr均明显低于正常对照组(t>3.093,P<0.01)。治疗后电针音乐治疗组和药物治疗组双侧前额叶白质Cho/Cr均升高(t>2.219,P<0.05),两组间比较无显著性差异(t<1.050,P>0.05)。结论胆碱水平可能是卒中后抑郁患者白质中胶质细胞及髓鞘功能和完整性的神经生化学基础,前额叶白质中胶质细胞和髓鞘功能的调节可能是电针结合音乐治疗的作用靶点之一。

Objective To observe effects of the electroacupuncture combined with music therapy on cerebral neurometabolites measured with magnetic resonance spectroscopy in patients with post-stroke depression.Methods From January,2013 to December,2017,60 patients with post-stroke depression were randomly divided into drug group(n=30)and electroacupuncture music group(n=30).Another 20 cases of normal control group were recruited.The concentration of N-acetylaspartate(NAA),creatine(Cr)and choline(Cho)in the bilateral prefrontal white matter was measured with magnetic resonance spectroscopy before and after eight-week treatment in three groups.The clinical efficiency was defined as the different of Hamilton Depression Rating Scale before and after treatment.Results There was no significant difference in the effective rate between two treatment groups(Z=-0.145,P>0.05).Before treatment,the Cho/Cr was lower in the electroacupuncture music group and the drug group than in the normal control group(t>3.093,P<0.05).After treatment,the Cho/Cr increased in both treatment groups(t>2.219,P<0.05),and no significant difference was found between them(P>0.05).Conclusion The choline level may be the neurobiochemical basis for glial cell or myelin sheath function and integrity in white matter of patients with post-stroke depression.The regulation of glial cell and myelin function in prefrontal white matter may be one of the action targets of electroacupuncture combined with music therapy.