健脾止动汤联合耳穴贴压对儿童多发性抽动症的下丘脑-垂体-肾上腺轴激素、神经递质的影响

Effects of Jianpi Zhidong Decoction Combined with Auricular Point Sticking on Hypothalamic-pituitary-adrenal Axis and Neurotransmitter Content of Children with Tourette Syndrome

目的:观察健脾止动汤联合耳穴贴压治疗儿童多发性抽动症(TS)的疗效及对下丘脑-垂体-肾上腺轴(HPA轴)激素、神经递质的影响。方法:选取2016年1月至2017年3月成都市新都区中医医院收治的符合《美国精神疾病诊断统计手册》第4版TS诊断标准的患儿80例作为研究对象,按照随机数字表法分为对照组和观察组,每组40例,同期入组40例健康儿童作为健康对照组,对照组和观察组均口服氟哌啶醇片剂治疗,对照组再给予耳穴贴压治疗,观察组再给予耳穴贴压联合健脾止动汤治疗,对照组和观察组均治疗12周,治疗前、治疗后检测中枢神经递质如多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、天门冬氨酸(ASP)、γ-氨基丁酸(GABA)和HPA轴相关激素皮质醇(COR)和促肾上腺皮质激素(ACTH),并与健康对照组比较,进行耶鲁综合抽动严重程度量表(TGTSS)评分,随访6个月,评估其临床疗效。结果:治疗前,对照组和观察组的多巴胺、NE、GABA明显低于健康对照组,差异有统计学意义(P<0.05),5-羟色胺、ASP明显高于健康对照组,差异有统计学意义(P<0.05);治疗后,对照组和观察组多巴胺、5-羟色胺、ASP均较治疗前明显降低,差异有统计学意义(P<0.05),NE、GABA均较治疗前明显升高,差异有统计学意义(P<0.05),且观察组治疗后多巴胺、5-羟色胺、ASP明显低于对照组,差异有统计学意义(P<0.05),NE、GABA明显高于对照组,差异有统计学意义(P<0.05)。治疗前对照组和观察组的COR、ACTH明显高于健康对照组,差异有统计学意义(P<0.05);对照组和观察组治疗后COR、ACTH均较治疗前明显降低,差异有统计学意义(P<0.05),且观察组治疗后COR、ACTH明显低于对照组,差异有统计学意义(P<0.05)。对照组和观察组治疗后运动抽动评分、发声抽动评分、抽动总分均较治疗前明显降低,差异有统计学意义(P<0.05),且观察组治疗后各项评分均明显低于对照组,差异有统计学意义(P<0.05)。对照组和观察组的临床总有效率分别为85%和97.5%,差异有统计学意义(P<0.05)。结论:TS的发病与中枢神经递质失衡及HPA轴功能亢进有关,健脾止动汤联合耳穴贴压治疗能够有效下调HPA轴水平,调节中枢神经递质失衡,协同提高临床治疗效果。

Objective: To observe the effect and the influence of Jianpi Zhidong Decoction combined with auricular point sticking on hypothalamic-pituitary-adrenal axis (HPA-axis) and neurotransmitter content of children with Tourette syndrome (TS). Methods: A total of 80 cases with TS who met the TS diagnostic criteria of the fourth edition of the American Psychiatric Diagnostic Manual were enrolled in this study,which were divided into observation group and control group with 40 cases were in each group according to random number table.Another 40 healthy cases were enrolled in the study as healthy control group.Observation group and control group were treated with haloperidol tablets.Observation group was treated with auricular point sticking,and control group was treated with Jianpi Zhidong Decoction combined with auricular point sticking.Both groups had been treated for 12 weeks.The central nervous system (CNS) neurotransmitter such as dopamine (DA),5-hydroxytryptamine (5-HT) norepinephrine (NE),aspartate (ASP),γ-aminobutyric acid (GABA) and HPA-related hormone such as cortisol (COR) and adrenocorticotropic hormone (ATCH) were detected before and after treatment,which were compared with the healthy control group.Yale comprehensive twitch severity scale (TGTSS) score were calculated.All the cases had been followed at least 6 months,and then the clinical efficacy was assessed. Results: Before treatment,the DA,NE and GABA levels in the observation group and the control group were significantly lower than those in healthy control group.The difference was statistically significant ( P <0.05).5-HT and ASP levels in 2 groups were significantly higher than those in healthy control group.The difference was statistically significant ( P <0.05).After treatment,the DA,5-HT,ASP levels in observation group and control group were significantly lower than those before treatment.The difference was statistically significant ( P <0.05).NE and GABA levels were significantly higher than those before treatment.The difference was statistically significant ( P <0.05).DA,5-HT,and ASP levels in the observation group were significantly lower than those in the control group.The difference was statistically significant ( P <0.05).NE,GABA levels of observation group were significantly higher than that of control group.The difference was statistically significant ( P <0.05).Before treatment,COR and ACTH levels in observation group and control group were significantly higher than those in healthy control group.The difference was statistically significant ( P <0.05).After treatment,COR and ACTH levels in the observation group and the control group were significantly lower than those in healthy control group.The difference was statistically significant ( P <0.05).COR and ACTH levels in the observation group was significantly lower than the control group.The difference was statistically significant ( P <0.05).The movement and vocalization tics and tics total scores of the observation group and the control group were significantly decreased after treatment.The difference was statistically significant ( P <0.05).The scores in the observation group were significantly lower than those in control group after treatment.The difference was statistically significant ( P <0.05).The total clinical effective rates in control group and observation group were 85% and 97.5% respectively.The difference was statistically significant ( P <0.05). Conclusion: The attack of TS is related to central nervous system imbalance and hyperactivity of HPA axis.Jianpi Zhidong Decoction combined with auricular point sticking can effectively reduce the level of HPA axis,regulate the imbalance of CNS neurotransmitter and improve the clinical therapeutic effects.