基于头针的音乐疗法对卒中后抑郁疗效的静息态功能磁共振观察

Effect of Music Therapy Based on Scalp Acupuncture on Post-stroke Depression:Study with Resting-state Functional Magnetic Resonance Imaging

目的采用静息态功能磁共振(rs-fMRI)观察音乐疗法结合头针对卒中后抑郁(PSD)患者脑功能的影响。方法2018年12月至2019年11月,山东中医药大学第二附属医院康复科PSD患者40例随机分为对照组和观察组,各20例,两组均在常规康复的基础上接受头针治疗,观察组在留针时接受音乐疗法治疗,共4周。治疗前后采用汉密尔顿抑郁量表(HAMD-17)、匹兹堡睡眠质量指数(PSQI)和改良Barthel指数(MBI)进行评定,并行rs-fMRI检测,记录低频振幅值(ALFF)。治疗结束后4周,对有疗效的患者进行电话随访,采用HAMD-17进行评定。结果两组各剔除3例。治疗4周后,两组HAMD-17、PSQI和MBI评分均显著改善(|t|>11.446,P<0.001),观察组各项评分均优于对照组(|t|>2.314,P<0.05);治疗后,观察组双侧楔叶、双侧舌回,右侧眶额叶皮质、右侧前扣带回和右侧颞中回ALFF增高;对照组右侧舌回、右侧角回和右侧枕叶外侧沟ALFF增高。共成功随访29例,末次随访时HAMD-17评分仍较治疗前显著降低(t>13.558,P<0.001)。结论音乐疗法可有效加强头针对PSD的治疗效果,改善睡眠,提高生活自理能力,疗效能较长时间维持。可能与激活情感环路重要脑区眶额皮质、颞中回,以及初级视觉皮质有关。

Objective To observe the effects of music therapy combined with scalp acupuncture on post-stroke depression(PSD)using resting-state functional magnetic resonance imaging(rs-fMRI).Methods From December,2018 to November,2019,40 patients with PSD from Rehabilitation Department of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group(n=20)and observation group(n=20).Both groups received routine rehabilitation and scalp acupuncture,while the observation group received music therapy as acupuncture,for four weeks.They were assessed with Hamilton Depression Scale(HAMD-17),Pittsburgh Sleep Quality Index(PSQI)and modified Barthel Index(MBI)before and after treatment,and scanned with rs-fMRI to obtain amplitude of low-frequency fluctuation(ALFF).The patients with definite improvement were followed up with HAMD-17 through telephone four weeks after treatment.Results There were three cases dropped down in each group.The scores of HAMD-17,PSQI and MBI improved in both groups(|t|>11.446,P<0.001),and improved more in the observation group than in the control group(|t|>2.314,P<0.05).ALFF of bilateral wedge lobe,bilateral lingual gyrus,right orbitofrontal cortex,right anterior cingulate gyrus and right middle temporal gyrus increased in the observation group,and it increased in the right lingual gyrus,right angular gyrus and lateral groove of right occipital lobe in the control group.A total of 29 patients were followed up successfully,and the HAMD-17 scores were still less than that before treatment(t>13.558,P<0.001).Conclusion Music therapy can further alleviate depression under scalp acupuncture in patients with PSD for a long time after treatment,and improve sleep and activities of daily living,which may relate with the activation of the emotional circuit,such as orbitofrontal cortex and the middle temporal gyrus,and the primary visual cortex.