运用“治病先治神”理论针刺治疗血液透析伴轻、中度肝郁脾虚型抑郁患者的疗效观察

Clinical Observation of Acupuncture in the Treatment of Hemodialysis with Mild-to-Moderate Depression of Liver Depression and Spleen Deficiency under the“Spirit Regulation Prior to Disease Treatment”Theory

目的观察“治病先治神”理论针刺治疗血液透析伴轻、中度肝郁脾虚型抑郁患者的临床疗效。方法选取2018年1月—2019年3月期间在首都医科大学附属北京中医医院血液透析中心轻、中度肝郁脾虚型抑郁状态维持血液透析患者60例,根据随机数字表法随机分为治疗组和对照组,每组各30例。治疗组运用“治病先治神”理论针刺治疗,对照组选择针刺非穴。治疗8/16周后,观察比较两组患者治疗前后汉密尔顿-17抑郁量表(Hamilton Depression Scale-17,HAMD-17)评分、生活质量调查量表(12-item health survey,SF-12)评分、血清白蛋白(Serum Albumin,ALB)、前白蛋白(Prealbumin,PA)、胆固醇(Cholesterol,CHO)、体重指数(Body Mass Index,BMI)、中医证候评分和中医疗效评价结果。结果治疗组HAMD-17评分及各项中医证候积分在治疗第8、16周后较治疗前下降(P<0.05),ALB、PA、BMI均较治疗前升高(P<0.05),第16周后SF-12评分较治疗前升高(P<0.05)。治疗第16周后,治疗组HAMD-17评分较治疗第8周降低(P<0.05);SF-12评分、ALB、PA及BMI较治疗第8周升高(P<0.05)。治疗第8周后,治疗组HAMD评分、善太息、乏力及纳差积分低于对照组(P<0.05),治疗第16周后,治疗组HAMD-17评分及全部证候各分均较对照组降低(P<0.05)。治疗第8周及16周时,治疗组ALB、PA、BMI及SF-12评分均高于对照组。治疗组治疗第16周后总有效率较治疗第8周时升高,差异有统计学意义(P<0.05);且治疗组第8、16周时总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论“治病先治神”理论针刺治疗血液透析伴轻、中度肝郁脾虚型抑郁状态效果确切。

Objective To observe the clinical efficacy of acupuncture in the treatment of hemodialysis patients with mild-to-moderate depression of liver depression and spleen deficiency under the theory of“spirit regulation prior to disease treatment”.Methods Sixty hemodialysis patients with mild-to-moderate depression of liver depression and spleen deficiency treated in the Hemodialysis Center of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from January 2018 to March 2019 were included and divided into a treatment group(n=30)and a control group(n=30)according to a random number table.The patients in the treatment group were treated with acupuncture based on the theory of“spirit regulation prior to disease treatment”,while those in the control group received acupuncture at sham acupoints.After 8 and 16 weeks of treatment,the Hamilton Depression Scale-17(HAMD-17)scores,12-Item Short Form Survey(SF-12)scores,serum albumin(ALB),prealbumin(PA),cholesterol(CHO),body mass index(BMI),traditional Chinese medicine(TCM)syndrome scores before and after treatment,and TCM efficacy results of the two groups were observed and compared.Results Compared with the results before treatment,the HAMD-17 score and the scores of TCM syndromes in the treatment group decreased after 8 and 16 weeks of treatment(P<0.05),while ALB,PA,and BMI all increased(P<0.05),and the SF-12 score increased after 16 weeks(P<0.05).After 16 weeks of treatment,the HAMD-17 score in the treatment group was lower than that after 8 weeks of treatment(P<0.05),and the SF-12 score,ALB,PA,and BMI were higher than those after 8 weeks of treatment(P<0.05).After 8 weeks of treatment,the HAMD score,frequent sighing,fatigue,and poor appetite scores in the treatment group were lower than those in the control group(P<0.05).After 16 weeks of treatment,the HAMD-17 score and all TCM syndrome scores in the treatment group were lower than those in the control group(P<0.05).After 8 and 16 weeks of treatment,the ALB,PA,BMI,and SF-12 scores in the treatment group were higher than those in the control group.After 16 weeks of treatment,the total effective rate of the treatment group was higher than that after 8 weeks of treatment(P<0.05),and after 8 and 16 weeks of treatment,the total effective rate of the treatment group was higher than that of the control group(P<0.05).Conclusion Acupuncture based on the theory of“spirit regulation prior to disease treatment”has a definite efficacy on hemodialysis patients with mild-to-moderate depression of liver depression and spleen deficiency.