针刺联合低频rTMS治疗轻中度抑郁障碍共病失眠:随机对照试验

Effect of acupuncture combined with low frequency rTMS on comorbid mild-to-moderate depressive disorder and insomnia:a randomized controlled trial

目的:观察针刺对轻中度抑郁障碍共病失眠患者抑郁情绪和睡眠质量的影响,探讨其作用机制.方法:将60例轻中度抑郁障碍共病失眠患者随机分为观察组(30例,脱落1例)和对照组(30例,脱落2例).观察组予针刺联合低频重复经颅磁刺激(rTMS)治疗,针刺穴取百会、印堂、内关、阳陵泉等,留针30 min,揿针穴取心俞、胆俞,留针2 d;针刺后于右侧前额叶背外侧皮质区(R-DLPFC)行1 Hz、80%运动阈值(MT)rTMS刺激,每次30 min.对照组予假针刺联合低频rTMS治疗,取穴、操作同观察组.两组针刺均隔日1次,每周3次;rTMS每日1次,每周连续5次,均治疗4周.观察两组患者治疗前后及治疗结束后1个月(随访时)汉密尔顿抑郁量表(HAMD-17)、匹兹堡睡眠质量指数(PSQI)评分,并检测治疗前后血清神经生长因子(BDNF)、γ-氨基丁酸(GABA)含量.结果:治疗后及随访时,两组患者HAMD-17评分均较治疗前降低(P<0.05),且观察组均低于对照组(P<0.05).治疗后,除对照组睡眠效率评分外,两组患者PSQI总分和各因子评分均较治疗前降低(P<0.05),观察组PSQI总分及睡眠质量、入睡时间、睡眠效率、日间功能障碍评分均低于对照组(P<0.05);随访时,除对照组睡眠时间和睡眠效率评分外,两组患者PSQI总分和各因子评分均较治疗前降低(P<0.05),且观察组PSQI总分及睡眠质量、入睡时间、睡眠时间、睡眠效率、日间功能障碍评分均低于对照组(P<0.05).治疗后,观察组血清BDNF、GABA含量较治疗前升高(P<0.05);观察组血清BDNF含量高于对照组(P<0.05).结论:针刺可改善轻中度抑郁障碍共病失眠患者抑郁情绪、睡眠质量,其机制可能与调节BDNF、GABA含量,促进脑神经功能恢复有关.

Objective To observe the impacts of acupuncture on depressive mood and sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia,and explore its effect mechanism.Methods A total of 60 patients with comorbid mild-to-moderate depressive disorder and insomnia were randomly divided into an observation group(30 cases,1 case dropped off)and a control group(30 cases,2 cases dropped off).In the observation group,acupuncture and low frequency repeated transcranial magnetic stimulation(rTMS)were combined for the intervention.Acupuncture was applied to Baihui(GV 20),Yintang(GV 24'),Neiguan(PC 6)and Yanglingquan(GB 34),etc.,the needles were retained for 30 min;and the intradermal needles were embedded at Xinshu(BL 15)and Danshu(BL 19)for 2 days.After acupuncture,the rTMS was delivered at the right dorsolateral prefrontal cortex(R-DLPFC),with 1 Hz and 80%of movement threshold,lasting 30 min in each treatment.In the control group,the sham-acupuncture was adopted,combined with low frequency rTMS.The acupoint selection and manipulation were the same as the observation group.In the two groups,acupuncture was given once every two days,3 times weekly;while,rTMS was operated once daily,for consecutive 5 days a week.The duration of treatment consisted of 4 weeks.Hamilton depression scale-17(HAMD-17)and Pittsburgh sleep quality index(PSQI)scores were observed before and after treatment,as well as 1 month after the treatment completion(follow-up period)separately.Besides,the levels of nerve growth factor(BDNF)and-aminobutyric acid(GABA)in the serum were detected before and after treatment in the two groups.Results After treatment and in follow-up,the HAMD-17 scores were lower than those before treatment in the two groups(P<0.05),and the scores in the observation group were lower than the control group(P<0.05).After treatment,the total scores and the scores of each factor of PSQI were reduced in the two groups in comparison with those before treatment except for the score of sleep efficiency in the control group(P<0.05);the total PSQI score and the scores for sleep quality,sleep latency,sleep efficiency and daytime dysfunction in the observation group were all lower than those in the control group(P<0.05).In the follow-up,except for the scores of sleep duration and sleep efficiency in the control group,the total PSQI score and the scores of all the other factors were reduced compared with those before treatment in the two groups(P<0.05);the total PSQI score and the scores of sleep quality,sleep latency,sleep duration,sleep efficiency and daytime dysfunction in the observation group were lower than the control group(P<0.05).After treatment,the levels of serum BDNF and CGABA were increased in comparison with those before treatment in the observation group(P<0.05),and the level of serum BDNF was higher than that in the control group(P<0.05).Conclusion Acupuncture relieves depressive mood and improves sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia.The effect mechanism may be related to the regulation of BDNF and GABA levels and the promotion of brain neurological function recovery.