调气解郁法针刺治疗难治性抑郁症:随机对照试验

Tiaoqi Jieyu acupuncture for treatment-resistant depression:a randomized controlled trial

目的:观察调气解郁法针刺对难治性抑郁症(TRD)临床症状的影响,并探讨患者针刺痛觉敏感性与症状改善的关系.方法:将78例TRD患者随机分为观察组(39例,脱落3例)和对照组(39例,脱落4例).对照组患者根据精神科医生的治疗方案(至少有一种药物为5-羟色胺再摄取抑制剂类药物)服用药物;观察组在对照组的基础上予调气解郁法针刺治疗,穴取百会、印堂、阳陵泉、太冲、合谷、内关、阴陵泉和足三里等,每周治疗3次,两组均治疗8周.于治疗8周后评定两组患者汉密尔顿抑郁量表24项(HAMD-24)评分应答率;分别于治疗前,治疗4、8周后及治疗结束后12周(随访)比较两组患者HAMD-24、汉密尔顿焦虑量表(HAMA)评分;于第1次治疗后及治疗8周后评定观察组患者针刺疼痛视觉模拟量表(VAS)评分,并将观察组患者第1次治疗后VAS评分与治疗前HAMD-24评分、病程进行相关性分析,VAS评分差值(治疗8周后-第1次治疗后)与HAMD-24评分差值(治疗前-治疗8周后)进行相关性分析.结果:治疗8周后,观察组患者HAMD-24评分应答率为52.8%(19/36),高于对照组的17.1%(6/35,P<0.001).与治疗前比较,两组患者治疗4、8周后及随访时HAMD-24、HAMA评分均降低(P<0.05),且观察组低于对照组(P<0.05).治疗8周后,观察组患者针刺疼痛VAS评分为(5.28±2.13)分,高于第1次治疗后的(3.33±1.62)分(P<0.001).观察组患者第1次治疗后VAS评分与治疗前HAMD-24评分呈负相关(r=-0.486,P=0.003);观察组患者针刺疼痛VAS评分与病程无相关性(P>0.05).治疗8周后,观察组患者VAS评分差值与HAMD-24评分差值呈正相关(r=0.514,P=0.001).结论:调气解郁法针刺可以改善TRD患者抑郁及焦虑情绪,症状改善与恢复针刺痛觉敏感性有关.

Objective To observe the effect of Tiaoqi Jieyu(regulating qi and relieving depression)acupuncture on the clinical symptoms of treatment-resistant depression(TRD),and to explore the relationship between the acupuncture pain sensitivity and symptom's improvement.Methods A total of 78 patients with TRD were randomly divided into an observation group(39 cases,3 cases dropped off)and a control group(39 cases,4 cases dropped off).The patients in the control group were treated with medications according to the treatment plan of psychiatrists(at least one medication was 5-hydroxytryptamine reuptake inhibitor).On the basis of the control group,the patients in the observation group were treated with Tiaoqi Jieyu acupuncture,and Baihui(GV 20),Yintang(GV 24^(+)),Yanglingquan(GB 34),Taichong(LR 3),Hegu(LI 4),Neiguan(PC 6),Yinlingquan(SP 9)and Zusanli(ST 36),etc.were selected.The acupuncture was given three times a week.Both groups were treated for 8 weeks.After 8-week treatment,the response rate of Hamilton depression scale-24(HAMD-24)score after was evaluated in the two groups.The scores of HAMD-24 and Hamilton anxiety scale(HAMA)were compared between the two groups before treatment,after 4,8-week treatment and 12 weeks after treatment(follow-up).After the first treatment and 8-week treatment,the visual analogue scale(VAS)score in the observation group was evaluated,and the correlation between VAS score after the first treatment and HAMD-24 score before treatment,between VAS score after the first treatment and the course of disease in the observation group was analyzed,and the correlation between difference of VAS after 8-week treatment and after the first treatment and difference of HAMD-24 score before treatment and after 8-week treatment was analyzed.Results After 8-week treatment,the response rate of HAMD-24 score in the observation group was 52.8%(19/36),higher than 17.1%(6/35)in the control group(P<0.001).Compared before treatment,the scores of HAMD-24 and HAMA in the two groups were decreased after 4-week treatment,8-week treatment and in follow-up(P<0.05),and those in the observation group were superior to the control group(P<0.05).After 8-week treatment,the acupuncture pain VAS score in the observation group was(5.28±2.13)points,which was higher than(3.33±1.62)points after the first treatment(P<0.001).There was a negative correlation between VAS score after the first treatment and HAMD-24 score before treatment in the observation group(r=-0.486,P-0.003);there was no correlation between acupuncture pain VAS score after the first treatment and the course of disease in the observation group(P>0.05).After 8-week treatment,there was a positive correlation between the difference of VAS score and the difference of HAMD-24 score in the observation group(r=0.514,P-0.001).Conclusion Tiaoqi Jieyu acupuncture could improve the depression and anxiety in patients with TRD,and the symptom's improvement is related to the recovery of acupuncture pain sensitivity.