调气解郁针法联合西药治疗难治性抑郁症临床研究

Clinical Study on Qi-Regulating and Depression-Resolving Acupuncture Method Combined with Western Medicine for Treatment-Resistant Depression

目的:观察调气解郁针法联合西药治疗难治性抑郁症(TRD)的临床疗效及对脑功能活动的影响。方法:按随机数字表法将40例TRD患者分为试验组与对照组各20例。对照组给予常规西药治疗,试验组在对照组基础上联用调气解郁针法治疗。比较2组治疗前后24项汉密尔顿抑郁量表(HAMD24)评分及试验组治疗前后视觉模拟评分法(VAS)评分;比较2组临床疗效及治疗前后静息态功能磁共振(rs-fMRI)扫描差异结果。提取差异脑区低频振幅(ALFF)值与HAMD24评分差值、VAS评分差值作Pearson相关性分析。结果:治疗后,试验组应答率高于对照组(P<0.05)。治疗后,2组HAMD24评分均低于治疗前(P<0.05),试验组VAS评分高于治疗前(P<0.05),且试验组治疗后HAMD24评分低于对照组(P<0.05)。治疗后,试验组主要正激活的脑区有左侧小脑脚、左侧颞中回、右侧颞中回、左侧尾状核,负激活的脑区有右侧距状裂周围皮层、右侧尾状核、右侧丘脑;对照组主要正激活的脑区有左侧颞中回、左侧颞下回、右侧眶部额上回、左侧额中回,负激活的脑区有右侧小脑、左侧楔前叶、右侧额中回。试验组左侧尾状核及左侧颞中回的ALFF值与HAMD24评分差值呈正相关(r=0.619,P<0.05;r=0.662,P<0.05);左侧尾状核的ALFF值与VAS评分差值呈负相关(r=-0.513,P<0.05);HAMD24评分差值与VAS评分差值呈负相关(r=-0.567,P<0.05)。对照组未发现相关性。结论:调气解郁针法联合西药治疗TRD疗效确切,能够激活患者左侧尾状核的ALFF信号强度,提高疼痛感知阈值,修正异常的认知和情感控制过程,增强与其他脑区的连接,有效缓解抑郁症状。

Objective:To observe the clinical effect of qi-regulating and depression-resolving acupuncture method combined with western medicine on treatment-resistant depression(TRD)and its effect on brain function.Methods:A total of 40 TRD patients were divided into the trial group and the control group according to the random number table method,with 20 cases in each group.The control group was given routine western medicine for treatment,and the trial group was additionally treated with qi-regulating and depression-resolving acupuncture method based on the treatment of the control group.The scores of Hamilton Depression Scale-24(HAMD24)were compared before and after treatment between the two groups and of Visual Analogue Scale(VAS)were compared before and after treatment in the trial group;the clinical effects and differential results of resting-state functional magnetic resonance imaging(rs-fMRI)scanning were compared before and after treatment between the two group.The differential amplitude of low-frequency fluctuation(ALFF)values of brain regions and differential values of scores of HAMD24 and VAS were extracted for Pearson correlation analysis.Results:After treatment,the rate of response in the trial group was higher than that in the control group(P<0.05).After treatment,the HAMS24 scores in the two groups were lower than those before treatment(P<0.05),and the VAS scores in the trial group was higher than that before treatment(P<0.05),and the HAMD-24 scores in the trial group were lower than those in the control group(P<0.05).After treatment,the main activated brain regions in the trial group included left cerebellar peduncle,left middle temporal gyrus,right middle temporal gyrus,and left caudate nucleus and the deactivated brain regions included peripheral cortex of right fissure calcarina,right caudate nucleus and right thalamus;the main activated brain regions in the control group include left middle temporal gyrus,left inferior temporal gyrus,superior frontal gyrus of right pars orbitalis and left middle frontal gyrus,and the deactivated brain regions included right cerebellum,left precuneus and right middle frontal gyrus.The ALFF value of time series of left caudate nucleus and left middle temporal gyrus were positively correlated with the differential value of HAMD24 in the trial group(r=0.619,P<0.05;r=0.662,P<0.05);the ALFF value of left caudate nucleus was negatively correlated with the differential value of VAS scores(r=-0.513,P<0.05);the differential value of HAMD24 scores was negatively correlated with that of VAS scores(r=-0.567,P<0.05).No correlation was found in the control group.Conclusion:The therapy of qi-regulating and depression-resolving acupuncture method combined with western medicine has a definite curative effect on TRD,which can activate the ALFF signal strength of left caudate nucleus of patients,increase the threshold of pain perception,correct the abnormal perception and emotion control process,enhance the connection with other brain regions and effectively relieve the symptoms of depression.