基于弥散张量成像探讨醒脑开窍针法联合舍曲林治疗首发青年抑郁症患者的临床研究

Clinical study on the treatment of first-episode young depression patients with Xingnao Kaiqiao acupuncture combined with sertraline based on diffusion tensor imaging

目的:基于弥散张量成像(DTI)技术从脑白质纤雏束微观结构的改变探讨针刺联合舍曲林治疗抑郁症的有效性和安全性。方法:将60例首发青年抑郁症患者,且为首次接受舍曲林治疗的患者,随机分为针药组和药物组,各30例。药物组采用单纯的舍曲林口服治疗,每天50mg,1天1次。针药组在药物组的基础上联合醒脑开窍针法治疗,1天1次,治疗4周。另以30例健康受试者为健康组。分别于治疗前、治疗4周、采用汉密尔顿抑郁量表(HAMD-17)、评估两组的效果和安全性。同时,分别于治疗前、治疗4周后采用DTI技术测定患者脑区各向异性分数(FA)值。结果:治疗4周后,两组HAMD-17评分均降低( P <0.05),针药组HAMD-17评分低于药物组( P <0.05)。与健康受试者相比,抑郁症共6个脑区FA值发生明显变化,分别为胼胝体压部、左侧扣带束、左侧皮质脊髓束、右侧丘脑辐射、双侧上纵束颞部。治疗前,两组抑郁症患者之间6个脑区的FA值差异无统计学意义( P >0.05):治疗后,针药组胼胝体压部、左侧扣带束、左侧皮质脊髓束、右侧丘脑辐射、双侧上纵束颞部FA值均高于药物组( P <0.05)。结论:针刺能从一定程度上修复某些脑区的脑白质纤维束徽观结构,辅助舍曲林治疗抑郁症利于增强疗效。

Objective: To explore the efficacy and safety of acupuncture combined with sertraline in the treatment of depression based on the changes in the microstructure of white matter fiber tracts using diffusion tensor imaging(DTI) technology. Methods: Sixty first-episode young patients with depression, who were treated with sertraline for the first time, were randomly divided into an acupuncture group and a drug group, with 30cases in each group. The drug group was treated with oral sertraline alone, 50mg per day, once a day. The acupuncture group was treated with Xingnao Kaiqiao acupuncture once a day for 4weeks on the basis of the drug group. Another 30healthy subjects were taken as the healthy group. Before and after 4weeks of treatment, the effect and safety of the two groups were evaluated using the Hamilton Depression Scale(HAMD-17). At the same time, the fractional anisotropy(FA) values of the brain regions of the patients were measured using DTI technology before and after 4weeks of treatment. Results: After 4weeks of treatment, the HAMD-17scores of the two groups were decreased( P <0.05), and the HAMD-17scores of the acupuncture group were lower than those of the drug group( P <0.05). Compared with the healthy subjects, the FA values of 6brain regions of depression showed significant changes, respectively, the splenium of corpus callosum, the left cingulate tract, the left cortical spinal cord tract, the right thalamic radiation, and the temporal part of the bilateral superior longitudinal tract. Before treatment, there was no significant difference in FA values of 6brain regions between the two groups of patients with depression( P >0.05). After treatment, the FA values of splenium of corpus callosum, left cingulate tract, left cortical spinal cord tract, right thalamic radiation and bilateral temporal part of superior longitudinal tract in the acupuncture-drug group were higher than those in the drug group( P <0.05). Conclusion: Acupuncture can repair the morphological structure of white matter fiber tracts in some brain regions to a certain extent, and assisting sertraline in the treatment of depression is conducive to enhancing the curative effect.