通督治郁针法对脑卒中后抑郁患者血清5-HT,NE和BDNF水平影响的研究

Study of Tongduzhiyu acupuncture in treating patients of PSD by influencing 5-HT,NE and BDNF in serum

目的观察通督治郁针法对脑卒中后抑郁(PSD)患者的临床疗效以及其对PSD患者血清5-羟色胺(5-HT)、去甲肾上腺素(NE)和脑源性神经营养因子(BDNF)水平的影响,探讨其可能的疗效作用机制。方法将60例PSD患者随机分为通督治郁组、常规针刺组和西药组各20例,3组患者均给予脑血管疾病的一般治疗。其中通督治郁组选取人中、印堂、神庭、百会、风府、内关、神门、合谷和太冲,常规针刺组选取治疗中风的常规穴位,西药组口服氟西汀胶囊,3组疗程均为8周。所有患者分别在治疗前、后,予以汉密尔顿抑郁量表(HAMD)评分,同时测定患者血清5-HT,NE和BDNF水平。结果治疗后3组HAMD评分较治疗前均显著降低(P<0.05),通督治郁组评分显著低于其他2组(P<0.05);通督治郁组、常规针刺组、西药组总有效率分别为95.0%,65.0%,70.0%,经统计学分析,通督治郁组总有效率明显高于其他2组(P<0.05);治疗后3组血清5-HT,NE,BDNF水平均较治疗前显著升高(P<0.05),通督治郁组升高幅度高于其他2组(P<0.05)。结论通督治郁针法可以显著改善PSD患者的抑郁症状并提高患者血清5-HT,NE和BDNF水平,其疗效机制可能与血清5-HT,NE和BDNF水平上调有关。

Objective By observing clinical therapeutic effect of Tongduzhiyu( to treat depression by dredging Du collateral) acupuncture on post-stroke depression( PSD) and the influnence on 5-HT,NE and BDNF,to explore the possible therapeutic mechanism. Methods 60 patients of PSD were randomly divided into treatment group,routine acupuncture group and control group,20 cases each. All groups were given general treatment for cerebrovascular diseases.The treatment group selected the acupoints of Renzhong( DU 26),Yintang( EX-HN3),Shenting( DU 24),Baihui( DU 20),Fengfu( DU 16),Neiguan( PC 6),Shenmen( HT 7),Hegu( LI 4) and Taichong( LR 3). Routine acupuncture group selected routine acupoints for the treatment of stroke.Western medicine group took fluoxetine capsules orally. The treatment period was 8 weeks. All patients were scored by Hamilton depression scale( HAMD) before and after the treatment respectively and levels of 5-HT,NE and BDNF were determined.Results After treatment,the HAMD rating scores of three groups significantly reduced( P<0.05); the treatment group's score was significantly lower than the other groups( P<0.05). The total effective rates are 95.0%,6 5.0%and 70.0% respectively; the treatment group's was better than the others'( P <0.05). After treatment,levels of5-HT,NE,BDNF in serum of three groups were evidently increased( P <0.05); the treatment group's level was significantly higher than the others'( P<0.05). Conclusion Tongduzhiyu acupuncture can improve the PSD patients' depressive symptoms obviously and increase the levels of 5-HT,NE and BDNF. The theraputic mechanism may be related to the rising of 5-HT,NE and BDNF in serum.