MBEFT治疗未服药的首发抑郁的疗效评定及电生理机制研究

发布时间：2018-06-23 14:57

  本文选题：抑郁症 + 心理干预　； 参考：《重庆医科大学》2012年博士论文

【摘要】：【背景】抑郁症是当今在全球严重影响人类健康的重大疾病，其发病率、复发率、自杀率、犯罪率高。大量研究显示，抑郁症患者对传统治疗（包括药物治疗、ECT、CBT等）的依从性较低，其主要原因是传统治疗的疗程长、费用高、副作用大、治疗过程中患者面临多种障碍等。开发和验证新的安全、经济、快捷、易行的治疗技术既是满足抑郁症临床治疗的迫切需要，更成为现代医学研究的热点和难点。 文献报道用MB和EFT分别治疗抑郁症后均能一定程度缓解患者症状，但整合两种技术治疗抑郁症是否有效抑或疗效更佳却极少报道。本研究希望通过观察MBEFT治疗不同类型的抑郁症的疗效和安全性，并初步探讨其治疗抑郁症的电生理机制，为尝试研发抑郁症治疗的新技术奠定基础。 【目的】（1）评价MBEFT干预不同类型的门诊首发抑郁症患者的临床效果。（2）验证MB治疗抑郁症的疗效。（3）比较MBEFT、MB对抑郁症不同临床症候群的改善效果，为今后在临床个性化运用提供指导。（4）通过对抑郁症患者心理干预前后HRV的变化，探讨MBEFT、MB对抑郁症患者自主神经系统的作用规律。 【方法】 第一部分为临床试验研究。研究对象为按照DSM-Ⅳ标准诊断为首次发作的抑郁症患者，年龄在18～60岁共51例，以病人就诊顺序随机入组的原则，分为MBEFT治疗组25例和MB治疗组26例；选取正常对照组（即HAMD-17项总分＜7，其他条件与治疗组完全匹配)25人，随机分为MBEFT对照组14例和MB对照组11例。对所有被试在履行知情同意程序后采集临床资料，并使用HAMD、SDS、SAS临床量表评定，作为治疗前（基线期）病情的严重程度和临床症侯群的评定。MBEFT治疗组和对照组接受每天1次，每次40分钟的MBEFT干预，连续7天。MB治疗组和对照组的接受每天1次，每次30分钟的MB干预，连续7天。每次心理干预都在神经科学中心心理治疗室由作者本人完成。于治疗结束、随访1周、2周、1月、3月、6月，对所有被试分别使用HAMD、SDS、SAS临床量表评定，评价近期、中期疗效。 第二部分为电生理试验部分。参加第一部分实验的所有被试于第1天（治疗前），使用RM6240多道生理信号记录仪记录静息态下5min的ECT，作为HRV的基线值。分别于第3、5、8天（治疗结束）、第15天（随访第1周）、第35天（随访1月）时采集静息态下的心电记录5min。使用RM6240多道生理信号采集处理系统做HRV频域分析。根据各受试组不同时点的HRV指标（LF、HF、LF/HF）的变化规律，反映交感-副交感神经系统的功能状态及平衡性，探讨MBEFT、MB影响抑郁症患者自主神经活动的作用规律。 【结果】第一部分临床评定结果 （1）抑郁症患者中女性显著多于男性，共病焦虑者高达70%，共病组的HAMD均分显著高于单纯抑郁症组。与MB治疗抑郁症相比，MBEFT治疗依从性高，但失访率也高，其中男性失访率远远高于女性。 （2）两种技术治疗抑郁症均有效，两种方法在改善临床症状方面无统计学差异。治疗结束时MBEFT组52%的患者可达临床痊愈，，36%的患者可达显著水平，12%的患者有改善；MB组60%可达到临床痊愈水平，40%为临床显著改善。 （3）MBEFT治疗结束后疗效稳定，随访至3月、6月疗效进一步显现，HAMD评分可达正常对照组水平。MB治疗结束至随访3月，疗效进一步显著；随访至6月，疗效有所减弱；随访过程中， HAMD评分始终不能降至正常对照组水平，病人有部分症状残存，预示随着时间推移，部分病例有复然的趋势。 （4）MBEFT适用于不同严重程度的抑郁症的治疗。1个疗程治疗结束时显示中度组症状改善情况优于轻度、重度两组；但随访1月比较，重度组疗效优于轻、中度组；随访6月比较，三组组间无差异。 （5）MB适用于不同严重程度的抑郁症的治疗。1个疗程治疗结束时显示，中度组症状改善情况可达显效水平，轻度、重度两组均可达到临床痊愈水平。随访至6月，中组、重度组疗效稳定，而轻度组疗效有所下降，提示有复燃的可能。 （6）两种疗法对于抑郁症临床各症侯群均有改善作用。治疗结束及随访中，两治疗组的认知障碍因子、迟缓因子的分值相对稳定，组间差异不显著（p＞0.05）。治疗焦虑"躯体化因子、睡眠障碍因子方面，MBEFT中期疗效明显优于MB组。MB中期随访结果预示病人的躯体化和睡眠障碍方面有复燃趋势。 （7）两种疗法对于改善单纯抑郁者、共病焦虑者的抑郁情绪均有效。 MBEFT治疗抑郁共病焦虑的早期疗效较好，但随访中HAMD分值有波动，而对单纯抑郁组疗效于随访1周有波动，随访1月、3月、6月都很稳定。MB对于抑郁共病焦虑和单纯抑郁的患者同样有效。两组间HAMD在随访1周、1月差异显著。MBEFT治疗抑郁共病焦虑者的焦虑情绪与MB效果无差异。 （8）医患双方在抑郁严重程度的评定上具有较好的一致性。也表明HAMD和SDS工具评定抑郁的有效。 （9）从自评（SDS、SAS）结果显示，MBEFT、MB对于改善抑郁患者的抑郁、焦虑情绪均有效，且疗效比较稳定。随访至3月，两种疗法对缓解焦虑的疗效更加显著；但MBEFT的疗效略优于MB。MBEFT对抑郁症（特别是共病焦虑的抑郁）疗效优于MB。 第二部分电生理实验结果 （1）1个疗程的MBEFT、MB干预均能显著降低抑郁症患者的LF值，达到正常人的水平；随访1周、1月LF值基本稳定。实验过程中两个正常对照的LF值无显著变化（p0.05）。 （2）1个疗程的MBEFT、MB的干预均能显著提升抑郁症患者的HF值，使之达到正常人水平；两种干预在随访中虽都有波动，但幅度不太大，差异不显著。MB干预提高抑郁症患者的HF值更明显，但差异无统计学意义。与MBEFT组，MB组治疗结束到随访1周，临床痊愈率、显效率均高于MBEFT组。两组间HF的变化幅度与临床疗效的判断结果比较一致。实验过程中两个正常对照的HF值无显著变化（p0.05）。 （3）1个疗程的MBEFT、MB干预显著降低抑郁症患者的LF/HF值，使之达到正常人水平；随访1周、1月LF/HF值比较稳定。随访中这种差异逐渐消失。实验过程中两个正常对照的LF值无显著变化（p0.05）。【结论】 1. MBEFT、MB对不同严重程度的抑郁症的抑郁、焦虑情绪改善均有效，但MBEFT对重度抑郁及抑郁共病焦虑者疗效更佳，疗效稳定且持久。MB治疗抑郁后仍有部分残存症状（特别是焦虑/躯体化和睡眠障碍方面），预示有复燃的可能。 2. MBEFT、MB影响HF的变化幅度与临床疗效的判断比较一致，提示HF可以作为临床疗效评价的一个灵敏的、客观的、量化的指标。MBEFT通过提高副交感神经的兴奋性，调节交感-副交感神经系统的平衡而缓解抑郁症状。
[Abstract]:Background of the Invention Depression is a major disease affecting human health in the world today . Its incidence , recurrence rate , suicide rate and crime rate are high . A large number of studies show that depression patients have low compliance with traditional therapy ( including drug therapy , ECT , cbt , etc . ) . The main reason is that the treatment course is long , the cost is high , the side effect is large , and the patient is faced with various obstacles in the course of treatment . The new safety , economic , shortcut and easy treatment technique is not only the urgent need to satisfy the clinical treatment of depression , but also becomes the hot spot and difficult point of modern medical research .

It is hoped that the therapeutic effect and safety of different types of depression can be achieved by observing the therapeutic effect and safety of the two techniques in the treatment of depression , and the electrophysiological mechanism for the treatment of depression is also discussed .

Objective : ( 1 ) To evaluate the clinical effect of MBTA on depressive patients with different types of outpatients . ( 2 ) To evaluate the effect of MB on depression in patients with depression . ( 3 ) To compare the effects of MBTs and MB on different clinical symptoms of depression . ( 4 ) To explore the effect of MBTs and MB on autonomic nervous system of patients with depression .

Methodology

The first part was the study of clinical trials . The subjects were diagnosed as depressive patients with first episode according to DSM - IV criteria , 51 patients aged between 18 and 60 years , and randomly entered into the group according to the sequential order of the patients , including 25 patients with MBTT treatment group and 26 MB treatment groups .
Twenty - five patients were randomly divided into two groups : control group ( n = 14 ) and control group ( n = 11 ) .

The second part is the electrophysiological test part . All the subjects who participated in the first part of the experiment were tested on the first day ( before treatment ) , and the ECT in the resting state was recorded by the RM6240 multi - channel physiological signal recorder for 5min . The frequency domain of HRV was measured by using the RM6240 multi - channel physiological signal acquisition and processing system .

The results of clinical evaluation of the first part of the results

( 1 ) There were more than 70 % of the patients with depression , 70 % of the patients with comorbid anxiety and 70 % of the patients with comorbid anxiety . Compared with the patients treated with MB , the treatment compliance was high , but the rate of follow - up was also high , among which the male lost rate was much higher than that of women .

( 2 ) Both techniques were effective in the treatment of depression . There were no statistical differences between the two methods in the improvement of clinical symptoms . 52 % of patients at the end of treatment could be recovered clinically , 36 % had a significant level and 12 % had improvement ;
60 % of MB group can achieve clinical cure level , 40 % is clinically significant improvement .

( 3 ) After treatment , the curative effect was stable after the end of the treatment , and the curative effect was further improved in the follow - up to March and June .
Follow - up to June showed a decrease in efficacy ;
During the follow - up period , the scores of these patients could not be reduced to the normal control group , and the patients had partial symptoms remaining , which indicated that some cases had a tendency to recover over time .

( 4 ) MBTs was suitable for the treatment of depression with different severity . At the end of treatment , the symptoms of moderate group were better than that of mild and severe groups .
However , the efficacy of severe group was better than that of mild and moderate group in the follow - up period .
There was no difference among the three groups after 6 months of follow - up .

( 5 ) MB is suitable for the treatment of depression with different severity . At the end of the course of treatment , the improvement of moderate group symptoms can reach the clinical cure level . After the follow - up to June , the effect of moderate group and severe group is stable , while the curative effect of mild group is decreased , indicating the possibility of reburning .

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