针刺迷走神经耳支结合抗抑郁药治疗抑郁症的临床研究

发布时间：2018-06-21 11:43

本文选题：迷走神经 + 迷走神经耳支　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:以耳针作为治疗手段,观察刺激迷走神经耳支(ABVN)对抑郁症患者症状和血清炎性因子的影响并探讨其潜在机制,为临床针灸治疗抑郁症方案的建立提供新的思路和手段。方法:本研究中的53例抑郁症患者均来自南京脑科医院医学心理科。根据入组时间的先后进行编号,利用随机数字表法随机分为耳针+药物组(针药组)30例和药物组(对照组)23例,治疗周期均为2周。所有患者均给予抗抑郁药(SSRIs和SNRIs)及安定类药物治疗以控制病情;针药组采用毫针刺激迷走神经耳支分布区,每次留针4小时,每日一次,每周五次。治疗前后分别评估患者病情并采集静脉血,记录量表评分总分及各因子分(汉密尔顿抑郁量表HAMD-17)和血液炎性因子(CRP、IL-1、IL-6和TNF-α)水平,治疗完成后对比两组患者治疗前后各项评分和指标的变化。结果:(1)临床疗效:针药组的愈显率和有效率明显优于对照组(P0.01);(2)抑郁症状:针药组治疗前后显著改善了 HAMD总分和焦虑/躯体化、睡眠障碍、体重和阻滞四项因子分(P0.01);与药物组相比,针药组对HAMD总分和焦虑/躯体化、睡眠障碍两项因子分的改善效果显著(P0.01);(3)血清炎性因子水平变化:治疗前后两组患者血清CRP、IL-1、IL-6和TNF-α的水平均未见明显改变(P0.05);(4)抑郁症病情和血清炎性因子水平相关性:IL-6变化率与HAMD总分减分率之间存在显著的中等相关性(P0.01),其中,与焦虑/躯体化、阻滞、睡眠障碍三项因子分的减分率间存在中等相关性(P0.05);TNF-α变化率与HAMD总分减分率强相关(P0.01),其中,与焦虑/躯体化、阻滞两项因子分的减分率强相关(P0.01),与体重、睡眠障碍两项因子分的减分率间存在显著中等相关性(P0.01)。结论:(1)针刺ABVN结合药物治疗抑郁症在2周内的临床疗效显著优于单纯抗抑郁剂治疗。(2)单一用药和加用ABVN针刺治疗在2周内均降低了抑郁症患者HAMD总分和除认知外的4项因子分;而针刺ABVN结合药物治疗对HAMD总分和焦虑/躯体化症状和睡眠障碍2项因子分的的改善优于单纯抗抑郁剂治疗。(3)血清IL-6和TNF-α水平与抑郁症病情呈正相关性,尤其与焦虑/躯体化症状和睡眠障碍方面的症状相关。(4)无论是单一用药还是加用ABVN针刺治疗2周后,抑郁症患者血清相关炎性因子水平均未发生明显变化。
[Abstract]:Objective: to observe the effect of stimulation of auricular branch of vagus nerve (ABVN) on symptoms and serum inflammatory factors in patients with depression and to explore its potential mechanism, and to provide new ideas and means for the establishment of clinical acupuncture and moxibustion in the treatment of depression. Methods: 53 patients with depression in this study were from Department of Medical Cardiology, Nanjing brain Hospital. According to the number of the time of entry, the patients were randomly divided into auricular acupuncture group (30 cases) and drug group (23 cases). The treatment period was 2 weeks. All patients were treated with antidepressants SSRIs and SNRIsand diazepam drugs to control the disease, and the acupuncture and medicine group were treated with filiform acupuncture to stimulate the distribution area of the auricular branch of vagus nerve, every time for 4 hours, once a day, five times a week. Before and after treatment, the patients' condition was evaluated and venous blood was collected, the total score of the scale, the scores of each factor (Hamilton Depression scale HAMD-17) and the levels of IL-6 and TNF- 伪 were recorded. After treatment, the changes of scores and indexes before and after treatment were compared between the two groups. Results (1) Clinical efficacy: the effective rate and the effective rate of acupuncture and medicine group were significantly better than that of control group (P 0.01) depressive symptoms: the total score of Hamd, anxiety / somatization, sleep disorder were significantly improved before and after treatment in acupuncture and medicine group. Compared with the drug group, the total score of Hamd and anxiety / somatization in the acupuncture and medicine group were higher than those in the drug group. The change of serum inflammatory factor level: before and after treatment, the serum levels of CRPnIL-1- IL-6 and TNF- 伪 in patients with sleep disorders were significantly improved (P 0.05) the correlation between the level of serum inflammatory factors and the level of serum inflammatory factors was not significantly changed. (P0.05TNF- 伪) the relationship between the level of serum inflammatory factors and the level of serum inflammatory factors was not significantly changed in the two groups before and after treatment. There was a significant moderate correlation between the rate of change and the total score reduction rate of Hamd, among which, There was a moderate correlation between the decrease rate of TNF- 伪 and anxiety / somatization, block and sleep disorder. The change rate of TNF- 伪 was strongly correlated with the total score of Hamd (P 0.01). There was a significant moderate correlation between the two factor scores of sleep disorder. Conclusion the clinical efficacy of acupuncture combined with ABVN in the treatment of depression in 2 weeks was significantly better than that of antidepressant alone and combined with ABVN in 2 weeks. The total score of Hamd and the four factor scores except cognition were decreased within 2 weeks. The improvement of total score of Hamd, anxiety / somatization symptom and sleep disorder by acupuncture ABVN combined with drug therapy was better than that of antidepressant therapy alone. The serum levels of IL-6 and TNF- 伪 were positively correlated with the condition of depression. Especially the symptoms related to anxiety / somatization and sleep disorder.) there was no significant change in serum levels of inflammatory factors in patients with depression after 2 weeks of treatment with either single medication or ABVN acupuncture.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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