补益心脾法及安神定志法干预阈下抑郁的临床研究

发布时间：2018-07-29 18:39

【摘要】：背景阈下抑郁(subthreshold depression,SD)是指存在部分抑郁症状,但未达到抑郁症的诊断标准,是一种介于健康和抑郁症之间的中间状态。随着社会竞争的日益加剧和人们生活节奏的加快,阈下抑郁具有很高的发生率。其与抑郁症会造成同样严重的职业功能下降、社会功能损害、医疗负荷增加,以及高比例的患病率、自杀率及致残率,因此引起了各国研究者的广泛重视。中医学中蕴含着丰富的治疗医学和预防医学思想,利用中医药对阈下抑郁人群进行辨证治疗,有利于阻止阈下抑郁向抑郁症下滑,并促进抑郁症向阈下抑郁及健康方向转变,从而提高生活质量,减轻国家、社会经济负担。目的本研究结合导师唐启盛教授的临床经验,选择阈下抑郁的常见证型心脾两虚、心胆气虚证型进行随机、对照、双盲的观察,以汉密尔顿抑郁量表和中医证候评定表进行疗效评定,目的在于验证补益心脾法及安神定志法治疗阈下抑郁的疗效,加深对阈下抑郁的认识。观察阈下抑郁向抑郁症的转化率及自愈率,从而推断中医辨证治疗是否阻碍了阈下抑郁向抑郁症的发展。方法及结果方法:本课题所选对象来源于北京中医药大学3个附属医院及其所属6个社区的门诊患者,观察阈下抑郁的患者,采用随机、对照、双盲原则,观察病例总数120例:心脾两虚型试验组及其对照组各30例,心胆气虚型试验组及其对照组各30例。心脾两虚型试验组给予归脾汤颗粒剂,心胆气虚型试验组给予安神定志丸颗粒剂,两对照组均给予淀粉糊精安慰剂颗粒。疗程均为6周,观察1周、2周、4周、6周的疗效,6周时停药。分析治疗前后各组指标的变化,对调查结果采用统计描述的方法分析。结果:以HAMD减分率及中医疗效指数评估临床疗效:心脾两虚型归脾汤组与心胆气虚型安神定志丸组两试验组的HAMD减分疗效均优于其对照组,组间有显著性差异。抑郁症转化率及阈下抑郁自愈率:两试验组与其对照组在6周时构成比均有明显差异,用χ2检验,P均小于0.05,两者间差异具有统计学意义。通过治疗,第6周时归脾汤试验组阈下抑郁患者中有25%的人回到无抑郁状态;仅有1例转化为抑郁症,考虑不排除有其他原因如日常生活压力改变等所导致;有71.43%的人停留在阈下抑郁状态。其对照组在6周时有79.31%的人停留在阈下抑郁的状态,有13.79%的人进展为抑郁症,有6.90%的人可自愈。第6周时安神定志丸组阈下抑郁患者中有43.33%的人回到无抑郁状态,且无一例转化为抑郁症,尚有56.67%的人停留在阈下抑郁状态;而对照组中有71.43%的人仍停留在阈下抑郁状态,有14.29%的人进展为抑郁症,有14.29%的人发生自愈。结论1.补益心脾法及安神定志法治疗阈下抑郁(心脾两虚型、心胆气虚型)具有良好的疗效,且未见明显的毒副作用;2.两试验组的抑郁症转化率明显低于其对照组,而治愈率明显高于对照组自愈率,说明归脾汤及安神定志丸在阈下抑郁向抑郁症下滑的进程中起到了有效的阻断作用;3.6周时,对照组心脾两虚型、心胆气虚型阈下抑郁分别有6.90%、14.29%的人恢复到无抑郁状态,说明心脾两虚型及心胆气虚型阈下抑郁具有自愈倾向。
[Abstract]:Subthreshold depression (SD) refers to the existence of some depressive symptoms, but the diagnosis of depression is a intermediate state between health and depression. With the increasing social competition and the quickening of people's life rhythm, the subthreshold depression has a high incidence. It is the same as depression. The serious occupational dysfunction, social function damage, the increase of medical load, the high proportion of disease rate, the rate of suicide and the rate of disability have caused widespread attention of the researchers in various countries. There are rich medical and preventive medicine ideas in traditional Chinese medicine, and it is beneficial to prevent and treat the subliminal depressive people by using traditional Chinese medicine. Subliminal depression to depression, and to promote depression to subliminal depression and health direction, so as to improve the quality of life, reduce the national, social and economic burden. The objective of this study, combined with the clinical experience of Professor Tang Qisheng, selected the common syndrome of subliminal depression of the heart and spleen two deficiency, heart and gallbladder deficiency syndrome of random, control, double blind view To evaluate the effect of the Hamilton depression scale and the TCM syndrome assessment form, the purpose is to verify the curative effect of the tonifying heart and spleen method and Anshen determination method in the treatment of subliminal depression, deepen the understanding of subliminal depression, observe the conversion rate and self healing rate of subliminal depression to depression, and infer whether TCM syndrome differentiation therapy hinders subthreshold depression. The development of depression. Methods and results: the subjects were selected from 3 affiliated hospitals of Beijing University of Chinese Medicine and 6 outpatients in their affiliated communities. The patients with subthreshold depression were observed by random, controlled and double blindness principle, and the total number of cases was observed in 120 cases, 30 cases of heart spleen two deficiency test group and the control group, and the heart and gallbladder deficiency type test. The test group and the control group were 30 cases. The experimental group of the two deficiency of the heart and spleen was given the granule of GUI PI decoction, the experimental group of the heart and the biliary Qi deficiency group was given Anshen Ding Zhi pill and the two control groups were given the starch dextrin placebo granules. The treatment course was 6 weeks, the curative effect of 1 weeks, 2 weeks, 4 weeks, 6 weeks was stopped. The changes of the indexes before and after the treatment were analyzed and the investigation was conducted to investigate the changes of the indexes before and after the treatment. Results the results were analyzed by the method of statistical description. Results: the HAMD reduction rate and the traditional Chinese medicine effect index were used to evaluate the clinical effect: the HAMD reduction effect of the two deficiency group and the heart and spleen qi deficiency group of Anshen Shen Zhi pill group was better than that of the control group. There was a significant difference between the group and the group. The conversion rate of depression and the self healing rate of subliminal depression were two test groups. The composition ratio of the control group was significantly different at 6 weeks, with the x 2 test, P was less than 0.05, and the difference between the two was statistically significant. Through treatment, 25% of the patients with subthreshold depression were returned to the non depressive state at sixth weeks. Only 1 cases were converted to depression, and other reasons were not excluded, such as daily stressful changes. 71.43% of the people stayed in the state of subliminal depression. In the control group, 79.31% of them stayed in the state of subliminal depression at 6 weeks, 13.79% of them developed depression, and 6.90% were able to heal themselves. At the time of the sixth weeks, 43.33% of the patients with subthreshold depression in Anshen Ding pill group returned to no depression, and none of them turned into depression. 56.67% of the people remain in the state of subliminal depression, while 71.43% of the control group still remain in the state of subliminal depression, 14.29% of them are depressive and 14.29% have self-healing. Conclusion 1. tonifying heart and spleen method and Anshen determination method have good curative effect on subliminal depression (heart and spleen two deficiency, heart qi deficiency type), and there is no obvious effect. The conversion rate of depression in the 2. two test group was significantly lower than that of the control group, and the cure rate was significantly higher than that of the control group, indicating that the Gupi Decoction and Anshen Ding Zhi pill played an effective blocking role in the process of subthreshold depression to depression, and at 3.6 weeks, the group of heart and spleen two deficiency and the heart and gallbladder deficiency type subliminal depression were respectively in the 3.6 weeks. 6.90% or 14.29% of them recovered to the state of no depression, indicating that the subthreshold depression of the heart spleen two deficiency type and the heart gallbladder Qi deficiency type had self healing tendency.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

【参考文献】