疏肝养心针刺法联合文拉法辛对抑郁障碍残留症状及单胺类神经递质水平的影响

目的 抑郁障碍治疗过程中残留症状成为症状复燃、疾病复发的主要因素,本文探索疏肝养心针刺法联合文拉法辛对抑郁障碍患者残留症状及临床痊愈的干预作用,以及对血清单胺类神经递质水平的影响。 方法 将2014年9月—2015年8月杭州市第七人民医院收治住院抑郁障碍患者91例随机分为药物组(单用文拉法辛)45例与针药组(针刺联合文拉法辛)46例,连续治疗8周后,用汉密尔顿抑郁量表(HAMD)评估治疗后抑郁障碍患者残留症状及临床痊愈情况,于治疗前后检测血清5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺结果(DA)水平。采用SPSS 17.0统计软件通过χ2检验、独立样本t检验、单因素方差分析等统计学方法观察2组治疗后残留症状、临床痊愈及血清5-HT、NE、DA水平差异。 结果 与本组治疗前比较,药物组、针药组治疗后HAMD总分及焦虑/躯体化、体重、认知障碍、阻滞及睡眠障碍等5个因子分降低(P<0.01);与治疗后药物组比较,针药组HAMD总分及焦虑/躯体化、睡眠障碍等2个因子分降低(P<0.01或P<0.05),临床痊愈率升高(P<0.05)。与本组治疗前比较,药物组、针药组血清5-HT、NE、DA水平降低(P<0.01);与治疗后药物组比较,针药组血清5-HT、NE、DA水平升高(P<0.01)。 结论 疏肝养心针刺法联合文拉法辛治疗抑郁障碍更有利于缓解患者残留症状、提高临床痊愈率,其作用机制可能与多方面提高血清5-HT、NE、DA水平有关。 

Effect of acupuncture of Soothing-Liver and Nourishing-Heart Method combined with venlafaxine on residual symptoms and serum monoamine neurotransmitter of depressive disorder patients

Objective Residual symptoms are principal elements of symptoms recurrence and diseases relapse in the treatment of depressive disorder, the aim of this article is to explore effects of acupuncture of soothing-liver and nourishingheart method combined with venlafaxine on residual symptoms, clinical recovery and serum monoamine neurotransmitter level in depressive disorder patients. Methods Total 91 depressive disorder patients were randomly divided into drug group (only venlafaxine) and acupuncture-drug group (acupuncture combined with venlafaxine), all of them were treated for 8 consecutive weeks. Hamilton Depression Scale (HAMD) was used to assess residual symptoms and clinical recovery after the treatment, the level of serum monoamine neurotransmitter was tested before and after the treatment. Residual symptoms, clinical recovery and serum 5-HT, NE and DA levels in the two groups were analyzed statistically by χ2 test, independent sample t test and one-way analysis of variance (ANOVA). Results HAMD total score, anxiety/somatization, weight, cognitive disorder, retardation and sleep disorder of drug group and acupuncture-drug group decreased after the treatment (P < 0. 01). As compare with the drug group, HAMD total score, anxiety/somatization and sleep disorder factor scores after the treatment in the acupuncture-drug group were lower (P < 0. 01 or P < 0. 05), however, the clinical recovery rate was higher (P < 0. 05). After the treatment, levels of 5-HT, NE and DA of both groups were decreased (P < 0. 01).When compare with drug group, levels of 5-HT, NE and DA after the treatment in the acupuncture-drug group were higher (P < 0. 01). Conclusion Acupuncture of soothing-liver and nourishing-heart method combined with venlafaxine for depressive disorder can promote the remission of residual symptoms and improve clinical recovery rate, the mechanism may relate to the elevated serum levels of 5-HT, NE and DA.