针刺干预抑郁的临床评价与中枢机制研究进展
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摘要
回顾了近10余年来在国际期刊发表的针刺干预抑郁症的相关研究文献,探讨针刺治疗抑郁的临床和机制研究中所取得的成果与发展方向。资料显示,针刺干预抑郁具有肯定的疗效与独特的优势,针刺干预抑郁症的研究在近些年取得了重要进展,尤其是在HPA轴、神经递质、信号通路、炎症反应和基因表达等方面。但具体机制尚不清楚,针刺对抑郁的研究有待进一步完善。
This article reviews related research literature on acupuncture intervention in depression published in international journals in recent more than 10 years and explore achievements in and the development direction of clinical and mechanism studies on acupuncture treatment for depression. The data show that acupuncture has a definite therapeutic effect and unique advantage in its intervention in depression. In recent years, studies on acupuncture intervention in depression made important progress, especially in the HPA axis, neurotransmitters, signaling pathways, inflammatory reactions and gene expressions. But the specific mechanisms are still unclear. Studies on acupuncture for depression remain to be further improved.
This article reviews related research literature on acupuncture intervention in depression published in international journals in recent more than 10 years and explore achievements in and the development direction of clinical and mechanism studies on acupuncture treatment for depression. The data show that acupuncture has a definite therapeutic effect and unique advantage in its intervention in depression. In recent years, studies on acupuncture intervention in depression made important progress, especially in the HPA axis, neurotransmitters, signaling pathways, inflammatory reactions and gene expressions. But the specific mechanisms are still unclear. Studies on acupuncture for depression remain to be further improved.
引文
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[2]Chen J,Lin W,Wang S,et al.Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat:the Symptom Checklist-90 scores[J].Neural Regen Res,2014,9(2):213-222.
[3]Sun H,Zhao H,Ma C,et al.Effects of electroacupuncture on depression and the production of glial cell linederived neurotrophic factor compared with fluoxetine:a randomized controlled pilot study[J].J Altern Complement Med,2013,19(9):733-739.
[4]Zhang ZJ,Chen HY,Yip KC,et al.The effectiveness and safety of acupuncture therapy in depressive disorders:systematic review and meta-analysis[J].J Affect Disord,2010,124(1-2):9-21.
[5]Qian X,Zhou X,You Y,et al.Traditional Chinese acupuncture for poststroke depression:a single-blind double-simulated randomized controlled trial[J].J Altern Complement Med,2015,21(12):748-753.
[6]Li M,Zhang B,Meng Z,et al.Effect of Tiaoshen Kaiqiao acupuncture in the treatment of ischemic poststroke depression:a randomized controlled trial[J].JTradit Chin Med,2017,37(2):171-178.
[7]Manber R,Schnyer RN,Allen JJB,et al.Acupuncture:a promising treatment for depression during pregnancy[J].J Affect Disord,2004,83(1):89-95.
[8]Engel CC,Cordova EH,Benedek DM,et al.Randomized effecttiveness trial of a brief course of acupuncture for posttraumatic stress disorder[J].Med Care,2014,52(12 Suppl 5):S57-S64.
[9]Wang Y,Hu YP,Wang WC,et al.Clinical studies on treatment of earthquake-caused posttraumatic stress disorder using electroacupuncture[J].Evid Based Complement Alternat Med,2012,2012:431279.
[10]段冬梅,图娅,陈利平,等.Efficacy evaluation for depression with somatic symptoms treated by electroacupuncture combined with Fluoxetine[J].J Tradit Chin Med,2009,29(3):167-173.
[11]刘兰英,陆倩,王玲玲,等.Influence of electro-acupuncture on the side effects of fluoxetine on depression patients[J].J Tradit Chin Med,2009,29(4):271-274.
[12]Chan YY,Lo WY,Yang SN,et al.The benefit of combined acupuncture and antidepressant medication for depression:a systematic review and meta-analysis[J].JAffect Disord,2015,176:106-117.
[13]Varghese FP,Brown ES.The Hypothalamic-PituitaryAdrenal axis in major depressive disorder:a brief primer for primary care physicians[J].Prim Care Companion JClin Psychiatry,2001,3(4):151-155.
[14]Thornton LM,Andersen BL,Blakely WP.The pain,depression,and fatigue symptom cluster in advanced breast cancer:covariation with the hypothalamicpituitary-adrenal axis and the sympathetic nervous system[J].Health Psychol,2010,29(3):333-337.
[15]Chen F,Zhou L,Bai Y,et al.Hypothalamic-pituitaryadrenal axis hyperactivity accounts for anxiety-and depression-like behaviors in rats perinatally exposed to bisphenol A[J].J Biomed Res,2015,29(3):250-258.
[16]Le JJ,Yi T,Qi L,et al.Electroacupuncture regulate hypothalamic-pituitary-adrenal axis and enhance hippocampal serotonin system in a rat model of depression[J].Neurosci Lett,2016,615:66-71.
[17]Tanahashi N,Takagi K,Amagasu N,et al.Effect of acupuncture stimulation on rats with depression induced by water-immersion stress[J].Neurosci Lett,2016,618:99-103.
[18]Gesto M,Soengas JL,Míguez JM.Acute and prolonged stress responses of brain monoaminergic activity and plasma cortisol levels in rainbow trout are modified by PAHs(naphthalene,beta-naphthoflavone and benzo(a)pyrene)treatment[J].Aquat Toxicol,2008,86(3):341-351.
[19]Yi LT,Li HM,Li YC,et al.Antidepressant-like behavioral and neurochemical effects of the citrusassociated chemical apigenin[J].Life Sci,2008,82(13-14):741-751.
[20]Park H,Yoo D,Kwon S,et al.Acupuncture stimulation at HT7 alleviates depression-induced behavioral changes via regulation of the serotonin system in the prefrontal cortex of maternally-separated rat pups[J].J Physiol Sci,2012,62(4):351-357.
[21]Duan D,Tu Y,Yang X,et al.Electroacupuncture restores5-HT system deficit in chronic mild stress-induced depressed rats[J].Evid Based Complement Alternat Med,2016,2016:79506355.
[22]Wu YY,Jiang YL,He XF,et al.5-HT in the dorsal raphe nucleus is involved in the effects of 100-Hz electroacupuncture on the pain-depression dyad in rats[J].Exp Ther Med,2017,14(1):107-114.
[23]Kwon S,Kim D,Park H,et al.Prefrontal-limbic Change in Dopamine Turnover by Acupuncture in Maternally Separated Rat Pups[J].Neurochemical Research,2012,37(10):2092-2098.
[24]Kwon S,Lee B,Yeom M,et al.Modulatory effects of acupuncture on murine depression-like behavior following chronic systemic inflammation[J].Brain Res,2012,1472:149-160.
[25]Lee B,Shim I,Lee HJ,et al.Effects of acupuncture on chronic corticosterone-induced depression-like behavior and expression of neuropeptide Y in the rats[J].Neurosci Lett,2009,453(3):151-156.
[26]Mo Y,Yao H,Song H,et al.Alteration of behavioral changes and hippocampus galanin expression in chronic unpredictable mild stress-induced depression rats and effect of electroacupuncture treatment[J].Evid Based Complement Alternat Med,2014,2014:179796.
[27]Bry K,Teramo K,Lappalainen U,et al.Interleukin-1receptor antagonist in the fetomaternal compartment[J].Acta Paediatr,1995,84(3):233-236.
[28]Wang Y,Jiang H,Meng H,et al.Antidepressant mechanism research of acupuncture:insights from a genome-wide transcriptome analysis of frontal cortex in rats with chronic restraint stress[J].Evid Based Complement Alternat Med,2017,2017:1676808.
[29]Liu Y,Feng H,Mo YL,et al.Effect of soothing-liver and nourishing-heart acupuncture on early selective serotonin reuptake inhibitor treatment onset for depressive disorder and related indicators of neuroimmunology:a randomized controlled clinical trial[J].J Tradit Chin Med,2015,35(5):507-513.
[30]Song C,Halbreich U,Han C,et al.Imbalance between pro-and anti-inflammatory cytokines,and between Th1and Th2 cytokines in depressed patients:the effect of electroacupuncture or fluoxetine treatment[J].Pharmacopasychiatry,2009,42(5):182-188.
[31]Lu J,Shao RH,Hu L,et al.Potential antiinflammatory effects of acupuncture in a chronic stress model of depression in rats[J].Neurosci Lett,2016,618:31-38.
[32]Lu J,Shao RH,Jin SY,et al.Acupuncture ameliorates inflammatory response in a chronic unpredictable stress rat model of depression[J].Brain Res Bull,2017,128:106-112.
[33]Takebayashi M,Hisaoka K,Nishida A,et al.Decreased levels of whole blood glial cell line-derived neurotrophic factor(GDNF)in remitted patients with mood disorders[J].Int J Neuropsychopharmacol,2006,9(5):607-612.
[34]Duan DM,Tu Y,Liu P,et al.Antidepressant effect of electroacupuncture regulates signal targeting in the brain and increases brain-derived neurotrophic factor levels[J].Neural Regen Res,2016,11(10):1595-1602.
[35]Duan DM,Dong X,Tu Y,et al.A microarray study of chronic unpredictable mild stress rat blood serum with electro-acupuncture intervention[J].Neurosci Lett,2016,627:160-167.
[36]Jiang H,Zhang X,Wang Y,et al.Mechanisms underlying the antidepressant response of acupuncture via pka/creb signaling pathway[J].Neural Plast,2017,2017:4135164.
[37]户丽,梁佳,金树英,等.针刺治疗抑郁症作用机制近5年研究进展[J].针刺研究,2013,38(3):253-258.
[38]Zhang X,Song Y,Bao T,et al.Antidepressant-like effects of acupuncture involved the ERK signaling pathway in rats[J].BMC Complement Altern Med,2016,16(1):380.
[39]Li W,Zhu Y,Saud SM,et al.Electroacupuncture relieves depression-like symptoms in rats exposed to chronic unpredictable mild stress by activating ERK signaling pathway[J].Neurosci Lett,2017,642:43-50.
[40]Yang X,Guo Z,Lu J,et al.The role of MAPK and dopaminergic synapse signaling pathways in antidepressant effect of electroacupuncture pretreatment in chronic restraint stress rats[J].Evid Based Complement Alternal Med,2017,2017:2357653.
[41]Wang Y,Jiang H,Meng H,et al.Antidepressant mechanism research of acupuncture:insights from a genome-wide transcriptome analysis of frontal cortex in rats with chronic restraint stress[J].Evid Based Complement Alternal Med,2017,2017:1676808.
[42]Guo Z,Tu Y,Guo TW,et al.Electroacupuncture pretreatment exhibits anti-depressive effects by regulating hippocampal proteomics in rats with chronic restraint stress[J].Neural Regen Res,2015,10(8):1298-1304.
[43]Duan DM,Yang XY,Tu Y,et al.Hippocampal gene expression in a rat model of depression after electroacupuncture at the Baihui and Yintang acupoints[J].Neural Regen Res,2014,9(1):76-83.
[44]Luo D,Ma R,Wu Y,et al.Mechanism underlying acupuncture-ameliorated depressive behaviors by enhancing glial glutamate transporter in chronic unpredictable mild stress(CUMS)rats[J].Med Sci Monit,2017,23:3080-3087.
[45]Xu J,She Y,Su N,et al.Effects of electroacupuncture on chronic unpredictable mild stress rats depression-like behavior and expression of p-ERK/ERK and p-P38/P38[J].Evid Based Complement Alternal Med,2015,2015:650729.
[46]She Y,Xu J,Duan Y,et al.Possible antidepressant effects and mechanism of electroacupuncture in behaviors and hippocampal synaptic plasticity in a depression rat model.[J].Brain Res,2015,1629:291-297.
[47]Kim H,Park HJ,Han SM,et al.The effects of acupuncture stimulation at PC6(Neiguan)on chronic mild stress-induced biochemical and behavioral responses[J].Neurosci Lett,2009,460(1):56-60.
[2]Chen J,Lin W,Wang S,et al.Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat:the Symptom Checklist-90 scores[J].Neural Regen Res,2014,9(2):213-222.
[3]Sun H,Zhao H,Ma C,et al.Effects of electroacupuncture on depression and the production of glial cell linederived neurotrophic factor compared with fluoxetine:a randomized controlled pilot study[J].J Altern Complement Med,2013,19(9):733-739.
[4]Zhang ZJ,Chen HY,Yip KC,et al.The effectiveness and safety of acupuncture therapy in depressive disorders:systematic review and meta-analysis[J].J Affect Disord,2010,124(1-2):9-21.
[5]Qian X,Zhou X,You Y,et al.Traditional Chinese acupuncture for poststroke depression:a single-blind double-simulated randomized controlled trial[J].J Altern Complement Med,2015,21(12):748-753.
[6]Li M,Zhang B,Meng Z,et al.Effect of Tiaoshen Kaiqiao acupuncture in the treatment of ischemic poststroke depression:a randomized controlled trial[J].JTradit Chin Med,2017,37(2):171-178.
[7]Manber R,Schnyer RN,Allen JJB,et al.Acupuncture:a promising treatment for depression during pregnancy[J].J Affect Disord,2004,83(1):89-95.
[8]Engel CC,Cordova EH,Benedek DM,et al.Randomized effecttiveness trial of a brief course of acupuncture for posttraumatic stress disorder[J].Med Care,2014,52(12 Suppl 5):S57-S64.
[9]Wang Y,Hu YP,Wang WC,et al.Clinical studies on treatment of earthquake-caused posttraumatic stress disorder using electroacupuncture[J].Evid Based Complement Alternat Med,2012,2012:431279.
[10]段冬梅,图娅,陈利平,等.Efficacy evaluation for depression with somatic symptoms treated by electroacupuncture combined with Fluoxetine[J].J Tradit Chin Med,2009,29(3):167-173.
[11]刘兰英,陆倩,王玲玲,等.Influence of electro-acupuncture on the side effects of fluoxetine on depression patients[J].J Tradit Chin Med,2009,29(4):271-274.
[12]Chan YY,Lo WY,Yang SN,et al.The benefit of combined acupuncture and antidepressant medication for depression:a systematic review and meta-analysis[J].JAffect Disord,2015,176:106-117.
[13]Varghese FP,Brown ES.The Hypothalamic-PituitaryAdrenal axis in major depressive disorder:a brief primer for primary care physicians[J].Prim Care Companion JClin Psychiatry,2001,3(4):151-155.
[14]Thornton LM,Andersen BL,Blakely WP.The pain,depression,and fatigue symptom cluster in advanced breast cancer:covariation with the hypothalamicpituitary-adrenal axis and the sympathetic nervous system[J].Health Psychol,2010,29(3):333-337.
[15]Chen F,Zhou L,Bai Y,et al.Hypothalamic-pituitaryadrenal axis hyperactivity accounts for anxiety-and depression-like behaviors in rats perinatally exposed to bisphenol A[J].J Biomed Res,2015,29(3):250-258.
[16]Le JJ,Yi T,Qi L,et al.Electroacupuncture regulate hypothalamic-pituitary-adrenal axis and enhance hippocampal serotonin system in a rat model of depression[J].Neurosci Lett,2016,615:66-71.
[17]Tanahashi N,Takagi K,Amagasu N,et al.Effect of acupuncture stimulation on rats with depression induced by water-immersion stress[J].Neurosci Lett,2016,618:99-103.
[18]Gesto M,Soengas JL,Míguez JM.Acute and prolonged stress responses of brain monoaminergic activity and plasma cortisol levels in rainbow trout are modified by PAHs(naphthalene,beta-naphthoflavone and benzo(a)pyrene)treatment[J].Aquat Toxicol,2008,86(3):341-351.
[19]Yi LT,Li HM,Li YC,et al.Antidepressant-like behavioral and neurochemical effects of the citrusassociated chemical apigenin[J].Life Sci,2008,82(13-14):741-751.
[20]Park H,Yoo D,Kwon S,et al.Acupuncture stimulation at HT7 alleviates depression-induced behavioral changes via regulation of the serotonin system in the prefrontal cortex of maternally-separated rat pups[J].J Physiol Sci,2012,62(4):351-357.
[21]Duan D,Tu Y,Yang X,et al.Electroacupuncture restores5-HT system deficit in chronic mild stress-induced depressed rats[J].Evid Based Complement Alternat Med,2016,2016:79506355.
[22]Wu YY,Jiang YL,He XF,et al.5-HT in the dorsal raphe nucleus is involved in the effects of 100-Hz electroacupuncture on the pain-depression dyad in rats[J].Exp Ther Med,2017,14(1):107-114.
[23]Kwon S,Kim D,Park H,et al.Prefrontal-limbic Change in Dopamine Turnover by Acupuncture in Maternally Separated Rat Pups[J].Neurochemical Research,2012,37(10):2092-2098.
[24]Kwon S,Lee B,Yeom M,et al.Modulatory effects of acupuncture on murine depression-like behavior following chronic systemic inflammation[J].Brain Res,2012,1472:149-160.
[25]Lee B,Shim I,Lee HJ,et al.Effects of acupuncture on chronic corticosterone-induced depression-like behavior and expression of neuropeptide Y in the rats[J].Neurosci Lett,2009,453(3):151-156.
[26]Mo Y,Yao H,Song H,et al.Alteration of behavioral changes and hippocampus galanin expression in chronic unpredictable mild stress-induced depression rats and effect of electroacupuncture treatment[J].Evid Based Complement Alternat Med,2014,2014:179796.
[27]Bry K,Teramo K,Lappalainen U,et al.Interleukin-1receptor antagonist in the fetomaternal compartment[J].Acta Paediatr,1995,84(3):233-236.
[28]Wang Y,Jiang H,Meng H,et al.Antidepressant mechanism research of acupuncture:insights from a genome-wide transcriptome analysis of frontal cortex in rats with chronic restraint stress[J].Evid Based Complement Alternat Med,2017,2017:1676808.
[29]Liu Y,Feng H,Mo YL,et al.Effect of soothing-liver and nourishing-heart acupuncture on early selective serotonin reuptake inhibitor treatment onset for depressive disorder and related indicators of neuroimmunology:a randomized controlled clinical trial[J].J Tradit Chin Med,2015,35(5):507-513.
[30]Song C,Halbreich U,Han C,et al.Imbalance between pro-and anti-inflammatory cytokines,and between Th1and Th2 cytokines in depressed patients:the effect of electroacupuncture or fluoxetine treatment[J].Pharmacopasychiatry,2009,42(5):182-188.
[31]Lu J,Shao RH,Hu L,et al.Potential antiinflammatory effects of acupuncture in a chronic stress model of depression in rats[J].Neurosci Lett,2016,618:31-38.
[32]Lu J,Shao RH,Jin SY,et al.Acupuncture ameliorates inflammatory response in a chronic unpredictable stress rat model of depression[J].Brain Res Bull,2017,128:106-112.
[33]Takebayashi M,Hisaoka K,Nishida A,et al.Decreased levels of whole blood glial cell line-derived neurotrophic factor(GDNF)in remitted patients with mood disorders[J].Int J Neuropsychopharmacol,2006,9(5):607-612.
[34]Duan DM,Tu Y,Liu P,et al.Antidepressant effect of electroacupuncture regulates signal targeting in the brain and increases brain-derived neurotrophic factor levels[J].Neural Regen Res,2016,11(10):1595-1602.
[35]Duan DM,Dong X,Tu Y,et al.A microarray study of chronic unpredictable mild stress rat blood serum with electro-acupuncture intervention[J].Neurosci Lett,2016,627:160-167.
[36]Jiang H,Zhang X,Wang Y,et al.Mechanisms underlying the antidepressant response of acupuncture via pka/creb signaling pathway[J].Neural Plast,2017,2017:4135164.
[37]户丽,梁佳,金树英,等.针刺治疗抑郁症作用机制近5年研究进展[J].针刺研究,2013,38(3):253-258.
[38]Zhang X,Song Y,Bao T,et al.Antidepressant-like effects of acupuncture involved the ERK signaling pathway in rats[J].BMC Complement Altern Med,2016,16(1):380.
[39]Li W,Zhu Y,Saud SM,et al.Electroacupuncture relieves depression-like symptoms in rats exposed to chronic unpredictable mild stress by activating ERK signaling pathway[J].Neurosci Lett,2017,642:43-50.
[40]Yang X,Guo Z,Lu J,et al.The role of MAPK and dopaminergic synapse signaling pathways in antidepressant effect of electroacupuncture pretreatment in chronic restraint stress rats[J].Evid Based Complement Alternal Med,2017,2017:2357653.
[41]Wang Y,Jiang H,Meng H,et al.Antidepressant mechanism research of acupuncture:insights from a genome-wide transcriptome analysis of frontal cortex in rats with chronic restraint stress[J].Evid Based Complement Alternal Med,2017,2017:1676808.
[42]Guo Z,Tu Y,Guo TW,et al.Electroacupuncture pretreatment exhibits anti-depressive effects by regulating hippocampal proteomics in rats with chronic restraint stress[J].Neural Regen Res,2015,10(8):1298-1304.
[43]Duan DM,Yang XY,Tu Y,et al.Hippocampal gene expression in a rat model of depression after electroacupuncture at the Baihui and Yintang acupoints[J].Neural Regen Res,2014,9(1):76-83.
[44]Luo D,Ma R,Wu Y,et al.Mechanism underlying acupuncture-ameliorated depressive behaviors by enhancing glial glutamate transporter in chronic unpredictable mild stress(CUMS)rats[J].Med Sci Monit,2017,23:3080-3087.
[45]Xu J,She Y,Su N,et al.Effects of electroacupuncture on chronic unpredictable mild stress rats depression-like behavior and expression of p-ERK/ERK and p-P38/P38[J].Evid Based Complement Alternal Med,2015,2015:650729.
[46]She Y,Xu J,Duan Y,et al.Possible antidepressant effects and mechanism of electroacupuncture in behaviors and hippocampal synaptic plasticity in a depression rat model.[J].Brain Res,2015,1629:291-297.
[47]Kim H,Park HJ,Han SM,et al.The effects of acupuncture stimulation at PC6(Neiguan)on chronic mild stress-induced biochemical and behavioral responses[J].Neurosci Lett,2009,460(1):56-60.