基于DTI技术对针刺联合盐酸文拉法辛治疗抑郁症的疗效研究
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摘要
目的:基于弥散张量成像(DTI)技术从脑白质纤维束微观结构的改变探讨针刺联合盐酸文拉法辛治疗抑郁症的有效性和安全性。方法:采用前瞻性研究方案,将60例抑郁症患者随机分为针药组和药物组,各30例。药物组采用单纯的盐酸文拉法辛口服治疗,第1周75 mg/d,第2周150 mg/d,第3～6周225 mg/d;针药组在药物组的基础上联合针刺治疗,以百会、印堂为主穴,根据患者的临床症状进行配穴,留针30 min,隔天1次,每周3次,两组均治疗12周。另以30例健康受试者为健康组。分别于治疗前、治疗2周、8周和12周采用汉密尔顿抑郁量表(HAMD-17)、贝克抑郁自评量表(BDI)、抗抑郁药副反应量表(SERS)评估两组的效果和安全性。同时,分别于治疗前、治疗12周后采用DTI技术测定患者脑区各向异性分数(FA)值。结果:治疗后,两组HAMD-17和BDI评分均降低(P<0.05),且治疗8周和12周,针药组HAMD-17和BDI评分低于药物组(P<0.05)。两组治疗后SERS量表评分比较差异无统计学意义(P>0.05)。与健康受试者相比,抑郁症共6个脑区FA值发生明显变化,分别为双侧额叶白质、胼胝体压部、左侧扣带回、双侧颞下回白质、双侧顶叶下白质、双侧颞枕深部白质。治疗前,两组抑郁症患者之间6个脑区的FA值差异无统计学意义(P>0.05);治疗后,针药组双侧额叶白质、双侧颞下回白质、双侧颞枕深部白质FA值均高于药物组(P<0.05)。结论:针刺能从一定程度上修复某些脑区的脑白质纤维束微观结构,辅助盐酸文拉法辛治疗抑郁症利于增强疗效。
Objective To explore the effectiveness and safety of the combined treatment with acupuncture and venlafaxine hydrochloride on depression in terms of the microstructure change of white matter fiber tracts of brain based on diffusion tensor imaging technology(DTI). Methods The prospective study design was adopted. All of 60 patients with depression were randomized into an acupuncture-medication group and a medication group, 30 cases in each one. In the medication group, venlafaxine hydrochloride was used, 75 mg per day in the 1 st week, 150 mg per day in the 2 nd week and 225 mg per day from the 3 rd to 6 th week. In the acupuncture-medication group, on the base of the treatment in the medication group, acupuncture was combined. Baihui(GV 20) and Yintang(GV 29) were the main acupoints. The supplementary acupoints were selected according to the clinical symptoms of individuals. The needles were retained for 30 min.Acupuncture was provided once every 2 days, 3 times a week. The consecutive 12 weeks of treatment were required in the two groups. Additionally, a normal group was prepared with 30 healthy volunteers. Separately, before treatment, in 2, 8 and 12 weeks of treatment, Hamilton's depression scale(HAMD-17), Beck depression inventory scale(BDI) and the antidepressant side effect scale(SERS) were adopted to evaluate the effectiveness and safety of the two groups. Moreover, before and after 12 weeks of treatment, DTI was adopted to detect the fractional anisotropy score(FA) of each brain region in the patients. Results After treatment, the scores of HAMD-17 and BDI were all reduced in the two groups(P<0.05). In 8 and 12 weeks of treatment, the scores of HAMD-17 and BDI in the acupuncture-medication group were less than those in the medication group(P<0.05). The difference in SERS score was not significant statistically between the two groups(P>0.05). Compared with the healthy volunteers, FA scores in 6 brain regions changed obviously in the patients with depression, including the white matter of bilateral frontal lobes, splenium of corpus callosum, left cingulated gyrus, white matter of bilateral inferior temporal gyrus, white matter of bilateral inferior parietal lobe and white matter of bilateral deep temporal occipital region separately. Before treatment, the differences in FA scores of these 6 brain regions were not significant statistically between the two groups(P>0.05). After treatment, FA scores in the white matter of bilateral frontal lobes, white matter of bilateral inferior temporal gyrus and white matter of bilateral deep temporal occipital region in the acupuncture-medication group were all higher than those in the medication group(P<0.05). Conclusion Acupuncture repairs the brain white matter fiber tracts in some brain regions to certain extent and the therapeutic effects are enhanced with the adjuvant medication of venlafaxine hydrochloride.
Objective To explore the effectiveness and safety of the combined treatment with acupuncture and venlafaxine hydrochloride on depression in terms of the microstructure change of white matter fiber tracts of brain based on diffusion tensor imaging technology(DTI). Methods The prospective study design was adopted. All of 60 patients with depression were randomized into an acupuncture-medication group and a medication group, 30 cases in each one. In the medication group, venlafaxine hydrochloride was used, 75 mg per day in the 1 st week, 150 mg per day in the 2 nd week and 225 mg per day from the 3 rd to 6 th week. In the acupuncture-medication group, on the base of the treatment in the medication group, acupuncture was combined. Baihui(GV 20) and Yintang(GV 29) were the main acupoints. The supplementary acupoints were selected according to the clinical symptoms of individuals. The needles were retained for 30 min.Acupuncture was provided once every 2 days, 3 times a week. The consecutive 12 weeks of treatment were required in the two groups. Additionally, a normal group was prepared with 30 healthy volunteers. Separately, before treatment, in 2, 8 and 12 weeks of treatment, Hamilton's depression scale(HAMD-17), Beck depression inventory scale(BDI) and the antidepressant side effect scale(SERS) were adopted to evaluate the effectiveness and safety of the two groups. Moreover, before and after 12 weeks of treatment, DTI was adopted to detect the fractional anisotropy score(FA) of each brain region in the patients. Results After treatment, the scores of HAMD-17 and BDI were all reduced in the two groups(P<0.05). In 8 and 12 weeks of treatment, the scores of HAMD-17 and BDI in the acupuncture-medication group were less than those in the medication group(P<0.05). The difference in SERS score was not significant statistically between the two groups(P>0.05). Compared with the healthy volunteers, FA scores in 6 brain regions changed obviously in the patients with depression, including the white matter of bilateral frontal lobes, splenium of corpus callosum, left cingulated gyrus, white matter of bilateral inferior temporal gyrus, white matter of bilateral inferior parietal lobe and white matter of bilateral deep temporal occipital region separately. Before treatment, the differences in FA scores of these 6 brain regions were not significant statistically between the two groups(P>0.05). After treatment, FA scores in the white matter of bilateral frontal lobes, white matter of bilateral inferior temporal gyrus and white matter of bilateral deep temporal occipital region in the acupuncture-medication group were all higher than those in the medication group(P<0.05). Conclusion Acupuncture repairs the brain white matter fiber tracts in some brain regions to certain extent and the therapeutic effects are enhanced with the adjuvant medication of venlafaxine hydrochloride.
引文
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[2]伍远菲,吴升伟,廖雪珍,等.密集颅部电针刺激治疗和针刺治疗对抑郁症患者再入院风险的影响[J].中医药临床杂志,2018,30(3):497-501.
[3]Kotlyar A.I Ching balance acupuncture treatment of migraines,insomnia,and depression in a post-ovariectomy patient receiving hormone replacement therapy[J].Med Acupunct,2018,30(1):41-45.
[4]Kamiya K,Okada N,Sawada K.Diffusional kurtosis imaging and white matter microstructure modeling in a clinical study of major depressive disorder[J].NMR Biomed,2018,31(7):e3938.
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[8]刘颖,曾祥柱,王筝,等.基于扩散张量成像及扩散峰度成像各向异性评估抑郁症脑部改变[J].临床放射学杂志,2018,37(1):17-21.
[9]董莎,姜会梨,王瑜,等.针刺对慢性束缚应激抑郁大鼠海马及前额叶皮层胶质纤维酸性蛋白和血清白介素-10表达的影响[J].针刺研究,2018,43(4):209-214.
[10]王珑,张迪,田旭升,等.电针对慢性应激抑郁大鼠海马CA3区突触可塑性的影响[J].中国针灸,2017,37(2):162-168.
[11]胡志,胡孝朋,陶龙香,等.基于弥散张量成像技术对抑郁症患者脑白质微结构的研究[J].安徽医药,2016,20(1):110-111.
[12]朱雪玲,王湘,肖晶,等.首发重症抑郁症的弥散张量成像研究:基于纤维束示踪的空间统计学分析结果[J].中国临床心理学杂志,2011,19(1):1-3.
[13]陈宇,吴明祥,陈文娇,等.运用TBSS技术对梗死后抑郁症患者的扩散张量成像研究[J].磁共振成像,2018,9(4):253-257.
[14]张炳蔚,许晶,张琳,等.晚发性抑郁症脑白质改变的弥散张量成像研究[J].大连医科大学学报,2014,36(5):440-444.
[15]胡雪钰,宁布,贾福军,等.抑郁症患者脑白质的弥散张量成像[J].广东医学,2015(1):12-15.
[16]蒲荣,邵润慧,卢峻,等.针刺对抑郁大鼠前额叶皮层核转录因子κB、诱导型一氧化氮合酶、一氧化氮表达的影响[J].针刺研究,2018,43(4):226-430.
[17]芦国芳,安建雄,马钧,等.三氧可通过减轻小鼠脑小胶质细胞激活预防抑郁症发生[J].转化医学杂志,2018,7(1):20-26.
[18]张鹏,姜会梨,王瑜,等.针刺干预对慢性束缚应激模型大鼠海马和额叶皮层γ-氨基丁酸A受体和B受体表达相关性研究[J].环球中医药,2018,11(5):656-660.
[2]伍远菲,吴升伟,廖雪珍,等.密集颅部电针刺激治疗和针刺治疗对抑郁症患者再入院风险的影响[J].中医药临床杂志,2018,30(3):497-501.
[3]Kotlyar A.I Ching balance acupuncture treatment of migraines,insomnia,and depression in a post-ovariectomy patient receiving hormone replacement therapy[J].Med Acupunct,2018,30(1):41-45.
[4]Kamiya K,Okada N,Sawada K.Diffusional kurtosis imaging and white matter microstructure modeling in a clinical study of major depressive disorder[J].NMR Biomed,2018,31(7):e3938.
[5]Tae WS,Ham BJ,Pyun SB,et al.Current clinical applications of diffusion-tensor imaging in neurological disorders[J].J Clin Neurol,14(2):129-140.
[6]美国精神医学学会.精神障碍诊断与统计手册(第五版)[M].北京:北京大学医学出版社,2015.
[7]肖振辉.中医内科学[M].北京:人民卫生出版社,2010.
[8]刘颖,曾祥柱,王筝,等.基于扩散张量成像及扩散峰度成像各向异性评估抑郁症脑部改变[J].临床放射学杂志,2018,37(1):17-21.
[9]董莎,姜会梨,王瑜,等.针刺对慢性束缚应激抑郁大鼠海马及前额叶皮层胶质纤维酸性蛋白和血清白介素-10表达的影响[J].针刺研究,2018,43(4):209-214.
[10]王珑,张迪,田旭升,等.电针对慢性应激抑郁大鼠海马CA3区突触可塑性的影响[J].中国针灸,2017,37(2):162-168.
[11]胡志,胡孝朋,陶龙香,等.基于弥散张量成像技术对抑郁症患者脑白质微结构的研究[J].安徽医药,2016,20(1):110-111.
[12]朱雪玲,王湘,肖晶,等.首发重症抑郁症的弥散张量成像研究:基于纤维束示踪的空间统计学分析结果[J].中国临床心理学杂志,2011,19(1):1-3.
[13]陈宇,吴明祥,陈文娇,等.运用TBSS技术对梗死后抑郁症患者的扩散张量成像研究[J].磁共振成像,2018,9(4):253-257.
[14]张炳蔚,许晶,张琳,等.晚发性抑郁症脑白质改变的弥散张量成像研究[J].大连医科大学学报,2014,36(5):440-444.
[15]胡雪钰,宁布,贾福军,等.抑郁症患者脑白质的弥散张量成像[J].广东医学,2015(1):12-15.
[16]蒲荣,邵润慧,卢峻,等.针刺对抑郁大鼠前额叶皮层核转录因子κB、诱导型一氧化氮合酶、一氧化氮表达的影响[J].针刺研究,2018,43(4):226-430.
[17]芦国芳,安建雄,马钧,等.三氧可通过减轻小鼠脑小胶质细胞激活预防抑郁症发生[J].转化医学杂志,2018,7(1):20-26.
[18]张鹏,姜会梨,王瑜,等.针刺干预对慢性束缚应激模型大鼠海马和额叶皮层γ-氨基丁酸A受体和B受体表达相关性研究[J].环球中医药,2018,11(5):656-660.