中医综合疗法治疗抑郁症的临床研究
|
摘要
[目的]本文旨在观察运用中医综合疗法治疗抑郁症的临床疗效,研究探讨其对抑郁症患者的效果、依从性和不良反应等指标,为临床提供了安全有效的且病人依从性高的治疗方法。
[方法]本文摘录了近十年西医对抑郁症流行病学趋势、危险因素、发病机制的研究及治疗进展；祖国医学对抑郁症病因病机辩证治疗的最新认识。临床观察的所有病例均来自于2008年10月至2009年12月在深圳市中医院脑病心理疾病科门诊诊治的抑郁症病人200例。男性病人80人,女性病人120人,病程最长者10年,最短者2个月。采用随机方法将合格病例分为治疗组100例,对照组100例。
治疗组(中医综合疗法)100例,其中男性37人,女性63人,年龄18-65岁,平均年龄35±5.5岁；对照组(西医综合疗法组)100例,其中男性43人,女性57人,年龄23-63岁,平均年龄38±4.5岁。将治疗组的患者根据患者的临床症状、舌象、脉象分为不同证型,治疗时以证型为基本出发点,保证理、法、方、药的一致性。若患者在治疗过程中证型发生变化,治疗即相应调整。西医综合治疗组以无羟色胺再摄取抑制剂(SSRIs)药物为主,综合运用心理疗法、行为治疗等,共治疗观察一年。分析两组治疗前后HAMD(汉密尔顿抑郁量表)减分率及中医证侯减分率的变化,分析研究两组依从性及两组治疗期间的不良反。
[结果]两组病人治疗后HAMD减分率均超过50%,显著进步,经统计学分析(t检验),治疗前后相比,有显著性差异,(p<0.05)。治疗后两组患者的中医证侯量表减分率经统计,p<0.05,差异有统计学意义,说明两组患者经治疗,均取得临床效果。而治疗后两组间HAMD减分率及两组中医证候量表减分率对照,p>0.05,无显著性差异,说明中医综合治疗组和西医综合治疗组效果相当；中医治疗组依从性及不良反应较对照组为佳,两组同期比较有显著性差异(p<0.05)。中医综合疗法治疗抑郁症病人,效果明确,且因为不良反应少及依从性好,易使患者接受及坚持治疗。
[结论]通过本文的研究,可以发现在传统中医理论的指导下,结合临床实践,运用序贯性、捆绑式、规范化的可操作性强中医综合疗法治疗抑郁症效果确切且易于被患者接受,可以为抑郁症的治疗开辟出一条全新的道路来,有望使大量抑郁症患者恢复健康,重返社会工作和学习中,而且因为低廉价格的中医技术,不仅减轻社会经济负担,而且可缓解抑郁症患者家庭的医疗费用,从为抑郁症患者的治疗提供了广阔的前景。
[objective] This research aims to observe the clinic effect of multimodality treatment of TCM to treat depression patients, researching into its effect、compliance, its adverse reaction and so on, in order to offer a new treatment in depression patients with advantage of safe, effect, and good compliance.
[Method] This article for nearly ten excerpt of depression popular trend, risk factors and pathogenesis of research and treatment, the traditional Chinese medicine etiology, pathogenesis Of depression dialectical understanding and the latest treatment. All the 200 cases (80males,120females) were depression patients hospitalized in Shenzhen Hospital affiliated to Guangzhou University of Chinese Medicine from October 2008 to December 2009. The course of depression of these patients is from two mouthes to 10 years. These patients were randomly divided into 2 groups:treatment group (n=100) and matched group (n=100).
In treatment group (multimodality treatment of TCM), there were 100 depression patients including 37 males and 63 females, aged from18-65, and the average age is 35±5.5; In matched group (Comprehensive treatment of Western medicine), there were 100 depression patients including 43 males and 57 females, aged from 23-63, and the average is 38±4.5. Then according to the symptoms, tonge appearance and pulse manifestation, the patients in treatmen group were divided into different patterns, and make sure that TCM's theories, methods, side and drug to be compliance during treatment. If the patterns of TCM changed during treatment,the Chinese herbal medicine should be Adjusted. Patients in matched group were treated by selective serotonin reuptake inhibitors(SSRIs), Integrating use of psychological therapy, behavioral therapy, etc. Both of the two groups were observed for one year.
Analysis of two groups'Reduction rate both in HAMD and Syndrome of TCM Scale before and after treatment,Simultaneously Analysis of two groups' Compliance and adverse reactions during treatment.
[Results] Both in two groups, the reduction rate of HAMD and reduction rate of Syndrome Scale of TCM, comparing those of two groups before treatment, were more than 50%, showing a significant difference which hints a significant clinical effect. After the treatment, the HAMD reduction rate between the two groups and Syndrome of TCM Scale reduction rate between the two groups were not significantly different, p> 0.05, showing that the efficacy of treatment group was similar to the matched group. The side effects of Treatment group were lower and better compliance than those of matched group, and there was superior difference(p<0.05). The statistical data hints the therapy of multimodality treatment of TCM for depression patients was clearly effect, good compliance and because of fewer adverse reactions and good compliance, so that it easy to make patients glad to accept and ashere to treatment.
[Conclusion] Through the study, it can be found that in traditional Chinese medicine theory, under the guidance of clinical practice, sequential, experienced and standardization of TCM maneuverability strong comprehensive therapy for depression patients shows more effect and More easily accepted by depression patients.可The multimodality treatment of TCM for depression to explore a new way to help depression patients to restore health, social work and study. Also because of the low price of TCM, Not only reduce the economic burden on society but also reduce the patient family's medical expenses, so it would provide a treatment with broad prospect for depression patients.
[方法]本文摘录了近十年西医对抑郁症流行病学趋势、危险因素、发病机制的研究及治疗进展；祖国医学对抑郁症病因病机辩证治疗的最新认识。临床观察的所有病例均来自于2008年10月至2009年12月在深圳市中医院脑病心理疾病科门诊诊治的抑郁症病人200例。男性病人80人,女性病人120人,病程最长者10年,最短者2个月。采用随机方法将合格病例分为治疗组100例,对照组100例。
治疗组(中医综合疗法)100例,其中男性37人,女性63人,年龄18-65岁,平均年龄35±5.5岁；对照组(西医综合疗法组)100例,其中男性43人,女性57人,年龄23-63岁,平均年龄38±4.5岁。将治疗组的患者根据患者的临床症状、舌象、脉象分为不同证型,治疗时以证型为基本出发点,保证理、法、方、药的一致性。若患者在治疗过程中证型发生变化,治疗即相应调整。西医综合治疗组以无羟色胺再摄取抑制剂(SSRIs)药物为主,综合运用心理疗法、行为治疗等,共治疗观察一年。分析两组治疗前后HAMD(汉密尔顿抑郁量表)减分率及中医证侯减分率的变化,分析研究两组依从性及两组治疗期间的不良反。
[结果]两组病人治疗后HAMD减分率均超过50%,显著进步,经统计学分析(t检验),治疗前后相比,有显著性差异,(p<0.05)。治疗后两组患者的中医证侯量表减分率经统计,p<0.05,差异有统计学意义,说明两组患者经治疗,均取得临床效果。而治疗后两组间HAMD减分率及两组中医证候量表减分率对照,p>0.05,无显著性差异,说明中医综合治疗组和西医综合治疗组效果相当；中医治疗组依从性及不良反应较对照组为佳,两组同期比较有显著性差异(p<0.05)。中医综合疗法治疗抑郁症病人,效果明确,且因为不良反应少及依从性好,易使患者接受及坚持治疗。
[结论]通过本文的研究,可以发现在传统中医理论的指导下,结合临床实践,运用序贯性、捆绑式、规范化的可操作性强中医综合疗法治疗抑郁症效果确切且易于被患者接受,可以为抑郁症的治疗开辟出一条全新的道路来,有望使大量抑郁症患者恢复健康,重返社会工作和学习中,而且因为低廉价格的中医技术,不仅减轻社会经济负担,而且可缓解抑郁症患者家庭的医疗费用,从为抑郁症患者的治疗提供了广阔的前景。
[objective] This research aims to observe the clinic effect of multimodality treatment of TCM to treat depression patients, researching into its effect、compliance, its adverse reaction and so on, in order to offer a new treatment in depression patients with advantage of safe, effect, and good compliance.
[Method] This article for nearly ten excerpt of depression popular trend, risk factors and pathogenesis of research and treatment, the traditional Chinese medicine etiology, pathogenesis Of depression dialectical understanding and the latest treatment. All the 200 cases (80males,120females) were depression patients hospitalized in Shenzhen Hospital affiliated to Guangzhou University of Chinese Medicine from October 2008 to December 2009. The course of depression of these patients is from two mouthes to 10 years. These patients were randomly divided into 2 groups:treatment group (n=100) and matched group (n=100).
In treatment group (multimodality treatment of TCM), there were 100 depression patients including 37 males and 63 females, aged from18-65, and the average age is 35±5.5; In matched group (Comprehensive treatment of Western medicine), there were 100 depression patients including 43 males and 57 females, aged from 23-63, and the average is 38±4.5. Then according to the symptoms, tonge appearance and pulse manifestation, the patients in treatmen group were divided into different patterns, and make sure that TCM's theories, methods, side and drug to be compliance during treatment. If the patterns of TCM changed during treatment,the Chinese herbal medicine should be Adjusted. Patients in matched group were treated by selective serotonin reuptake inhibitors(SSRIs), Integrating use of psychological therapy, behavioral therapy, etc. Both of the two groups were observed for one year.
Analysis of two groups'Reduction rate both in HAMD and Syndrome of TCM Scale before and after treatment,Simultaneously Analysis of two groups' Compliance and adverse reactions during treatment.
[Results] Both in two groups, the reduction rate of HAMD and reduction rate of Syndrome Scale of TCM, comparing those of two groups before treatment, were more than 50%, showing a significant difference which hints a significant clinical effect. After the treatment, the HAMD reduction rate between the two groups and Syndrome of TCM Scale reduction rate between the two groups were not significantly different, p> 0.05, showing that the efficacy of treatment group was similar to the matched group. The side effects of Treatment group were lower and better compliance than those of matched group, and there was superior difference(p<0.05). The statistical data hints the therapy of multimodality treatment of TCM for depression patients was clearly effect, good compliance and because of fewer adverse reactions and good compliance, so that it easy to make patients glad to accept and ashere to treatment.
[Conclusion] Through the study, it can be found that in traditional Chinese medicine theory, under the guidance of clinical practice, sequential, experienced and standardization of TCM maneuverability strong comprehensive therapy for depression patients shows more effect and More easily accepted by depression patients.可The multimodality treatment of TCM for depression to explore a new way to help depression patients to restore health, social work and study. Also because of the low price of TCM, Not only reduce the economic burden on society but also reduce the patient family's medical expenses, so it would provide a treatment with broad prospect for depression patients.
引文
[1]胡志,秦侠,徐晓超.老年人生活事件、兴趣、生活能力与老年抑郁症患者患病率[J].中国初级卫生保健,2004：18(4)：27-29.
[2]严海萍.抑郁症的治疗进展.中国临床医药研究杂志,2006(6)：59-60.
[3]王玉露.抑郁症发病原因及治疗概况.福建中医药,2009,40(3)：60-62.
[4]李晓晶,马欣欣,李素琴.抑郁症发病机制与药物治疗研究进展.河北医药,2006(28)：130-131.
[5]王玉露.抑郁症发病原因及治疗概况.福建中医药,2009,40(3)：60-62.
[6]冯正直.抑郁症：实质与治疗[M].人民日报出版社,2009：54-81,168-322.
[7]阎小华,吴怀安,邓小敏等.抑郁病人红细胞儿茶酚氧位甲基转移酶活性的研究[J].中华精神科杂志,2005(38)：105-106.
[8]董继承,张少丽,缪竞诚.内源性抑郁症生物学病因研究进.展齐鲁医学杂志,2009,24(6)：559-561.
[9]RASGON N, BAUER N, GLENN T, et al. Menstrual cycle related mood changes in women with bipolar disorder[J]. Bipolar Disord,2003,5:48-52.
[10]牟君,谢鹏.海马神经发生障碍--抑郁症发病机制的新观念.第三军医大学学报,2006,28(11)：1264-1266.
[11]HARLOW B L, WISE LA, OTTO M W, et al. Depression and its influence on reproductive endocrine and mestrual cycle markers associated with perimenopause; the Harvard study of moods and cycles [J]. Arch Genpsychiatry, 2003,60:29-36.
[12]冯秀萍,赵博.抑郁症的中医学探讨.贵阳中医学院学报,2009,31(2)：6-8.
[13]肖怡,赵志付.中医对抑郁症的认识和治疗概述.北京中医药,2008,27(9)：740-742.
[14]刘军莲,李勇枝,高建义等.中医药抗抑郁研究进展.中药材,2008,31(6)：931-934.
[15]薛蕾,李佳,姜姜斌.抑郁症病机辨析.山东中医杂志,2008,27(4)：224-225.
[16]冯辉.抑郁症病机及临证治疗思路.天津中医药,2006,23(5)：383-385.
[17]宋通贵,孙萍,张燕等.中医辨证论治抑郁症的探讨.中国实用医药,2009,4(25)：220-221.
[18]虢周科,富文俊.抑郁症辨证论治探讨.实用中医药杂志,2007,23(9) 597-598.
[19]卫永琪.中医辨证治疗老年抑郁症[J].四川中医,2004,22(12)：44-45.
[20]吕红艳.辨证论治抑郁症疗效观察[J].广西中医药,2002,25(2)：14-15.
[21]苏根.辨证施治老年抑郁症30例[J].中医研究,2004,17(1)：45-46.
[22]邢协强,谢新年.抑郁症的中医辨证论治[J].医学临床研究,2003,20(7)：541-542.
[23]海英,张辉.针刺治疗卒中后抑郁状态40例[J].辽宁中医学院学报,2003,5(2)：126.
[24]王天俊.针刺治疗抑郁症临床观察[J].中国针灸,2005,25(2)：107-108.
[25]尹秀茹.电针治疗抑郁症30例临床观察[J].河北中医,2005,27(7)：527—528.
[26]江小荣.芒针治疗抑郁症47例临床观察[J]中医药学刊,2003,1(9)：567—568.
[27]张丹莉.针刺在抑郁症患者中的应用[J].中国临床康复,2005,9(20)：217.
[28]唐胜修,徐祖豪,唐萍等.针刺治疗抑郁性神经症的临床研究[J].中国针灸,2003,23(10)：585—586.
[29]王寅,赵志付,伍昱等.针刺治疗脑卒中后抑郁失眠临床疗效评价[J].中国针灸,2004,24(9)：603—606.
[30]王小云,沈碧琼.中医综合疗法治疗女性抑制郁症60例[J].2001,22(6)：539-540.
[2]严海萍.抑郁症的治疗进展.中国临床医药研究杂志,2006(6)：59-60.
[3]王玉露.抑郁症发病原因及治疗概况.福建中医药,2009,40(3)：60-62.
[4]李晓晶,马欣欣,李素琴.抑郁症发病机制与药物治疗研究进展.河北医药,2006(28)：130-131.
[5]王玉露.抑郁症发病原因及治疗概况.福建中医药,2009,40(3)：60-62.
[6]冯正直.抑郁症：实质与治疗[M].人民日报出版社,2009：54-81,168-322.
[7]阎小华,吴怀安,邓小敏等.抑郁病人红细胞儿茶酚氧位甲基转移酶活性的研究[J].中华精神科杂志,2005(38)：105-106.
[8]董继承,张少丽,缪竞诚.内源性抑郁症生物学病因研究进.展齐鲁医学杂志,2009,24(6)：559-561.
[9]RASGON N, BAUER N, GLENN T, et al. Menstrual cycle related mood changes in women with bipolar disorder[J]. Bipolar Disord,2003,5:48-52.
[10]牟君,谢鹏.海马神经发生障碍--抑郁症发病机制的新观念.第三军医大学学报,2006,28(11)：1264-1266.
[11]HARLOW B L, WISE LA, OTTO M W, et al. Depression and its influence on reproductive endocrine and mestrual cycle markers associated with perimenopause; the Harvard study of moods and cycles [J]. Arch Genpsychiatry, 2003,60:29-36.
[12]冯秀萍,赵博.抑郁症的中医学探讨.贵阳中医学院学报,2009,31(2)：6-8.
[13]肖怡,赵志付.中医对抑郁症的认识和治疗概述.北京中医药,2008,27(9)：740-742.
[14]刘军莲,李勇枝,高建义等.中医药抗抑郁研究进展.中药材,2008,31(6)：931-934.
[15]薛蕾,李佳,姜姜斌.抑郁症病机辨析.山东中医杂志,2008,27(4)：224-225.
[16]冯辉.抑郁症病机及临证治疗思路.天津中医药,2006,23(5)：383-385.
[17]宋通贵,孙萍,张燕等.中医辨证论治抑郁症的探讨.中国实用医药,2009,4(25)：220-221.
[18]虢周科,富文俊.抑郁症辨证论治探讨.实用中医药杂志,2007,23(9) 597-598.
[19]卫永琪.中医辨证治疗老年抑郁症[J].四川中医,2004,22(12)：44-45.
[20]吕红艳.辨证论治抑郁症疗效观察[J].广西中医药,2002,25(2)：14-15.
[21]苏根.辨证施治老年抑郁症30例[J].中医研究,2004,17(1)：45-46.
[22]邢协强,谢新年.抑郁症的中医辨证论治[J].医学临床研究,2003,20(7)：541-542.
[23]海英,张辉.针刺治疗卒中后抑郁状态40例[J].辽宁中医学院学报,2003,5(2)：126.
[24]王天俊.针刺治疗抑郁症临床观察[J].中国针灸,2005,25(2)：107-108.
[25]尹秀茹.电针治疗抑郁症30例临床观察[J].河北中医,2005,27(7)：527—528.
[26]江小荣.芒针治疗抑郁症47例临床观察[J]中医药学刊,2003,1(9)：567—568.
[27]张丹莉.针刺在抑郁症患者中的应用[J].中国临床康复,2005,9(20)：217.
[28]唐胜修,徐祖豪,唐萍等.针刺治疗抑郁性神经症的临床研究[J].中国针灸,2003,23(10)：585—586.
[29]王寅,赵志付,伍昱等.针刺治疗脑卒中后抑郁失眠临床疗效评价[J].中国针灸,2004,24(9)：603—606.
[30]王小云,沈碧琼.中医综合疗法治疗女性抑制郁症60例[J].2001,22(6)：539-540.