中西医集成方案治疗中、重度抑郁症的临床观察
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摘要
【目的】观察中西医集成方案治疗中、重度抑郁症的临床疗效。【方法】将160例原发性中、重度抑郁症患者随机分为试验组(中西医集成方案治疗组)和对照组(西药组),每组各80例。对照组给予艾司西酞普兰治疗12周,试验组在对照组的基础上,给予中药加味逍遥汤颗粒治疗12周,并于治疗开始后前4周进行针刺干预(以百会、印堂为主穴)。在治疗前及治疗后第2、4、6和12周分别用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)和抗抑郁药副反应量表(SERS)进行评分,并随访治疗结束后1年内的复发情况,比较试验组与对照组的临床疗效。【结果】(1)试验组和对照组各脱落7例,最终146例患者纳入研究。(2)治疗12周后,试验组的总有效率为79.45%,对照组为63.01%,试验组的疗效明显优于对照组(P<0.05)。(3)治疗开始后第2、4、6和12周,试验组和对照组的HAMD评分及其焦虑躯体化因子评分、睡眠因子评分、迟缓因子评分和SDS评分均较治疗前显著降低(P<0.001),且试验组均显著低于对照组(P<0.001)。(4)试验组治疗开始后第2周、4周、6周和12周的SERS评分均显著低于对照组(P<0.001)。(5)试验组和对照组1年内的复发率分别为24.14%和43.49%,试验组的复发率显著低于对照组(P<0.05)。【结论】中西医集成方案对中、重度原发性抑郁症的总体疗效及对HAMD各因子的改善效果均显著优于单纯西药治疗,安全性也优于单纯西药治疗,且1年内的复发率低于单纯西药治疗。
Objective To investigate the curative effect of integrated Chinese-western medicine therapy in treating moderate or severe depression. Methods A total of 160 patients with moderate or severe primary depression were randomly allocated into test group(receiving integrated Chinese-western medicine therapy)and control group(receiving western medicine therapy), 80 cases in each group. The both groups received escitalopram for 12 weeks, additionally, the test group received modified Xiaoyao Decoction Granules for 12 weeks and received acupuncture mainly on Baihui and Yintang(EX-HN3)4 weeks before treatment. Before treatment and at post-treatment week 2,4,6,12,the clinical curative effect was evaluated by Hamilton Depression(HAMD)Rating Scale, Self-rating Depression Scale(SDS)and Asberg Rating Scale for Side Effects(SERS). Recurrence was followed up within one year after treatment, and the curative effect in the test group and control group was compared. Results(1)Seven cases dropped out from the test group and control group,respectively. Eventually,a total of 146 cases were enrolled in the experiment.(2)After treatment for 12 weeks,the total effective rate was 79.45% in the test group,and was 63.01% in the control group,the therapeutic effect in the test group being superior to that in the control group(P<0.05).(3)At post-treatment week 2,4,6,12,the HAMD scores,the scores of anxious somatization, sleeping and retardation factors, and the SDS scores were significantly decreased in the two groups as compared with those before treatment(P < 0.001),and the above indexes in the test group were lower than those in the control group(P < 0.001).(4)The scores of SERS was lower in the test group than that in the control group at post-treatment week 2,4,6 and 12(P < 0.001).(5)The recurrence rate within one year in the test group(24.14%)was lower than that in the control group(43.49%),the difference being significant(P < 0.05). Conclusion Integrated Chinese-western medicine therapy had better total curative effects on moderate or severe primary depression,is more effective on improving the scores of the factors of HAMD,and is more safer and has lower one-year recurrence rate than western medicine alone.
Objective To investigate the curative effect of integrated Chinese-western medicine therapy in treating moderate or severe depression. Methods A total of 160 patients with moderate or severe primary depression were randomly allocated into test group(receiving integrated Chinese-western medicine therapy)and control group(receiving western medicine therapy), 80 cases in each group. The both groups received escitalopram for 12 weeks, additionally, the test group received modified Xiaoyao Decoction Granules for 12 weeks and received acupuncture mainly on Baihui and Yintang(EX-HN3)4 weeks before treatment. Before treatment and at post-treatment week 2,4,6,12,the clinical curative effect was evaluated by Hamilton Depression(HAMD)Rating Scale, Self-rating Depression Scale(SDS)and Asberg Rating Scale for Side Effects(SERS). Recurrence was followed up within one year after treatment, and the curative effect in the test group and control group was compared. Results(1)Seven cases dropped out from the test group and control group,respectively. Eventually,a total of 146 cases were enrolled in the experiment.(2)After treatment for 12 weeks,the total effective rate was 79.45% in the test group,and was 63.01% in the control group,the therapeutic effect in the test group being superior to that in the control group(P<0.05).(3)At post-treatment week 2,4,6,12,the HAMD scores,the scores of anxious somatization, sleeping and retardation factors, and the SDS scores were significantly decreased in the two groups as compared with those before treatment(P < 0.001),and the above indexes in the test group were lower than those in the control group(P < 0.001).(4)The scores of SERS was lower in the test group than that in the control group at post-treatment week 2,4,6 and 12(P < 0.001).(5)The recurrence rate within one year in the test group(24.14%)was lower than that in the control group(43.49%),the difference being significant(P < 0.05). Conclusion Integrated Chinese-western medicine therapy had better total curative effects on moderate or severe primary depression,is more effective on improving the scores of the factors of HAMD,and is more safer and has lower one-year recurrence rate than western medicine alone.
引文
[1]邵妍,陈以国,王鹏琴,等.针刺结合中药治疗抑郁症的临床疗效分析及评价体系[J].中国中医基础医学杂志,2013,19(3):331.
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[4]王旭东,乔明琦,张樟进,等.中医药治疗抑郁症的研究进展[J].南京中医药大学学报,2016,32(1):93.
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[9]马琴,周德安,王麟鹏.针刺治疗抑郁症的临床疗效观察及因子分析[J].中国针灸,2011,31(10):875.
[10]莫贤炜,张雷,关溯,等.作用于5-羟色胺受体的抗抑郁药物研究进展[J].中国药科大学学报,2016,47(6):639.
[11]李淑云,吴洪军,周贵兰.西酞普兰与氟西汀治疗抑郁症的对照研究[J].中外医学研究,2011,9(9):16.
[12]Kem P G,Kronenberg G.Depressed new neurons-adult hippocampal neurogenesis and acellular plasticity hypothesis of major depression[J].Biol Psychiatry,2003,54(5):499.
[13]谭涛,王金贵,孙庆.中西医结合治疗抑郁症疗效观察[J].山西中医,2012,28(9):16.
[14]Guan X T,Zhan X H,Yu H L,et al.Clinical epidemiological investigation analysis on 38 mild and middle degree depression patients with syndrome of stagnation of liver qi[J].CJTCMP,2015,30(6):2059.
[15]郭小青,田正良,米金辉.抑郁症中医病因病机分析[J].浙江中医杂志,2002,37(9):374.
[16]王玲玲,刘兰英,吕梅,等.针灸治疗抑郁症临床思路[J].针灸临床杂志,2003,19(7):7.
[17]杜元灏,李桂平.调神疏肝针法治疗郁证的理论基础[J].中国针灸,2005,25(2):143.
[18]谌琦,郭小青,王李雯.近十年中医药治疗抑郁症的临床研究概况[J].河南中医药学刊,2010(3):558.
[19]李新纯,唐武,李庆.疏肝宁神汤治疗抑郁症60例[J].新中医,2003,35(4):60.
[20]牛永利,赵俊龙,李红阁.针刺联合中药治疗肝气郁结型抑郁症的临床观察[J].陕西中医,2016,37(10):1406.
[21]贾爱民,温霞.涤痰汤加减治疗抑郁症13例[J].河南中医,2003,23(9):26.
[22]蔡艳,李斌.中西医结合治疗抑郁症72例临床观察[J].浙江临床医学,2011,13(4):427.
[23]周秀芳,胡捷,张迎梅,等.附子逍遥散配合快速针刺法治疗抑郁症的临床观察[J].中国药房,2016,27(11):1515.
[24]李文迅,韩焱晶,陶娟,等.电针对抑郁模型大鼠海马神经元凋亡的影响[J].中国中医药信息杂志,2005,12(2):33.
[25]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.
[26]罗和春,库宝善.电针治疗常见精神病[M].北京:北京医科大学、中国协和医科大学联合出版社,1993:144-147.
[27]冯慧,刘义,余正和,等.疏肝养心针刺法对选择性5-羟色胺再摄取抑制剂治疗抑郁症的增效作用及其对炎性细胞因子的影响研究[J].中国全科医学,2015,18(30):3722.
[2]郝伟.精神病学[M].6版.北京:人民卫生出版社,2008:106.
[3]鱼浚镛,田金洲.试述中医对抑郁症的认识[J].天津中医药,2011,28(4):343.
[4]王旭东,乔明琦,张樟进,等.中医药治疗抑郁症的研究进展[J].南京中医药大学学报,2016,32(1):93.
[5]董景五.疾病和有关健康问题的国际统计分类(ICD-10)[M].2版.北京:人民卫生出版社,2008:265-266.
[6]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:373-379.
[7]高树中,杨俊.针灸治疗学[M].3版.北京:中国中医药出版社,2012.
[8]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志,2001,34(3):184.
[9]马琴,周德安,王麟鹏.针刺治疗抑郁症的临床疗效观察及因子分析[J].中国针灸,2011,31(10):875.
[10]莫贤炜,张雷,关溯,等.作用于5-羟色胺受体的抗抑郁药物研究进展[J].中国药科大学学报,2016,47(6):639.
[11]李淑云,吴洪军,周贵兰.西酞普兰与氟西汀治疗抑郁症的对照研究[J].中外医学研究,2011,9(9):16.
[12]Kem P G,Kronenberg G.Depressed new neurons-adult hippocampal neurogenesis and acellular plasticity hypothesis of major depression[J].Biol Psychiatry,2003,54(5):499.
[13]谭涛,王金贵,孙庆.中西医结合治疗抑郁症疗效观察[J].山西中医,2012,28(9):16.
[14]Guan X T,Zhan X H,Yu H L,et al.Clinical epidemiological investigation analysis on 38 mild and middle degree depression patients with syndrome of stagnation of liver qi[J].CJTCMP,2015,30(6):2059.
[15]郭小青,田正良,米金辉.抑郁症中医病因病机分析[J].浙江中医杂志,2002,37(9):374.
[16]王玲玲,刘兰英,吕梅,等.针灸治疗抑郁症临床思路[J].针灸临床杂志,2003,19(7):7.
[17]杜元灏,李桂平.调神疏肝针法治疗郁证的理论基础[J].中国针灸,2005,25(2):143.
[18]谌琦,郭小青,王李雯.近十年中医药治疗抑郁症的临床研究概况[J].河南中医药学刊,2010(3):558.
[19]李新纯,唐武,李庆.疏肝宁神汤治疗抑郁症60例[J].新中医,2003,35(4):60.
[20]牛永利,赵俊龙,李红阁.针刺联合中药治疗肝气郁结型抑郁症的临床观察[J].陕西中医,2016,37(10):1406.
[21]贾爱民,温霞.涤痰汤加减治疗抑郁症13例[J].河南中医,2003,23(9):26.
[22]蔡艳,李斌.中西医结合治疗抑郁症72例临床观察[J].浙江临床医学,2011,13(4):427.
[23]周秀芳,胡捷,张迎梅,等.附子逍遥散配合快速针刺法治疗抑郁症的临床观察[J].中国药房,2016,27(11):1515.
[24]李文迅,韩焱晶,陶娟,等.电针对抑郁模型大鼠海马神经元凋亡的影响[J].中国中医药信息杂志,2005,12(2):33.
[25]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.
[26]罗和春,库宝善.电针治疗常见精神病[M].北京:北京医科大学、中国协和医科大学联合出版社,1993:144-147.
[27]冯慧,刘义,余正和,等.疏肝养心针刺法对选择性5-羟色胺再摄取抑制剂治疗抑郁症的增效作用及其对炎性细胞因子的影响研究[J].中国全科医学,2015,18(30):3722.