“疏肝调神”针刺法改善轻度抑郁障碍患者抑郁症状临床疗效观察

Observation on the effect of randomized controlled trial of “Shugan Tiaoshen” acupuncture method on alleviating depressive symptoms and improving executive control function in patients with mild depressive disorder

关键词:  “疏肝调神”法  针刺  轻度抑郁障碍  大脑执行控制功能  随机对照试验

Key words:  “Shugan Tiaoshen” method  acupuncture  mild depressive disorder  brain executive control function  randomized controlled trial

摘要:

[目的] 采用心理学实验范式客观评估轻度抑郁障碍患者执行控制功能特征，观察“疏肝调神”针刺法对抑郁症状及认知功能的调节效应。[方法] 90例轻度抑郁障碍患者按1∶1∶1比例随机分为针刺组、药物组和安慰针刺组，每组30例，另招募30例健康受试者作为基线对照。针刺组予“疏肝调神”针刺治疗，每周2次；药物组予盐酸氟西汀，每次20 mg，每日1次，口服；安慰针刺组采用不破皮安慰假针，取穴及疗程等与针刺组相同。3组均干预4周，随访至第8周。比较3组患者治疗前后及治疗结束后4周（随访）汉密尔顿抑郁量表（HAMD-17）评分、抑郁自评量表（SDS）评分、2-back任务反应时、2-back正确率及执行控制容量实验正确率，评定临床疗效和安全性。[结果] 基线数据显示抑郁患者组的2-back任务反应时、2-back正确率及执行控制容量正确率均低于健康组（P<0.01）。抑郁症状指标显示，治疗后及随访时，针刺组HAMD-17、SDS评分降低幅度均显著优于药物组和安慰针刺组（P<0.05）；认知功能指标显示，治疗后针刺组2-back反应时缩短、执行控制容量正确率提升的程度均显著高于药物组和安慰针刺组（P<0.05），随访时针刺组疗效维持良好。针刺组临床总有效率86.7%，高于药物组的70.0%（P<0.05）和安慰针刺组的40.0%（P<0.05）。治疗期间，3组患者均未发生严重不良反应。[结论] 轻度抑郁障碍患者存在特征性执行控制功能损害；“疏肝调神”针刺法不仅能有效改善抑郁症状，还可显著提升工作记忆和执行控制能力，其综合疗效优于盐酸氟西汀胶囊与安慰针刺。

Abstract:

[Objective] To objectively assess the executive control function characteristics of patients with mild depressive disorders using psychological experimental paradigm，and to observe the effects of “Shugan Tiaoshen” acupuncture methed on depressive symptoms and cognitive functions. [Methods] Ninety patients with mild depressive disorder were randomly divided into the acupuncture group，the drug group and the sham acupuncture group according to the ratio of 1∶1∶1，with 30 patients in each group，and 30 healthy subjects provided normative data. The acupuncture group received “Shugan Tiaoshen” acupuncture methed twice weekly；the medication group was administered fluoxetine hydrochloride capsules（20 mg once daily）；and the sham acupuncture group received non-penetrating placebo needles at identical acupoint as that of the acupuncture group. All three groups were intervened for 4 weeks. The Hamilton Depression Scale（HAMD-17），Self-Rating Depression Scale（SDS） scores，2-back task response time，correct rate and execution of controlled volume experiment were compared among the three groups before and after the treatment and 4 weeks after the end of treatment（follow-up），and the clinical efficacy and safety were evaluated. [Results] Baseline data showed that the depressed patient group was significantly worse than the healthy group in terms of 2-back task response time，2-back correct rate，and correct rate of executive control volume（all P<0.01）. After treatment and in the follow-up，the reduction of HAMD-17 and SDS scores in the acupuncture group was significantly better than that in the drug group and the sham acupuncture group（P<0.05）；cognitive function indexes showed that the shortening of 2-back reaction time，the correct rate of executive control volume in the acupuncture group were significantly higher than that in the control group（P<0.05）. The total clinical effectiveness rate of 86.7% in the acupuncture group was higher than that of 70.0%（P<0.05） in the drug group and 40.0%（P<0.05） in the sham acupuncture group. During the treatment period，no serious adverse reactions occurred in all three groups. [Conclusion] Patients with mild depressive disorder have characteristic impairment of executive control function；“Shugan Tiaoshen” acupuncture method can not only effectively improve the symptoms of depression，but also significantly improve the working memory and executive control ability，and its comprehensive therapeutic efficacy is better than that of fluoxetine hydrochloride capsule and sham acupuncture.