首页|针刺治疗卒中后抑郁的临床观察研究

针刺治疗卒中后抑郁的临床观察研究

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目的 客观评价针刺调节脑卒中后抑郁(Post-stroke depression,PSD)患者情绪的临床疗效与安全性,并探索针刺干预的可能作用靶点。方法 将76例PSD患者随机分为治疗组和对照组,对照组采用脑卒中常规治疗措施,治疗组在此基础上加用针刺治疗,以上星、百会、神庭、风池、率谷为主穴,辅以太冲、合谷、曲池、内关、阳陵泉、足三里、太溪进行针刺,每周5次,连续治疗4周,在治疗结束后的第90天进行随访。比较治疗前、治疗后以及随访后患者17项汉密尔顿抑郁量表评分(HAMD)、改良版Barthel指数(MBI)和治疗前、后血清5-羟色胺、去甲肾上腺素水平以及肠道菌群变化。结果 两组患者治疗后、随访后的HAMD评分、MBI指数均低于本组治疗前(P<0。01),且治疗组患者治疗后、随访后的汉密尔顿量表评分显著低于对照组(P<0。01);治疗组治疗后患者5-羟色胺、去甲肾上腺素水平优于本组治疗前(P<0。01),且显著高于对照组(P<0。01)。针刺后患者的优势菌群拟杆菌、厚壁菌、布劳特菌有上升趋势(P>0。05)。治疗前后的差异菌群主要富集与ECM-受体相互作用等信号通路上,差异具有统计学意义(P<0。01)。结论 针刺可以帮助患者提升日常生活能力,还能在一定程度上改善PSD患者肠道菌群的相对丰度,从而调节5-HT、NE水平以缓解患者的抑郁情绪,在临床上值得推广。
Clinical Observation on Acupuncture Treatment of Post-Stroke Depression
Objective To objectively evaluate the clinical efficacy and safety of acupuncture in regulating the mood of patients with post-stroke depression(PSD)and explore the possible target of acupuncture intervention.Methods 76 patients with PSD were randomly divided into treatment group and control group.The control group was treated with routine treatment measures for stroke,and the treatment group was treated with acupuncture on this basis.The main acupoints were Shangxing,Baihui,Shenting,Fengchi and Dugu,supplemented by acupuncture on Taichong,Hegu,Quchi,Neiguan,Yanglingquan,Zusanli and Taixi,5 times a week,continuously treated for 4 weeks,followed up on the 90th day after treatment.The levels of serum 5-hydroxytryptamine,norepinephrine and intestinal microflora before and after treatment were compared with the 17 Hamilton Depression Scale scores(HAMD),modified Barthel Index(MBI),and the levels of serum 5-hydroxytryptamine and norepinephrine before and after treatment.Results The HAMD score and MBI index of the two groups after treatment and follow-up were lower than those before treatment.The levels of 5-hydroxytryptamine and norepinephrine in the treatment group after treatment were higher than those before treatment(P<0.01),and significantly higher than those in the control group(P<0.01).After acupuncture,the dominant bacterial groups of Bacteroides,Thick-wall bacteria and Broughter bacteria in patients showed an upward trend(P>0.05).The difference of bacteria before and after treatment was mainly concentrated in signal pathways such as ECM-receptor interaction,and the difference was statistically significant(P<0.01).Conclusion Acupuncture can help patients improve their ability of daily living,and also improve the relative abundance of intestinal flora in PSD patients to a certain extent,so as to regulate the levels of 5-HT and NE to relieve the depression of patients,which is worthy of promotion in clinical practice.

Acupuncture therapyPost stroke depressionIntestinal flora5-hydroxytryptamineNoradrenaline

陆佳婧、谢静、侯瑜超、李琪、郭震、周艳丽、李璟

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上海中医药大学附属岳阳中西医结合医院 上海 200437

针刺疗法 卒中后抑郁 肠道菌群 5-羟色胺 去甲肾上腺素

上海市卫生健康委员会及上海市中医药管理局上海市科学技术委员会"科技创新行动计划"医学创新研究专项上海市科学技术委员会科技计划

SHGZS-20221223Y1192200020MC1920500

2024

世界科学技术-中医药现代化
中科院科技政策与管理科学研究所,中国高技术产业发展促进会

世界科学技术-中医药现代化

CSTPCD北大核心
影响因子:1.175
ISSN:1674-3849
年,卷(期):2024.26(4)
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