补益心脾法降低心脾两虚型抑郁障碍患者自杀意念的队列研究
Nourishing the Heart and Spleen in Reducing Suicidal Ideation of Patients with Major Depressive Disorder(Deficiency of Heart and Spleen):A Cohort Study
袁善方 1王艳 2唐启盛 1黄世敬 3尹洪娜 4林安基 5孙文军1
作者信息
- 1. 北京中医药大学第三附属医院脑病科,北京,100029
- 2. 云南省大理白族自治州中医医院针灸科,云南,671000
- 3. 中国中医科学院广安门医院脑病科,北京,100053
- 4. 黑龙江中医药大学附属第二医院针灸科,哈尔滨,150001
- 5. 北京中医药大学厦门医院脑病科,厦门,361001
- 折叠
摘要
目的:探究补益心脾法对伴自杀意念的抑郁障碍(MDD)的临床疗效.方法:2017年1月至2018年4月招募全国13家中医、中西医结合及精神专科医院符合纳入标准的MDD患者366例作为研究对象,按治疗方案自然形成中医、西医与中西医结合治疗3个队列,并根据中药暴露时间(TCM-ET)分为高、中、低3个水平.间隔3个月随访,以蒙哥马利-阿斯伯格抑郁评定量表(MARDS)评估患者抑郁症状变化及终点事件发生情况.结果:中医、西医、中西医结合治疗队列的2年自杀意念发生率分别为39.0％、49.1％、29.0％.在自杀意念发生率的多因素比较上,以西医队列为参照,中医队列自杀意念发生率降低28.1％(HR=0.719,95％CI为0.476～1.087,P＞0.05),差异无统计学意义.中西医队列自杀意念发生率降低42.1％(HR=0.579,95％CI为0.373～0.899,P＜0.01).中医队列中,以低水平TCM-ET为参照,中水平TCM-ET自杀意念发生率降低22.2％(HR=0.778,95％CI为0.404～1.500,P＞0.05),差异无统计学意义,高水平TCM-ET自杀意念发生率降低66.6％(HR=0.394,95％CI为0.167～0.931,P＜0.05).中西医队列中,以低水平TCM-ET为参照,中水平TCM-ET自杀意念发生率降低70.3％(HR=0.419,95％CI为0.189～0.927,P＜0.05),高水平TCM-ET自杀意念发生率降低83.1％(HR=0.217,95％CI为0.094～0.501,P＜0.01).结论:补益心脾法中医治疗与西医治疗具有同等的疗效,中西医结合治疗可更好降低心脾两虚型MDD患者自杀意念发生率;中、高水平TCM-ET对降低心脾两虚型MDD患者自杀意念的临床疗效与低水平TCM-ET相比更为显著.
Abstract
Objective:To observe the clinical effect of nourishing the heart and spleen on major depressive disorder(MDD)with suicidal ideation.Methods:From January 2017 to April 2018,366 MDD patients(deficiency of heart and spleen)in 13 hospitals including traditional Chinese medicine(TCM)hospitals,integrated Chinese and Western medicine hospitals and psychiatric hospi-tals were taken as the study subjects in this cohort.Three cohort groups(TCM,Western medicine,and integrated Chinese and West-ern medicine)were formed naturally according to treatment regime,and they were divided into high,medium and low levels based on the TCM exposure time(TCM-ET).The follow-up interval was 3 months,and the Montgomery-Asberg Depression Rating Scale(MADRS)was used in the follow-up to assess the dynamic status of MDD patients and the occurrence of the endpoint events.Re-sults:The 2-year incidence of suicidal ideation of MDD patients in the TCM,Western medicine,and integrated Western and Chi-nese medicine cohorts was 39.0％,49.1％,and 29.0％,respectively.In the multifactorial comparison of suicidal ideation,com-pared with the condition in Western medicine cohort,the risk of suicidal ideation was reduced by 28.1％(HR=0.719,95％CI 0.476 to 1.087,P＞0.05)in TCM cohort,and by 42.1％(HR=0.579,95％CI 0.373 to 0.899,P＜0.01)in integrated Chinese and Western medicine cohort.In TCM cohort,compared with the condition under low-level TCM-ET,the risk of suicidal ideation was reduced by 22.2％(HR=0.778,95％CI 0.404 to 1.500,P＞0.05)under medium-level TCM-ET,and by 66.6％(HR=0.394,95％CI 0.167 to 0.931,P＜0.05)under high-level TCM-ET.In integrated Chinese and Western medicine cohort,com-pared with the condition under low-level TCM-ET,the risk of suicidal ideation was lowered by 70.3％(HR=0.419,95％CI 0.189 to 0.927,P＜0.05)with medium-level TCM-ET,and by 83.1％(HR=0.217,95％CI 0.094 to 0.501,P＜0.01)with high-level TCM-ET.Conclusion:Western medicine and TCM method of nourishing the heart and spleen present the same effect,and integrat-ed Chinese and Western medicine is more significant in reducing the suicidal ideation of MDD patients(deficiency of heart and spleen).Compared with low-level TCM-ET,medium-level and high-level TCM-ETs are more clinically effective in reducing the sui-cidal ideation.
关键词
中药/补益心脾法/心脾两虚/抑郁/自杀意念/多中心/前瞻性队列研究/临床疗效Key words
Chinese medicine/Nourishing the heart and spleen/Deficiency of heart and spleen/Major depressive disorder/Sui-cidal ideation/Multiple centers/Prospective cohort study/Clinical effect引用本文复制引用
基金项目
国家中医药行业专项(201507001)
首发科研专项(首发2022-2-7035)
国家中医药管理局岐黄学者项目(10400633210001)
北京自然科学基金(7222274)
第五批全国中医临床优秀人才项目()
中华中医药学会求实项目(2022-QNQSDEP-14)
教育部工程研究中心培育项目(BZYSY-2022-GCYJZXQX-09)
云南省区域中医(针灸)诊疗中心建设项目()
出版年
2023
国家科技期刊平台
NSTL
维普
万方数据