从针刺太冲穴治疗抑郁症探讨肝经与额叶联系的静息态功能磁共振研究

作者	单位
易洋	重庆医科大学中医药学院
杨德兰	重庆医科大学第一附属医院精神科
徐放明	重庆医科大学中医药学院
谢鹏	重庆医科大学第一附属医院神经内科
谢洪武	重庆医科大学中医药学院
孙娟	武警安顺市支队卫生队
宋云娥	重庆医科大学中医药学院
吕发金	重庆医科大学第一附属医院放射科
林云	第三军医大学西南医院放射科
胡皓	武警安顺市支队卫生队
冯伟	武警安顺市支队卫生队

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中文摘要:

目的探讨针刺太冲穴治疗抑郁症的机制及肝经与额叶的联系。方法将符合美国精神疾病诊断与统计手册第4版(DSM-Ⅳ)抑郁症诊断标准的42例首发中度抑郁症患者分为药物组(氟西汀)、针药组(太冲穴联合氟西汀)及针刺组(太冲穴),每组14例,疗程均为1个月,运用3.0T磁共振方法,分别对相应脑区治疗前后进行静息态功能磁共振扫描,采用比率低频振幅(fractional amplitude of low frequency fluctuations,fALFF)的方法分析数据,各组治疗前后进行配对t检验比较,并将治疗后的图像与汉密尔顿(HAMD)评分做相关分析。结果与本组治疗前比较,针药组左侧额叶(BA6、BA9、BA48)、右侧额叶(BA4、BA46)、双侧顶下小叶(BA40、BA48)、楔前叶(BA7)、后扣带回(BA31)、左侧枕叶(BA17)及右侧枕叶中部(BA18)的fALFF值降低(P<0.05);药物组右侧顶下小叶(BA40)和右侧枕叶(BA17)的fALFF值降低(P<0.05);针刺组左侧额叶(BA10)、右侧额叶(BA45)、左侧枕叶(BA19)、右侧枕叶中部(BA17)、左侧楔前叶(BA7),后扣带回(BA31)的fALFF值降低(P<0.05)。针药组及针刺组的左侧额叶fALFF值均与HAMD评分呈正相关;药物组左侧额中回、左侧顶叶、左侧枕叶fALFF值与HAMD评分呈正相关。结论针刺联合抗抑郁药的疗效优于单一的针刺或药物治疗;额叶功能的改变与病情程度相关;肝经与额叶之间存在较为广泛的联系,可能是针刺太冲穴治疗抑郁症的机制。

英文摘要:

Objective To explore the mechanism of depression treatment by needling at Taichong (LV3) and the correlation between the liver meridian and the frontal lobe.Methods Forty-two patients with moderate depression at the first attack in line with Diagnostic and Statistical Manual of Mental Disorders (4th ed) by American Psychiatric Association were assigned to the fluoxetine group,the needling+fluoxetine group,and the needling group,14 in each.The therapeutic course for them all was one month.Resting fMRI scanning was performed before and after treatment using 3.0 T magnetic resonance.Data were analyzed using fractional amplitude of low frequency fluctuations (fALFF).Paired t-test was used for comparison.Correlation analysis was performed in the fALFF images after treatment and Hamilton’s depression scale.Results Compared with before treatment,fALFF values in the left frontal lobe (BA6,BA9,BA48),the right frontal lobe (BA4,BA46),the bilateral inferior parietal lobules (BA40,BA48),the precuneus (BA7),the posterior cingutate (BA31),the left occipital lobe (BA17),and the right occipital lobe (BA18) of the needling+fluoxetine group were lowered (P<0.05).fALFF values in the right inferior parietal lobule (BA40) and the right occipital lobe (BA17) of the fluoxetine group were lowered (P<0.05).fALFF values in the left frontal lobe (BA10),the right frontal lobe (BA45),the left occipital lobe (BA19),the right occipital lobe (BA17),the left precuneus (BA7),and the posterior cingutate (BA31) were lowered in the needling group (P<0.05).Hamilton’s depression scale was positively correlated with the fALFF value in the left frontal lobe of the needling+fluoxetine group and the needling group,while Hamilton’s depression scale was positively correlated with the fALFF value in the left middle frontal gyrus,the left parietal lobe,and the left occipital lobe in the fluoxetine group.Conclusions Combination of needling and antidepressive agents was superior to needling or antidepressive agents alone.Changes of the frontal lobe functions were correlated with the severity of depression.More extensive correlation existed between the liver meridian and the frontal lobe,which might be the antidepressive mechanism of needling Taichong (LV3).

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