针药并用对围绝经期抑郁症患者HAMD积分、SDS积分及HPO轴的影响

摘要

Objective By observing the clinical efficacy of acupuncture plusBu Shen Jie Yu Qing Xin decoction (herbal decoction for tonifying kidney, anti-depression and clearing heart fire) in treating perimenopausal depression, to discuss about the effect of acupuncture plus medication on Hamilton Depression Scale (HAMD), Self-rating Depression Scale (SDS) and hypothalamic-pituitary-ovarian (H-P-O) axis in perimenopausal depression patients.Method By following a completely randomized design, sixty perimenopausal depression patients were divided into a Chinese medication group (Bu Shen Jie Yu Qing Xin decoction) with 30 cases, and an acupuncture-medication group (acupuncture plusBu Shen Jie Yu Qing Xin decoction) with 30 cases, to receive 12-week treatment in total. The HAMD and SDS were estimated prior to the treatment and in the 4th, 8th and 12th weeks; the serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), prolactin (PRL), and progesterone (P) contents were detected before and after the treatment.Result Acupuncture plus medication and Chinese medication alone were both effective in treating perimenopausal depression, and the therapeutic efficacy of acupuncture plus medication was superior to that of Chinese medication alone (P<0.05). In the acupuncture-medication group, the HAMD score dropped significantly in the 4th, 8th and 12th weeks compared to that before the treatment, and the score dropped significantly in the 8th and 12th weeks compared to that before the treatment in the Chinese medication group (P<0.01). The HAMD score in the acupuncture-medication group was significantly lower than that in the Chinese medication group in the 4th, 8th and 12th weeks (P<0.01). After the treatment, the items including anxiety, insight, sleep, and despair were significantly changed in the Chinese medication group (P<0.05); 7 items were significantly changed in the acupuncture-medication group (P<0.05). The scores of anxiety, insight, sleep, diurnal-nocturnal, obstruction, and body weight in the acupuncture-medication group were significantly superior to those in the Chinese medication group (P<0.05). The SDS score dropped significantly in the 4th, 8th and 12th weeks in the acupuncture-medication group, and in the 8th and 12th weeks in the Chinese medication group (P<0.01,P<0.05); in the 4th and 8th weeks, the SDS score in the acupuncture-medication group was significantly lower than that in the Chinese medication group (P<0.05), while the between-group difference was statistically insignificant in the 12th week (P>0.05). After 12-week treatment, the contents of FSH and LH declined significantly in both groups (P<0.01, P<0.05), and the contents of E2 and T increased significantly in the acupuncture-medication group (P<0.01,P<0.05). The decrease of FSH and LH, and the increase of E2 were more significant in the acupuncture-medication group (P<0.05,P<0.01).Conclusion Acupuncture plus medication can improve the symptoms of perimenopausal depression, and it takes a faster action than Chinese medication alone. Acupuncture plus medication can mitigate 7 items in HAMD, while Chinese medication can improve anxiety, insight, sleep and despair. Acupuncture plus medication can produce a more significant efficacy in improving anxiety, insight, sleep, diurnal-nocturnal, obstruction, and body weight compared to Chinese medication. For perimenopausal depression, acupuncture plus medication can correct the endocrine disorder and improve depression state by down-regulating the levels of FSH and LH, and up-regulating the contents of E2 and T to improve the function of H-P-O axis.%目的 通过观察针灸配合补肾解郁清心方治疗围绝经期抑郁症的临床疗效,探讨针药并用对围绝经期抑郁症患者HAMD积分、SDS积分及HPO轴的影响.方法 将60例围绝经期抑郁症患者按照完全随机方法分为中药组(补肾解郁清心方)30例、针药组(针灸+补肾解郁清心方)30例,共治疗12星期,于治疗前及治疗第4、8、12星期进行HAMD积分、SDS积分的评定;治疗前后进行血清FSH、LH、E2、T、PRL、P浓度的评定.结果 针药并用与中药治疗围绝经期抑郁症均有效,而针药并用治疗的疗效优于单纯中药治疗(P<0.05).针药组在治疗第4、8、12星期时,中药组在治疗第8、12星期时,HAMD积分较治疗前明显下降(P<0.01).治疗第4、8、12星期,针药组HAMD积分均明显低于中药组(P<0.01).中药组治疗后焦虑、认知、睡眠、绝望各因子与治疗前比较有统计学差异(P<0.05);针药组治疗后7项因子与治疗前比较差异均有统计学意义(P<0.05).针药组在焦虑、认知、睡眠、日夜变化、阻滞、体重各因子明显优于中药组(P<0.05).针药组在治疗第4、8、12星期,中药组在治疗第8、12星期,SDS积分较治疗前下降(P<0.01,P<0.05);治疗第4、8星期,针药组SDS积分均低于中药组(P<0.05),治疗第12星期时,两组间比较差异无统计学意义(P>0.05).治疗12星期后,两组FSH、LH较治疗前明显下降(P<0.01,P<0.05),针药组E2、T较治疗前明显上升(P<0.01,P<0.05).针药组FSH、LH下降,E2升高更明显(P<0.05,P<0.01).结论 针药并用能改善患者围绝经期抑郁症相关症状,降低HAMD积分,起效快于单纯中药治疗,且针药组能改善HAMD7项因子;中药组能改善焦虑、认知、睡眠、绝望因子.针药组在改善焦虑、认识、睡眠、日夜变化、阻滞、体重各因子方面都明显优于中药组.针药并用干预围绝经期抑郁症,能通过下调FSH、LH水平,提高E2、T含量来改善HPO轴的功能状态,纠正内分泌紊乱,缓解抑郁状态.