【作者】 徐凯；

【导师】 柴铁劬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学（专业学位）， 2013， 博士

【摘要】 目的：观察靳三针治疗抑郁症的疗效和安全性,并探讨相关作用机理；为靳三针治疗抑郁症提供更多的循证医学依据,为将来进一步的研究打下坚实的基础,并向临床推广该法。方法：本课题研究分为临床研究及实验研究两个方面：(1)临床研究：将符合纳入标准的60例抑郁症的患者随机分为两组,其中靳三针组30例,赛乐特组30例。①靳三针组：取穴：四神针、智三针、脑三针、颞三针(双侧),随证加减。按照操作规范进针,根据虚实行补泻手法,每次30分钟,每日1次,4周为1个疗程。②赛乐特组：给予赛乐特(盐酸帕罗西汀片)20mg口服,早晨1次服用,服用4周为1个疗程。两组与疗程结束后收集、统计相关的实验数据。(2)实验研究：220-250g SPF级SD大鼠,适应性饲养1周后,用SPSS19.0统计软件随机分组,得到正常组、模型组、靳三针组、赛乐特组四组,每组8只大鼠。除正常组8只大鼠外,余下24只大鼠采用慢性不可预见温和应激(Chronic unpredictable mild stress, CUMS),结合孤养,复制抑郁症大鼠模型。正常组每天空抓不予任何处理,模型组每天于CUMS刺激完后1小时空抓不予任何处理。靳三针组每天CUMS刺激完后1小时,予靳三针治疗。每天1次,共18天。赛乐特组每天CUMS刺激完后1小时,给予赛乐特灌胃,剂量为每天10mg/kg,每天1次,共18天。成果：临床成果：(1)汉密顿抑郁量表(HAMD)评分：两组治疗后HAMD评分均明显降低；靳三针组和赛乐特组相比,差别无统计学意义,说明靳三针抗抑郁效果明显,可达到赛乐特抗抑郁效果。(2)疗效结果：两组有效率(痊愈+显著进步+进步/总数)均为100%。两组疗效比较差别无统计学意义,可认为靳三针与赛乐特治疗抑郁症疗效相当。(3)副反应量表(TESS)评分结果：治疗开始1周后,靳三针就比赛乐特副作用小,治疗结束时,靳三针副作用亦比赛乐特小。(4)外周血去甲肾上腺素、多巴胺、5-羟色胺含量：靳三针能提高抑郁症患者外周血去甲肾上腺素、多巴胺含量,而赛乐特组患者外周血去甲肾上腺索、多巴胺含量未见改变；靳三针、赛乐特均能提高抑郁症患者外周血5-羟色胺含量,但赛乐特改善更明显。动物实验成果：(1)蔗糖水消耗实验：CUMS第9天靳三针组、赛乐特组大鼠比模型组大鼠兴趣已有所提高;CUMS结束后第1天靳三针组、赛乐特组比模型组大鼠兴趣提高更多,且赛乐特组比靳三针组大鼠兴趣要高。兴趣改变效果：靳三针能提高抑郁症模型大鼠的兴趣,但效果不及赛乐特。(2) Open-Field行为实验：水平运动：CUMS第9天及结束后第1天,靳三针组、赛乐特组比模型组大鼠水平运动均有所提高,且赛乐特组比靳三针组水平运动兴趣要高。水平运动(即运动活动性水平改变效果)：靳三针能提高抑郁症模型大鼠的运动活动性水平,但效果不及赛乐特。垂直运动：CUMS结束后第1天,靳三针组、赛乐特组比模型组大鼠垂直运动均有提高,靳三针组和赛乐特组大鼠垂直运动无显著差异。垂直运动(即探索兴趣提高效果)：靳三针能提高抑郁症模型大鼠探索新奇环境的兴趣,并且达到了赛乐特的效果。(3)大鼠脑海马组织去甲肾上腺素、多巴胺、5-羟色胺含量：所有经CUMS处理后的大鼠,海马中去甲肾上腺素含量未见差异,比正常大鼠要低。靳三针组大鼠多巴胺含量有所提高,赛乐特组大鼠多巴胺含量未见明显变化；可以认为在提高抑郁症模型大鼠海马组织多巴胺含量方面,靳三针比赛乐特效果好。靳三针组、赛乐特组经过处理后,5-羟色胺含量均有所提高；赛乐特效果比靳三针好。结论：(1)靳三针治疗抑郁症安全、有效,副作用小；(2)靳三针能提高抑郁症患者外周血去甲肾上腺素、多巴胺、5-羟色胺含量；(3)靳三针能提高抑郁症模型大鼠的兴趣以及运动度,改善大鼠抑郁状态；(4)靳三针能提高抑郁症模型大鼠脑海马多巴胺及5-羟色胺含量,而去甲肾上腺素含量提高不明显。更多还原

【Abstract】 ObjectiveTo observe the effect and safety of depression treatment by Jin’s Three Needles and discuss the related mechanism;to provide more evidence for depression treatment by Jin’s Three Needles and to spread this method to clinic.MethodsThis study was divided into two aspects:clinical studies and animal experiments(1) clinical study60cases were stratified random into two groups.30cases were in Jin’ s Three Needles group and30cases were in Seroxat group.①the Jin’s Three Needles group:Acupoint selection:The Four-Shen Points,Naosanzhen, Brain tri-points (two sides), addition and subtraction with symptoms. Inserting needle According to the operation rules, reinforcing and reducing with different symptoms.30minutes each time, once per day with4weeks as a course.②the Seroxat group:Given seroxat20mg daily in the morning,4weeks as a course.After the end of treatment, collected and counted the data.(2)animal experimentsAfter1week adaptive feeding,220-250g SPF SD rats were randomly grouped into4groups:the normal group、the model group、the Jin’s Three Needles group、the Seroxat group,8rats each group. All these rats were under Chronic unpredictable mild stress (CUMS) and feeded alone to make the model of depression, except the normal group.The normal group were caught everyday without any treatment. the rats in the model group were accepted CUMS stimulation for1hour and caught with no treatment. One hour after CUMS, the rats in Jin’s three Needle group were accepted Jin’s three Needles therapy, one time a day, a total of18days; The rats in seroxat group were given paroxetine by intragastric administration,10mg/kg per day,18days as a course.ResultsThe clinic results:(1)Hamilton Depression Scale scoreAfter acupuncture treatment, the HAMD score of the Jin’s Three Needles group was significantly decreased, this meant the Jin’s Three Needles was effective, which was equal to the effect of the Seroxat group.(2)Efficacy resultsThe efficiency of two groups (cure+significant progress+progress/total) were100%. The differences between the two groups was no statistical significance.(3)TESS scoreTwo weeks after treatment, the side effects on Jin’s three needles group was less than seroxat group.(4)the level of DA, NE,5-HT in peripheral blood;Jin’s three needles can improve the level of DA, NE,5-HT in patients’ peripheral blood,but seroxat can not improve the level’s of DA, NE.Animal experiments results:(1)Sucrose consumption testOn the ninth day of CUMS, the rats in Jin’s three needles group and seroxat group were more interested than in the model group;On the18th day of CUMS, the rats in Jin’s three needles group and seroxat group were more interesting than in the model group, but the Jin’s three needles group’s rats were less interesting than in the seroxat group.(2)Open-Field experiments:On the end of CUMS, the rats’horizontal and vertical movement in Jin’s three needles group and seroxat group have improved more than in the model group, but the rats horizontal movement in seroxat group have improved more than in the Jin’s three needles group.(3)The level of DA,NE,5-HT in hippocampus tissue of rat brain:NE:After treatment, there was no difference beteew these three CUMS groups, and the NE level was lower than the normal rats.DA:Jin’s three needl os group increased significantly, whi le seroxat group did not.5-HT:both Jin’s three needles group and Seroxat group were increased significantly, and Seroxat group increased more than Jin’s three needles group.Conclusion(1)The depression treatment with Jin’s three needles is safety, effective and little side effect;(2)Jin’s three needles can improve the peripheral blood NE, DA,5-HT levels of the depressive patients;(3)Jin’s three needles can improve the depression model rats’interests and ameliorate status of depression;(4)Jin’s three needles can improve the level of DA and5-HT in the depression model rats’hippocampal tissue, while NE is not improved obviously.更多还原