“通督调神”针刺对缺血性脑卒中后抑郁患者血清铁蛋白水平的影响及疗效研究

“通督调神”针刺对缺血性脑卒中后抑郁患者血清铁蛋白水平的影响及疗效研究(硕士)(论文35000字)
中文摘要
目的：
通过临床观察“通督调神”针刺对缺血性脑卒中后抑郁患者（Post-stroke depression，PSD）抑郁症状的改善情况以及针刺对PSD患者血清铁蛋白（Serum Ferritin,SF）水平的影响，探究针刺治疗PSD可能的疗效机制，为针刺治疗PSD提供依据。
方法：
1、将60例符合缺血性脑卒中后抑郁的患者随机分为针刺治疗组和药物对照组，每组30例，同时对两组患者给予脑血管病的二级预防和相关的基础治疗，如低盐低脂饮食、营养脑神经、改善循环、抗血小板聚集、抗凝、控制血压、调节血糖、血脂；防治并发症等相关的对症治疗，一疗程为四周，连续治疗两个疗程，脑卒中发病后应针对病情进行相应的康复治疗，每次的康复时间和强度以患者能耐受为度。在此治疗基础上，药物对照组采用口服盐酸帕罗西汀片（赛乐特），20mg，每日一次，清晨顿服，连续服用8周，针刺治疗组在药物对照组治疗基础上加用“通督调神针刺”，取穴为百会、神庭、印堂、人中、风府；肝气郁结型配太冲（双）、膻中，心脾两虚型配神门（双）、内关（双），4周为1个疗程，共2个疗程。观察两组患者治疗前、治疗4周末、治疗8周末血清铁蛋白的水平，测定采用免疫发光检测法，以及汉密尔顿抑郁量表（Hamilton depression scale，HAMD）、Zung抑郁自评量表（Self-Rating Depresion Seale，SDS）的评分变化。
2、数据采用SPASS21.0统计软件包进行处理分析，试验测得各种数据，采用均数±标准差(χ(—)±s)表示，组内均数比较采用配对t检验，计数资料用频数、百分比描述，采用X2检验，统计结果用SPASS21.0软件进行分析，P<0.05认为有差异，P<0.01认为有显著性差异，P>0.05认为无显著性差异。
结果：
1、血清SF的变化：
   在两组治疗后第4周后，通督调神针刺组和药物对照组与治疗前相比较，患者血清SF水平均有显著性差异(P<0.05),而两组之间比较则无差异(P>0.05)；治疗第8周后，两组患者血清SF较治疗前有显著性差异(P<0.01)，而两组之间比较则无显著性差异(P>0.05)，表明两个疗程结束后，针刺治疗组和药物组均可降低PSD患者血清SF水平，针刺组与药物组疗效相当。
2、HAMD量表的评分变化：
治疗4周后，两组患者HAMD的评分分别和治疗前相比较，患者HAMD评分显著降低(P<0.05)，而两组间比较则无显著性差异(P>0.05)，治疗8周后，治疗组和对照组分别与治疗前相比，患者HAMD评分显著降低(P<0.01)，而两组之间比较则无显著性差异(P>0.05)，两组间的总有效率比较并无显著性差异(P>0.05)。
3、Zung抑郁自评量表的评分变化：
治疗后第4周，两组的Zung抑郁自评量表的评分较治疗前有差异(P<0.05)，而两组之间比较则无差异(P>0.05)；治疗第8周后，两组的Zung抑郁自评量表的评分较治疗前有显著性差异(P<0.01)，且组间比较也有显著性差异(P<0.01)。
结论：
1、通督调神针刺疗法可降低PSD患者血清SF含量。
2、通督调神针刺疗法可改善PSD患者的抑郁症状，而且随着疗程的增加，针刺组对PSD患者抑郁改善程度优于西药组。
3、针刺疗法对PSD患者临床疗效确切、不良反应少、安全可靠。
4、通督调神针刺疗法对PSD患者的临床治疗作用机制可能与调低血清SF水平相关。

关键词：卒中后抑郁、通督调神针刺、SF

Abstract
Objective:
Through clinical observation "tong du tiao shen" acupuncture in patients with depression after ischemic stroke on the improvement of their depressive symptoms and acupuncture Serum Ferritin in patients with PSD, To explore the therapeutic effect of acupuncture on PSD, and provide the basis for acupuncture treatment of PSD.
Method：
1、A total of 60 patients with ischemic stroke depression were randomly divided into acupuncture treatment group and drug control group,30 cases per group,Two groups of patients were given secondary prevention and related basic treatment of cerebrovascular disease,Such as low salt and low fat diet, nutritional brain nerve, improvement of circulation, anti-platelet aggregation, anticoagulation, control of blood pressure, regulation of blood glucose, blood lipids;Prevention and treatment of complications and other related symptomatic treatment,One session is four weeks,Two courses of continuous treatment,After the onset of cerebral apoplexy, corresponding rehabilitation should be conducted for the disease,The duration and intensity of each recovery is as good as the patient's ability to endure.On the basis of this treatment,The drug control group was treated with oral hydrochloride paroxetine tablets (celeste), 20mg, daily, morning, and 8 weeks in a row,The acupuncture treatment group was applied to the treatment of the control group with the “tong du tiao shen”acupuncture,The cave is bai hui,shen ting,yin tang,ren zhong,feng fu;The liver qi yu tie type with taichong (double), dan zhong,Heart and spleen two virtual type with shen men (double), nei guan (double),4 weeks for 1 course of treatment, 2 courses.To observe the level of serum ferritin in the two groups before treatment, 4 weekends and 8 weekends,Immunofluorescence assay was used,The scores of the Hamilton depression scale (HAMD) and the Zung depression self-rating scale (SDS) were changed.
2. The data were analyzed by SPASS21.0 statistical software package, and the data were measured and the average number of the data was measured,Group mean compare with paired t test, counting data description with frequency, percentage, using X2 test, analyze the results using SPASS21.0 software, P < 0.05 think there's a significant difference, P < 0.01 think there is a very significant difference, P > 0.05 thought there was no significant difference.
Result:
1. Changes in serum SF:
In the two groups after 4 weeks after treatment, tong du tiao shen acupuncture group and drug control group compared with before treatment, patients' serum SF levels had significant difference (P < 0.05), and compared between two groups had no significant difference (P > 0.05);After the 8th week of treatment, the serum SF of the two groups was significantly different (P<0.01) compared with the previous treatment (P< 0.01), while the comparison between the two groups showed no significant difference (P > 0.05).After two sessions, both acupuncture and drug groups reduced serum SF level in PSD patients, and the acupuncture group was equivalent to the drug group.
2、The grading changes of the HAMD scale:
After 4 weeks of treatment, the scores of HAMD in the two groups were compared with those of the previous treatment, and the HAMD score significantly decreased (P< 0.05), while the comparison between the two groups showed no significant difference (P > 0.05).8 weeks after treatment, tong du god acupuncture group and drug control group, respectively, compared with before treatment, patients with HAMD scores decreased significantly (P < 0.01), and compared between two groups had no significant difference (P > 0.05), the total effective rate between the two groups was no significant sex difference (P > 0.05).
3.Zung depression self-rating scale changes:
After 4 weeks of treatment, the Zung depression self-rating scale of the two groups was significantly different from the treatment (P< 0.05), while the comparison between the two groups showed no significant difference (P >0.05). 8 weeks after treatment, the scores of the two groups of Zung depression self-rating scale were significantly different (P<0.01) than before treatment, and there was a significant difference between the groups (P< 0.01). 
Conclusion:
1. The acupuncture therapy can reduce the serum SF content of PSD patients.
2. “Tong du tiao shen”acupuncture therapy can improve the depressive symptoms in PSD patients, and with the increase of the treatment, acupuncture has better than western medicine in the improvement of depression in PSD patients.
3. Acupuncture therapy is effective for the clinical efficacy of PSD patients, less adverse reactions and safe and reliable.
4. The mechanism of acupuncture therapy for PSD patients may be related to the reduction of serum SF level.
Keywords: After stroke, depression, acupuncture, SF

中英文缩略词对照表
英文简称    英文全称    中文全称
SF    Serum ferritin    血清铁蛋白
PSD    Post-stroke depression    卒中后抑郁
HAMD    Hamilton depression scale    汉密尔顿抑郁量表
5 - H T    5-hydroxy tryptamine    5-羟色胺
N E    norepinephrine    去甲肾上腺素
CRP    C-reactive protein    C反应蛋白
BDNF    Brain-derived neurotrophic factor    脑源性神经营养因子
HPA    The Hypothalamus-pituitary-adrenal    下丘脑-垂体-肾上腺
HPT      Hypothalamus-pituitary-gland    下丘脑-垂体-甲状腺
     HPG    Hypothalamus-pituitary-gonads    下丘脑-垂体-性腺
SOD      Hyper  oxide  dismutase         超氧化物歧化酶
MDA      Malondialdehyde    丙二醛
SDS         Self-rating depression scale      抑郁自评量表
    OS    Oxidative  Stress    氧化应激
   SSRI    se-lective serotonin reuptake inhibitor      5-羟色胺再摄取抑制剂
IL         Interleukin    白细胞介素

目录
中文摘要  …………………………………………………………1
英文摘要  ………………………………………………………… 3
英文缩略词表  …………………………………………………… 6
正文
1 前言  ……………………………………………………… 7
2 资料与方法  ……………………………………………… 9
3 结果  ………………………………………………………19
4 讨论  ………………………………………………………25
5 结论  ………………………………………………………40
6 问题与展望  ………………………………………………41
7 参考文献  …………………………………………………42
综述  ………………………………………………………………47
个人简历  …………………………………………………………54
攻读学位期间发表的学术论文目录  ……………………………54
致谢  ………………………………………………………………55
附录  ………………………………………………………………56