针刺对抑郁症的影响及其与代谢改变的相关性：一项随机对照试验。
The effect of acupuncture on depression and its correlation with metabolic alterations: A randomized controlled trial.
作者信息
Li Wei, Sun Manqin, Yin Xuan, Lao Lixing, Kuang Zaoyuan, Xu Shifen
机构信息
School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou.
Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
出版信息
Medicine (Baltimore). 2020 Oct 23;99(43):e22752. doi: 10.1097/MD.0000000000022752.
BACKGROUND
Electroacupuncture (EA) treatment has antidepressant effect and when patients were treated with EA and antidepressants, the effect could be maintained for a longer time. However, the effect of EA combined with antidepressants based on metabolism is still in the initial observation stage, which requires further research.
METHODS
A total of 60 patients with moderate depression were assigned into 2 groups at a ratio of 1:1, the EA group (receiving EA and antidepressants) and the control group (taking antidepressants only) in this randomized controlled pilot trial. The EA treatment was performed 3 times a week for 8 consecutive weeks and then follow up for 4 weeks. The patients' depressive mood was measured by the Hamilton Depression scale (HAMD) at baseline, week 4, week 8 and week 12. Before and after 8-week treatment, morning urine samples from all patients were analyzed by the gas chromatography-mass spectrometry (GC-MS) to find possible metabolic markers of depression and of EA treatment related changes.
RESULTS
Compared with the control group, the EA group showed more significant improvements in depressive symptoms measured by HAMD at week 4 (16.89 ± 5.74 vs 25.58 ± 7.03, P < .001), week 8 (9.59 ± 5.13 vs 25.04 ± 7.49, P < .001) and week 12 (11.07 ± 6.85 vs 27.25 ± 7.14, P < .001). The significant differences in urinary specific metabolites before and after EA treatment were malonic acid (fatty acid biosynthesis), cysteine (glutamate metabolism), glutathione (glutamate metabolism), tryptophan (tryptophan metabolism), proline (glutamate metabolism), and N-acetyl-5-hydroxytryptamine. These metabolites are involved in tryptophan metabolism, glutamate metabolism, and fatty acid biosynthesis.
CONCLUSION
EA treatment combined with antidepressants is more effective in improving depressive symptoms than antidepressants alone. EA may treat depression by acting on tryptophan metabolism, glutamate metabolism, and fatty acid biosynthesis.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR-2000030786.
背景
电针（EA）治疗具有抗抑郁作用，当患者接受电针和抗抑郁药联合治疗时，疗效可维持更长时间。然而，基于代谢的电针联合抗抑郁药的效果仍处于初步观察阶段，需要进一步研究。
方法
在这项随机对照试验中，将60例中度抑郁症患者按1:1的比例分为两组，即电针组（接受电针和抗抑郁药治疗）和对照组（仅服用抗抑郁药）。电针治疗每周进行3次，连续进行8周，然后随访4周。在基线、第4周、第8周和第12周，采用汉密尔顿抑郁量表（HAMD）测量患者的抑郁情绪。在8周治疗前后，对所有患者的晨尿样本进行气相色谱-质谱联用（GC-MS）分析，以寻找抑郁症可能的代谢标志物以及与电针治疗相关的变化。
结果
与对照组相比，电针组在第4周（16.89±5.74 vs 25.58±7.03，P<.001）、第8周（9.59±5.13 vs 25.04±7.49，P<.001）和第12周（11.07±6.85 vs 27.25±7.14，P<.001）时，HAMD测量的抑郁症状改善更为显著。电针治疗前后尿液中特定代谢物的显著差异包括丙二酸（脂肪酸生物合成）、半胱氨酸（谷氨酸代谢）、谷胱甘肽（谷氨酸代谢）、色氨酸（色氨酸代谢）、脯氨酸（谷氨酸代谢）和N-乙酰-5-羟色胺。这些代谢物参与色氨酸代谢、谷氨酸代谢和脂肪酸生物合成。
结论
电针联合抗抑郁药治疗在改善抑郁症状方面比单纯抗抑郁药更有效。电针可能通过作用于色氨酸代谢、谷氨酸代谢和脂肪酸生物合成来治疗抑郁症。
试验注册
中国临床试验注册中心：ChiCTR-2000030786。
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