Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial

doi:10.13703/j.0255-2930.20211221-0002

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Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial

更新时间：2023-05-10

- Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial
- Chinese Acupuncture and Moxibustion Vol. 42, Issue 11, Pages: 1216-1220(2022)
- 作者机构：
  
  扬州大学临床医学院苏北人民医院康复医学科
- 作者简介：
- 基金信息：
- DOI：10.13703/j.0255-2930.20211221-0002
  CLC： R246.6
- Published：2022
- 稿件说明：
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Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial[J]. Chinese Acupuncture and Moxibustion, 2022, 42(11): 1216-1220.
DOI：

Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial[J]. Chinese Acupuncture and Moxibustion, 2022, 42(11): 1216-1220. DOI： 10.13703/j.0255-2930.20211221-0002.

摘要

目的：观察疏肝调神法针刺联合重复经颅磁刺激（r TMS）治疗脑卒中后抑郁（PSD）的疗效，并探讨其作用机制。方法：将90例PSD患者随机分为针刺+r TMS联合组（30例）、r TMS联合组（30例，脱落1例）和西药组（30例，脱落1例）。西药组予草酸艾司西酞普兰片，每次口服10 mg，每日1次；在西药组治疗基础上，r TMS联合组加用r TMS，频率20 Hz，每次20 min，每日1次，每周5次；在r TMS联合组治疗基础上，针刺+r TMS联合组加用疏肝调神法针刺，穴取百会、四神聪、印堂、神庭等，每次40 min，每日1次，每周5次，各组均治疗4周。于治疗前后，观察各组汉密尔顿抑郁量表（HAMD-17）、蒙特利尔认知评估量表（Mo CA）、匹兹堡睡眠质量指数（PSQI）评分，检测各组患者血清5-羟色胺（5-HT）、脑源性神经营养因子（BDNF）含量。结果：治疗后，各组患者HAMD-17评分较治疗前降低（P<0.01），针刺+r TMS联合组、r TMS联合组PSQI评分较治疗前降低（P<0.01），且针刺+r TMS联合组、rTMS联合组以上指标均低于西药组（P<0.05），针刺+r TMS联合组PSQI评分低于r TMS联合组(P<0.05）。治疗后，针刺+r TMS联合组、r TMS联合组Mo CA评分及血清BDNF含量较治疗前升高（P<0.01），各组患者血清5-HT含量较治疗前升高（P<0.01），且针刺+r TMS联合组、r TMS联合组以上指标均高于西药组（P<0.05），针刺+r TMS联合组高于r TMS联合组（P<0.05）。结论：在西药草酸艾司西酞普兰片治疗基础上，疏肝调神法针刺联合r TMS治疗可以有效改善PSD患者认知功能和睡眠质量，效果优于单纯西药或r TMS联合西药治疗，推测其作用机制可能与提高外周血清5-HT和BDNF含量有关。

Abstract

Objective To observe the curative effect of Shugan Tiaoshen（soothing liver and regulating mind）acupuncture combined with repetitive transcranial magnetic stimulation（rTMS） in the treatment of post-stroke depression（PSD）

and to explore its mechanism. Methods Ninety patients of PSD were randomly divided into an acupuncture+rTMS combination group（30 cases）

a rTMS combination group（30 cases

1 case dropped off） and a western medication group（30 cases

1 case dropped off）. The western medication group was treated with escitalopram oxalate tablets

10 mg orally each time

once a day; on the basis of the treatment in the western medication group

the rTMS combination group was additionally given rTMS

and the frequency was 20 Hz

20 min each time

once a day

5 times a week; on the basis of the treatment in the r TMS combination group

the acupuncture+rTMS combination group was additionally treated with Shugan Tiaoshen acupuncture at Baihui（GV 20）

Sishencong（EX-HN 1）

Yintang（GV 24+）

Shenting（GV 24）

etc. for 40 min each time

once a day

weekly 5 times

and each group was treated for 4 weeks. Before and after treatment

the scores of Hamilton depression scale-17（HAMD-17）

Montreal cognitive assessment scale（MoCA）

Pittsburgh sleep quality index（PSQI） were observed

and serum levels of 5-hydroxytryptamine（5-HT） and brain-derived neurotrophic factor（BDNF） were detected in each group. Results After treatment

the HAMD-17 scores in the three groups were lower than those before treatment（P<0.01）

and the PSQI scores in the acupuncture+rTMS combination group and the rTMS combination group were lower than those before treatment（P<0.01）; the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were lower than those in the western medication group（P<0.05）

and the PSQI score in the acupuncture+rTMS combination group was lower than that in the rTMS combination group（P<0.05）. After treatment

the MoCA scores and serum BDNF levels in the acupuncture+rTMS combination group and the rTMS combination group were higher than those before treatment（P<0.01）

and the serum 5-HT levels in the three groups were higher than those before treatment（P<0.01）;and the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were higher than those in the western medication group（P<0.05）

and which in the acupuncture+rTMS combination group were higher than those in the rTMS combination group（P<0.05）. Conclusion On the basis of western medication escitalopram oxalate

the addition of Shugan Tiaoshen acupuncture combined with rTMS therapy can effectively improve cognitive function and sleep quality in patients with PSD

and the effect is better than that of western medication alone or rTMS combined with western medication.Its mechanism of action may be related to the increase of peripheral serum 5-HT and BDNF levels.

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