補(bǔ)益心脾法及安神定志法干預(yù)閾下抑郁的臨床研究
發(fā)布時(shí)間：2018-07-29 18:39
【摘要】：背景閾下抑郁(subthreshold depression,SD)是指存在部分抑郁癥狀,但未達(dá)到抑郁癥的診斷標(biāo)準(zhǔn),是一種介于健康和抑郁癥之間的中間狀態(tài)。隨著社會(huì)競(jìng)爭的日益加劇和人們生活節(jié)奏的加快,閾下抑郁具有很高的發(fā)生率。其與抑郁癥會(huì)造成同樣嚴(yán)重的職業(yè)功能下降、社會(huì)功能損害、醫(yī)療負(fù)荷增加,以及高比例的患病率、自殺率及致殘率,因此引起了各國研究者的廣泛重視。中醫(yī)學(xué)中蘊(yùn)含著豐富的治療醫(yī)學(xué)和預(yù)防醫(yī)學(xué)思想,利用中醫(yī)藥對(duì)閾下抑郁人群進(jìn)行辨證治療,有利于阻止閾下抑郁向抑郁癥下滑,并促進(jìn)抑郁癥向閾下抑郁及健康方向轉(zhuǎn)變,從而提高生活質(zhì)量,減輕國家、社會(huì)經(jīng)濟(jì)負(fù)擔(dān)。目的本研究結(jié)合導(dǎo)師唐啟盛教授的臨床經(jīng)驗(yàn),選擇閾下抑郁的常見證型心脾兩虛、心膽氣虛證型進(jìn)行隨機(jī)、對(duì)照、雙盲的觀察,以漢密爾頓抑郁量表和中醫(yī)證候評(píng)定表進(jìn)行療效評(píng)定,目的在于驗(yàn)證補(bǔ)益心脾法及安神定志法治療閾下抑郁的療效,加深對(duì)閾下抑郁的認(rèn)識(shí)。觀察閾下抑郁向抑郁癥的轉(zhuǎn)化率及自愈率,從而推斷中醫(yī)辨證治療是否阻礙了閾下抑郁向抑郁癥的發(fā)展。方法及結(jié)果方法:本課題所選對(duì)象來源于北京中醫(yī)藥大學(xué)3個(gè)附屬醫(yī)院及其所屬6個(gè)社區(qū)的門診患者,觀察閾下抑郁的患者,采用隨機(jī)、對(duì)照、雙盲原則,觀察病例總數(shù)120例:心脾兩虛型試驗(yàn)組及其對(duì)照組各30例,心膽氣虛型試驗(yàn)組及其對(duì)照組各30例。心脾兩虛型試驗(yàn)組給予歸脾湯顆粒劑,心膽氣虛型試驗(yàn)組給予安神定志丸顆粒劑,兩對(duì)照組均給予淀粉糊精安慰劑顆粒。療程均為6周,觀察1周、2周、4周、6周的療效,6周時(shí)停藥。分析治療前后各組指標(biāo)的變化,對(duì)調(diào)查結(jié)果采用統(tǒng)計(jì)描述的方法分析。結(jié)果:以HAMD減分率及中醫(yī)療效指數(shù)評(píng)估臨床療效:心脾兩虛型歸脾湯組與心膽氣虛型安神定志丸組兩試驗(yàn)組的HAMD減分療效均優(yōu)于其對(duì)照組,組間有顯著性差異。抑郁癥轉(zhuǎn)化率及閾下抑郁自愈率:兩試驗(yàn)組與其對(duì)照組在6周時(shí)構(gòu)成比均有明顯差異,用χ2檢驗(yàn),P均小于0.05,兩者間差異具有統(tǒng)計(jì)學(xué)意義。通過治療,第6周時(shí)歸脾湯試驗(yàn)組閾下抑郁患者中有25%的人回到無抑郁狀態(tài);僅有1例轉(zhuǎn)化為抑郁癥,考慮不排除有其他原因如日常生活壓力改變等所導(dǎo)致;有71.43%的人停留在閾下抑郁狀態(tài)。其對(duì)照組在6周時(shí)有79.31%的人停留在閾下抑郁的狀態(tài),有13.79%的人進(jìn)展為抑郁癥,有6.90%的人可自愈。第6周時(shí)安神定志丸組閾下抑郁患者中有43.33%的人回到無抑郁狀態(tài),且無一例轉(zhuǎn)化為抑郁癥,尚有56.67%的人停留在閾下抑郁狀態(tài);而對(duì)照組中有71.43%的人仍停留在閾下抑郁狀態(tài),有14.29%的人進(jìn)展為抑郁癥,有14.29%的人發(fā)生自愈。結(jié)論1.補(bǔ)益心脾法及安神定志法治療閾下抑郁(心脾兩虛型、心膽氣虛型)具有良好的療效,且未見明顯的毒副作用;2.兩試驗(yàn)組的抑郁癥轉(zhuǎn)化率明顯低于其對(duì)照組,而治愈率明顯高于對(duì)照組自愈率,說明歸脾湯及安神定志丸在閾下抑郁向抑郁癥下滑的進(jìn)程中起到了有效的阻斷作用;3.6周時(shí),對(duì)照組心脾兩虛型、心膽氣虛型閾下抑郁分別有6.90%、14.29%的人恢復(fù)到無抑郁狀態(tài),說明心脾兩虛型及心膽氣虛型閾下抑郁具有自愈傾向。
[Abstract]:Subthreshold depression (SD) refers to the existence of some depressive symptoms, but the diagnosis of depression is a intermediate state between health and depression. With the increasing social competition and the quickening of people's life rhythm, the subthreshold depression has a high incidence. It is the same as depression. The serious occupational dysfunction, social function damage, the increase of medical load, the high proportion of disease rate, the rate of suicide and the rate of disability have caused widespread attention of the researchers in various countries. There are rich medical and preventive medicine ideas in traditional Chinese medicine, and it is beneficial to prevent and treat the subliminal depressive people by using traditional Chinese medicine. Subliminal depression to depression, and to promote depression to subliminal depression and health direction, so as to improve the quality of life, reduce the national, social and economic burden. The objective of this study, combined with the clinical experience of Professor Tang Qisheng, selected the common syndrome of subliminal depression of the heart and spleen two deficiency, heart and gallbladder deficiency syndrome of random, control, double blind view To evaluate the effect of the Hamilton depression scale and the TCM syndrome assessment form, the purpose is to verify the curative effect of the tonifying heart and spleen method and Anshen determination method in the treatment of subliminal depression, deepen the understanding of subliminal depression, observe the conversion rate and self healing rate of subliminal depression to depression, and infer whether TCM syndrome differentiation therapy hinders subthreshold depression. The development of depression. Methods and results: the subjects were selected from 3 affiliated hospitals of Beijing University of Chinese Medicine and 6 outpatients in their affiliated communities. The patients with subthreshold depression were observed by random, controlled and double blindness principle, and the total number of cases was observed in 120 cases, 30 cases of heart spleen two deficiency test group and the control group, and the heart and gallbladder deficiency type test. The test group and the control group were 30 cases. The experimental group of the two deficiency of the heart and spleen was given the granule of GUI PI decoction, the experimental group of the heart and the biliary Qi deficiency group was given Anshen Ding Zhi pill and the two control groups were given the starch dextrin placebo granules. The treatment course was 6 weeks, the curative effect of 1 weeks, 2 weeks, 4 weeks, 6 weeks was stopped. The changes of the indexes before and after the treatment were analyzed and the investigation was conducted to investigate the changes of the indexes before and after the treatment. Results the results were analyzed by the method of statistical description. Results: the HAMD reduction rate and the traditional Chinese medicine effect index were used to evaluate the clinical effect: the HAMD reduction effect of the two deficiency group and the heart and spleen qi deficiency group of Anshen Shen Zhi pill group was better than that of the control group. There was a significant difference between the group and the group. The conversion rate of depression and the self healing rate of subliminal depression were two test groups. The composition ratio of the control group was significantly different at 6 weeks, with the x 2 test, P was less than 0.05, and the difference between the two was statistically significant. Through treatment, 25% of the patients with subthreshold depression were returned to the non depressive state at sixth weeks. Only 1 cases were converted to depression, and other reasons were not excluded, such as daily stressful changes. 71.43% of the people stayed in the state of subliminal depression. In the control group, 79.31% of them stayed in the state of subliminal depression at 6 weeks, 13.79% of them developed depression, and 6.90% were able to heal themselves. At the time of the sixth weeks, 43.33% of the patients with subthreshold depression in Anshen Ding pill group returned to no depression, and none of them turned into depression. 56.67% of the people remain in the state of subliminal depression, while 71.43% of the control group still remain in the state of subliminal depression, 14.29% of them are depressive and 14.29% have self-healing. Conclusion 1. tonifying heart and spleen method and Anshen determination method have good curative effect on subliminal depression (heart and spleen two deficiency, heart qi deficiency type), and there is no obvious effect. The conversion rate of depression in the 2. two test group was significantly lower than that of the control group, and the cure rate was significantly higher than that of the control group, indicating that the Gupi Decoction and Anshen Ding Zhi pill played an effective blocking role in the process of subthreshold depression to depression, and at 3.6 weeks, the group of heart and spleen two deficiency and the heart and gallbladder deficiency type subliminal depression were respectively in the 3.6 weeks. 6.90% or 14.29% of them recovered to the state of no depression, indicating that the subthreshold depression of the heart spleen two deficiency type and the heart gallbladder Qi deficiency type had self healing tendency.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7
本文編號(hào)：2153637
[Abstract]:Subthreshold depression (SD) refers to the existence of some depressive symptoms, but the diagnosis of depression is a intermediate state between health and depression. With the increasing social competition and the quickening of people's life rhythm, the subthreshold depression has a high incidence. It is the same as depression. The serious occupational dysfunction, social function damage, the increase of medical load, the high proportion of disease rate, the rate of suicide and the rate of disability have caused widespread attention of the researchers in various countries. There are rich medical and preventive medicine ideas in traditional Chinese medicine, and it is beneficial to prevent and treat the subliminal depressive people by using traditional Chinese medicine. Subliminal depression to depression, and to promote depression to subliminal depression and health direction, so as to improve the quality of life, reduce the national, social and economic burden. The objective of this study, combined with the clinical experience of Professor Tang Qisheng, selected the common syndrome of subliminal depression of the heart and spleen two deficiency, heart and gallbladder deficiency syndrome of random, control, double blind view To evaluate the effect of the Hamilton depression scale and the TCM syndrome assessment form, the purpose is to verify the curative effect of the tonifying heart and spleen method and Anshen determination method in the treatment of subliminal depression, deepen the understanding of subliminal depression, observe the conversion rate and self healing rate of subliminal depression to depression, and infer whether TCM syndrome differentiation therapy hinders subthreshold depression. The development of depression. Methods and results: the subjects were selected from 3 affiliated hospitals of Beijing University of Chinese Medicine and 6 outpatients in their affiliated communities. The patients with subthreshold depression were observed by random, controlled and double blindness principle, and the total number of cases was observed in 120 cases, 30 cases of heart spleen two deficiency test group and the control group, and the heart and gallbladder deficiency type test. The test group and the control group were 30 cases. The experimental group of the two deficiency of the heart and spleen was given the granule of GUI PI decoction, the experimental group of the heart and the biliary Qi deficiency group was given Anshen Ding Zhi pill and the two control groups were given the starch dextrin placebo granules. The treatment course was 6 weeks, the curative effect of 1 weeks, 2 weeks, 4 weeks, 6 weeks was stopped. The changes of the indexes before and after the treatment were analyzed and the investigation was conducted to investigate the changes of the indexes before and after the treatment. Results the results were analyzed by the method of statistical description. Results: the HAMD reduction rate and the traditional Chinese medicine effect index were used to evaluate the clinical effect: the HAMD reduction effect of the two deficiency group and the heart and spleen qi deficiency group of Anshen Shen Zhi pill group was better than that of the control group. There was a significant difference between the group and the group. The conversion rate of depression and the self healing rate of subliminal depression were two test groups. The composition ratio of the control group was significantly different at 6 weeks, with the x 2 test, P was less than 0.05, and the difference between the two was statistically significant. Through treatment, 25% of the patients with subthreshold depression were returned to the non depressive state at sixth weeks. Only 1 cases were converted to depression, and other reasons were not excluded, such as daily stressful changes. 71.43% of the people stayed in the state of subliminal depression. In the control group, 79.31% of them stayed in the state of subliminal depression at 6 weeks, 13.79% of them developed depression, and 6.90% were able to heal themselves. At the time of the sixth weeks, 43.33% of the patients with subthreshold depression in Anshen Ding pill group returned to no depression, and none of them turned into depression. 56.67% of the people remain in the state of subliminal depression, while 71.43% of the control group still remain in the state of subliminal depression, 14.29% of them are depressive and 14.29% have self-healing. Conclusion 1. tonifying heart and spleen method and Anshen determination method have good curative effect on subliminal depression (heart and spleen two deficiency, heart qi deficiency type), and there is no obvious effect. The conversion rate of depression in the 2. two test group was significantly lower than that of the control group, and the cure rate was significantly higher than that of the control group, indicating that the Gupi Decoction and Anshen Ding Zhi pill played an effective blocking role in the process of subthreshold depression to depression, and at 3.6 weeks, the group of heart and spleen two deficiency and the heart and gallbladder deficiency type subliminal depression were respectively in the 3.6 weeks. 6.90% or 14.29% of them recovered to the state of no depression, indicating that the subthreshold depression of the heart spleen two deficiency type and the heart gallbladder Qi deficiency type had self healing tendency.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7
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