针灸治疗重性抑郁障碍的神经网络重建机制研究

Major depressive disorder (MDD) is a psychiatric condition with high morbidity, disability, suicide and recurrence rate and become the hot and difficult topics in the medical study. Given the unsatisfactory response rates of many FDA-approved antidepressants, acupuncture is increasingly considered an important alternative therapy. A large number of clinical trials have confirmed that acupuncture is a generally safe, effective, and well-tolerated therapy for depression, but for MDD, the acupuncture clinical trials were only reported out of China. According to the clinical symptoms in patients with MDD, the chief TCM patterns are liver qi constraint，spleen deficient and heart yang insufficiency, and the secondary TCM patterns are blood stasis, qi and blood deficiency. So we propose to combine acupuncture with moxibustion and select Baihui (DU20), shenting(DU24), Neiguan (PC6), shenmen（HT7）, Hegu (LI4), Taichong (LV3), Zusanli(ST36), Zhongwan (RN 12) , and Gaunyuan (RN4) and Back-shu points of five zangorgans to Soothe the Liver, regulating the heart, warm the yang qi, boost qi and invigorate blood for MDD. This therapy could improve the clinical symptoms effectively and prevent the suicidal ideation.We hypothesize that the acupuncture's antidepressant effect is based on the neural network reconstructing mechanism through studying the cerebral cortex function, hippocampal synaptic plasticity, Neurons electrophysiological change. We will employ multi-disciplinary methods in neuropsychology, medical physics, and computer science to explore the important mechanism underlying acupuncture and moxibustion treating MDD.

重性抑郁障碍（MDD）是危害人类健康的重大精神疾病，有效治疗重性抑郁障碍、阻止其病情向自杀倾向发展是当今医学研究的急迫任务。由于MDD患者对抗抑郁药的应答率不甚理想，针灸疗法作为重要的替代疗法正日益受到重视。大量研究证实，针灸治疗抑郁症安全有效，但针灸治疗重性抑郁障碍仅在国外有较多临床报道。重性抑郁障碍临床表现多以肝郁脾虚、心阳不振为主证，血瘀、气血亏虚为兼证，因此本项目拟采用"疏肝调心、温阳益气活血"法，取百会、神庭、内关、神门、合谷、太冲穴、中脘、关元、足三里及五脏背俞穴治疗重性抑郁障碍，将针刺与艾灸结合，并整合神经心理学、医用物理学、计算机科学等多学科研究方法，从大脑皮层功能变化、海马突触重塑性等角度探索针灸治疗重性抑郁障碍的神经网络重建机制，为针灸治疗重性抑郁障碍的临床推广提供重要的理论依据。

重性抑郁障碍（MDD）是危害人类健康的重大精神疾病，有效治疗重性抑郁障碍、阻止其病情向自杀倾向发展是当今医学研究的急迫任务。由于MDD患者对抗抑郁药的应答率不甚理想，针灸疗法作为重要的替代疗法正日益受到重视。大量研究证实，针灸治疗抑郁症安全有效，但针灸治疗重性抑郁障碍仅在国外有较多临床报道。重性抑郁障碍临床表现多以肝气郁结、心阳不振为主证，血瘀、气血亏虚为兼证，因此本项目采用"疏肝调心、温阳益气活血"法，取百会、神庭、内关、合谷、太冲穴、足三里、中脘、关元等穴治疗重性抑郁障碍，将针刺与艾灸结合，并整合神经心理学、神经影像学、计算机科学、电生理等多学科研究方法，从大脑皮层功能变化、海马突触重塑性、神经元的电生理改变等角度探索针灸治疗重性抑郁障碍的神经网络重建机制，为针灸治疗重性抑郁障碍提供重要的理论依据。针灸在改善重性抑郁障碍的程度与抗抑郁药物相比，无明显差异，并且副反应量表显示，针灸可以明显避免抗抑郁药物副作用的产生.前额叶脑功能数据分析提示:针灸组内对比，汉密尔顿17项分数改善情况和前额叶血氧水平变化情况相关性分析，结果显示情绪改善情况与前额叶血氧水平相关，抗抑郁药组表现出相似的情况。可以推测前额叶脑功能的恢复是重性抑郁患者情绪改善的内在基础，但在患者进行认知功能、脑功能测试的数据中，前额叶功能的恢复在重性抑郁症患者的改善中未表现出明显相关性。