5-羟色胺能递质在电针治疗"痛性抑郁"中的机制研究

Based on the certain relationship between pain and depression, the study explores how 5-HT functions in painful depression from the aspect of depression caused by primary chronic headache, and observes the metabolin of therapeutic effect of electroapcupuncture on painful depression. ①Clinical research: The therapeutic effects of electroapcupuncture on painful depression, particularly on contents of free 5-HT in peripheral blood and its metabolin 5-HIAA are observed. 100 cases of depression patients caused by primary headache are allocated in 2 groups (electroacupuncture group VS medication group, 50 cases in each group). After treatment for 2 months: contents of 5-HT in peripheral blood, 5-HIAA in urine are tested. Remission rate of headache, HAMD、SDS、SF-36 are recorded and calculated. Center randomization and the blind evaluation are taken in the process. ②Experiment: Co-existence of headache and depression rat model generates from combination of migraine rat model made from nitroglycerin and depression rat model made from chronic irritation. Electroacupuncture and medication groups are taken as treatment groups, while co-exist headache and depression group as blank control. Contents of 5-HT, monoamine as well as other indicators of pain and depression in brain are tested. In conclusion, the study explored mechanism of painful depression in terms of change of central and peripheral 5-HT and its metabolin contents as well as relatiship with symptoms from both clinical and experimental researches.

基于疼痛与抑郁的关系，从慢性原发性头痛所致的抑郁症切入，研究5-HT这一抑郁与疼痛共同的生物学基础在"痛性抑郁"中的机制，观察"痛性抑郁"电针治疗的效应机制。①临床：观察电针治疗痛性抑郁与效应机制有关的外周游离5-HT和其代谢物5-HIAA含量。100例原发性头痛继发抑郁患者随机分2组（电针止痛抗郁、药物止痛抗郁，每组各50例），治疗2个月后观察：外周血中5-HT、尿中5-HIAA含量，头痛缓解率、HAMD、SDS、SF-36。中心随机及第三者评价盲法控制实验过程。②实验：硝酸甘油偏头痛大鼠模型及慢性应激抑郁症大鼠模型结合，制造头痛抑郁共患大鼠模型。电针止痛抗郁、药物止痛抗郁、头痛抑郁共患模型对照，观察大鼠脑内5-HT、单胺氧化酶含量及其与疼痛、抑郁指标的相关性。总之，结合临床和实验部分，拟通过观察中枢及外周5-HT 及其代谢产物含量，对 "痛性抑郁"从5-羟色胺能递质相关机制进行研究。

本课题通过对动物实验和临床观察两个方面的研究，以5-HT及其代谢产物为切入点，初步阐述了电针治疗原发性头痛伴抑郁的神经递质作用机理。证明，电针治疗可比较明显降低原发性头痛伴抑郁大鼠脑内单胺氧化酶的含量，降低单胺类神经递质5-HT、NE的降解率，改善头痛伴抑郁患者的行为活动，从而为临床应用和推广电针治疗原发性头痛伴有抑郁症提供科学的依据。虽然研究得出电针治疗原发性头痛伴抑郁与西药治疗在改变相关神经递质方面没有明显的差异，但电针以其费用低廉、副作用小、对临床症状改善明显等优势更值得推广和应用。.在动物实验中，本课题通过电针刺激偏头痛伴抑郁模型大鼠的百会穴和合谷穴，能明显降低海马、下丘脑组织中的单胺氧化酶含量，提高海马、下丘脑、血浆中的5-HT含量，改善与抑郁症相关的糖水消耗实验、旷场实验指标。这为电针治疗头痛伴抑郁提供科学的依据，从单胺类神经递质及其相关的酶的角度，初步阐述了电针治疗头痛伴抑郁的机理之一。.在临床观察中，通过在中国中医科学院针灸医院开展小型临床 RCT 试验研究，共纳入30 例长期原发性头痛引发的抑郁患者。在经过为期4周的基线期观察之后，随机分为电针治疗组和西药组，两组患者根据既定方案进行为期8周的治疗。西药组4例、针刺组2例因治疗效果不佳而自行脱失，另有西药组2例、针刺组3例无故失去联系而脱失，共有19例患者完成实验。比较4周基线期、治疗4 周、治疗 8 周、治疗后4周、治疗后8周头痛发作频率、发作时间、头痛强度的量化评分、头痛指数、综合症候量表评分、汉密尔顿抑郁量表评分，以及治疗前后患者外周静脉血血浆5-HT和尿中5-HIAA的含量。研究结果表明，电针可以明显降低头痛伴抑郁患者的头痛发作频率、持续时间和头痛强度，改善头痛和抑郁的相关症状，降低患者体内5-HT的消耗，从而对头痛伴抑郁起到比较好的治疗作用。.