中医非药物疗法对抑郁症患者HPA轴功能调控机理研究

Background: Depression brings heavy burden to the society due to high incidence and mortality. Antidepressant is the first-calss treatment, but with several limitations which can not be overlooked. Traditional Chinese medicine has its own advances in theory as well as clinical methods in treating depression. Series of non-drug therapeutic methods have been developed. Traditional electro acupuncture and the innovative Chinese meidical psychotherapy are essential parts. This project was proposed on the basis of the previous project"Mechanism of Chinese Medical Non-drug Therapy on Depression Comorbid with Insomnia" and plenty of clinical practice. Aim:to explore the psychological and physiological mechanism of Chinese medical non-drug therapy. Method: 20 patients will be included according to inclusion criteria. Traditional Chinese medical psycholotherapy group(Low Resistance State Thought Induction Psychotherapy) will be adapted as intervention. Intervention lasts for 6 weeks. Data collection will be completed at baseline and after treatment. Data includes psychological scales, resting fMRI, cortisone,and peripheral neurotransmitter level. At the same time, 20 healthy participants will be included as control. Conclusion in anticipation: To find out the different regulation mechanism on HPA axis by Low Resistance State Thought Induction Psychotherapy, from the upper regulation part hippocampus to the effector cotisone.

背景：抑郁症以高发病率、致残率带来沉重社会疾病负担，抗抑郁剂的使用具有一定的局限性，中医学以其独特的理论与方法优势，孕育诸多非药物疗法，传统的电针及创新的中医心理治疗是其中不可或缺的组成部分。该研究立题于已结题项目"中医非药物疗法治疗抑郁症伴失眠的机制研究"结果与大量临床实践基础之上而提出。目的：进一步探讨中医心理TIP技术对抑郁症患者HPA轴功能的调节作用。方法：纳入符合条件的20名抑郁症患者，接受为期6周的中医心理干预，在基线期及治疗后采集数据，包括心理量表、静息态脑功能图像采集、唾液皮质醇以及外周神经递质水平，同时，纳入健康被试20例作为对照。预期结论：探讨中医心理疗法对HPA轴的调节机制, 从HPA轴中枢调节成分海马功能及效应物皮质醇水平探讨可能的治疗机制。

在中医非药物疗法治疗抑郁症伴失眠的机制研究中证实，中医非药物疗法低阻抗意念导入疗法（TIP）治疗抑郁症的有效性，并可以达到减少抑郁症患者睡眠觉醒次数、缩短REM期睡眠时间的作用。本课题以此为基础，选择20例抑郁症患者为研究对象，采用低阻抗意念导入疗法进行为期6周的干预，20名健康被试作为对照组。以心理指标（HAMD、HAMA、MADRS）、生理指标（唾液皮质醇、5-HT、BDNF、静息态脑功能）为主要评价指标，干预组治疗前后各收集一次，健康对照组仅收集1次，MMPI两组均在纳入时收集1次，探讨低阻抗意念导入疗法对抑郁症患者HPA轴功能的影响，揭示其作用机制：1、干预组疗效：干预组治疗前后比较发现，低阻抗意念导入疗法能够显著改善抑郁症患者抑郁、焦虑等心理状态；2、HPA轴调控机制：抑郁症患者的唾液皮质醇显著高于健康对照组，血清5-HT、血清BDNF、血清DA含量则显著低于对照组。研究中血清检测结果显示低阻抗意念导入疗法能够有效降低抑郁症患者唾液皮质醇浓度，提高血清5-HT、血清BDNF浓度以及DA含量，有效调节HPA轴功能的作用，从而达到治疗抑郁的作用。此外脑功能初步结果显示抑郁症患者脑功能有别于健康人，左丘脑功能与抑郁状态存在中等程度的相关，中医非药物疗法TIP技术如何影响抑郁症患者脑功能变化尚需进一步数据处理与分析说明。