针刺对原发性抑郁症患者脑干诱发电位的影响_英文_

World Journal of Acupuncture-Moxibustion (WJAM)V ol. 23, No.3, 30th Sep. 2013・39・Impacts of acupuncture on brainstem evoked potentialsin patients with primary depression针刺对原发性抑郁症患者脑干诱发电位的影响LIU Yong-hui (刘永辉)1, DUAN Zhi-gang (段志刚)2, ZENG Sheng (曾胜)2, WAN Si (万思)2,CAO Ya-qiong (曹雅琼)2, LIU Tai (刘泰)11. First Affiliated Hospital of Guangxi University of TCM, Nanning 530023, China;2. Guangxi University of TCM（1. 广西中医药大学第一附属医院，南宁 530023，中国；2. 广西中医药大学）A R T I C L E I N F OFirst author: LIU Yong-hui (1982-), male, a tt ending physician.Research fi eld: clinical and scien tifi c research of encephalopathy with TCM. E-mail: liuyonghui626@ Accepted on March 6, 2013A B S T R A C TObjective To observe the impacts of acupuncture on brainstem evoked potentials in the patients with primary depression. Methods Forty cases of primary depression were treated by acupuncture at B ihuì (百会 GV 20), Yìntáng (印堂 GV 29), Dàzhuī (大椎 GV 14), bilateral Shénmén (神门 HT 7), bilateral Tàichōng (太冲 LR 3), bilateral Nèiguān (内关 PC 6) and Sānyīnjiāo (三阴交 SP 6). The needles were retained for 30 min. Acupuncture treatment was given once every two days, three treatments a week. The brainstem auditory evoked poten ti al (BAEP) and visual evoked poten ti al (VEP) were observed in 6 weeks of treatment. The change in Hamilton depression scale (HAMD) score was observed before and after treatment in the depression group. Results A ft er treatment, VEP wave latency was shortened signifi cantly in pa ti ents of depression (P<0.05), BAEPⅢwave latency was shortened signifi cantly (P<0.05). The score of HAMD was decreased apparently in the depression group (P<0.05). Conclusions The stressability of visual and auditory stimuli in the central nervous system was decreased in the patients of depression. Acupuncture shortens remarkably the brainstem evoked poten ti als latency in the pa ti ents of depression and achieves the effective results in the treatment of primary depression.KEY WORDS: depression; acupuncture; brainstem auditory evoked potential (BAEP); visual evoked poten ti al (VEP)Clinical ResearchPrimary depression is also named depressive disorder. It is the nervous symptomatic disorder characterized as persistent depressed mood, commonly associated with anxiety, physical discomfort and sleep disorder. Additionally, with the accelerative pace of life, people have to bear more and more stresses, and the prevalence of the disease is increasing yearly in tendency[1]. The evoked potentials are abnormal in the patients of depression and the wave latency was prolonged signifi cantly in brainstem auditory evoked potential (BAEP) and visual evoked potential (VEP) [2]. This research observed the impacts of acupuncture on brainstem evoked potentials in 40 patients of primary depression and the report is as follows.CLINICAL DATAGeneral dataThe patients of depression were enrolled from the wards and clinics of the Encephalopathy Department of TCM, the First Affiliated Hospital of Guangxi University of TCM from February 2011 to September 2012. Of 40 cases, 17 cases were male and 23 cases female, aged from 20 to 60 years, averagely (38±13) years old; the duration of sickness was in the range from 2 months to 10 years, averagely (16.9±8.3)World Journal of Acupuncture-Moxibustion (WJAM)V ol. 23, No.3, 30th Sep. 2013・40・months. The subjects (40 cases) in the control groupwere the staffs and students of the First AffiliatedHospital of Guangxi University of TCM. Of 40 cases,15 cases were male and 25 cases female, aged from22 to 58 years, averagely (29 ± 10) years old. In theenrolment, there were no physical and metal disorder,no history of drug or food abuse involved. Inclusive criteriaAged in the range from 18 to 65 years,in compliance with the diagnostic standard ofdepression issued in Chinese Classification and Diagnostic Criteria of Mental Disorders in China, Third-Reversed Edition (CCMD-3), >50 scores in self-rating depression scale (SDS) and ≥8 scoresin Hamilton depression scale (HAMD) (24 items);the first onset, somatic symptoms as the chiefcomplaints, but without the evidence of corresponding organic disorder, in the scope of SDS>50 scores and HAMD>8 scores, diagnosed as primary depression; in accordance with the diagnostic criteria of traditional Chinese medicine (TCM), in reference to Internal Medicine of TCM, chief complaints: mental depression and irritability, accompanied symptoms: chest fullness, distending pain in hypochondriac region, wandering pain, epigastriac distention, belching, poor appetite, irregular defecation.Exclusive criteriaUnstable life physical signs, serious liver andkidney dysfunctions, auditory disorders or visualdysfunction, in pregnancy, and inability to cooperatein the research.METHODSMain points: Bǎihuì (百会 GV 20), Yìntáng (印堂 GV 29), Dàzhuī (大椎 GV 14), bilateral Shénmén (神门 HT 7), bilateral Tàichōng (太冲 LR 3), bilateral Nèiguān (内关 PC 6) and Sānyīnjiāo (三阴交 SP 6). Adding Zúsānlǐ (足三里 ST 36) for poor appetite.The patient was in sitting position. GV 14 was punctured at first. After the needle sensation arrived, the even needling manipulation was applied for 30 s before the needle was withdrawn. Afterwards, the patient was in lying position, GV 20, GV 29, PC 6, HT 7, SP 6, LR 3 and the symptomatic points were inserted. After the arrival of needling sensation, the needles were retained for 30 min and manipulated manually with even needling technique once every 15 min, for 5–10 s each time. The treatment was given once every two days, 3 treatments a week. The observation was done in 6 weeks of treatment. The acupuncture physicians were those of acupuncture and moxibustion specialty and had been participated in the training of standard acupuncture operation in the research.OBSERV ATION INDICES AND METHODS Determination of brain evoked potentials The assigned person detected the evoked potentials of all the patients. The subjects were required to be relaxed physically and mentally and keep a clear mind and ensure the mind concentrated. Denmark Keypoint 4-channel EMG/evoked potential instrument was adopted to detect each item twice and the mean was calculated. 1) BAEP: the subject lay down and received the hearing detection to except the auricular disease. According to the international 10–20 lead method, the recording electrode was attached to the calvaria of subject (Cz), the reference lead was to the ear lobe on the same side of sound stimulation and the forehead was grounding. The clicking sound was adopted, the stimulation intensity was the auditory threshold plus 60 dB, the maximal intensity was less than 120 dB, the stimulation frequency was 10 Hz, the filtering band pass was in the range from 100 to 2000 Hz, the superposition was 1000–2000 times, the analyzing time was 10 ms and the record was repeated twice. 2) VEP detection: the checkerboard pattern reversal stimulus was adopted. Before the detection, the subject was required for visual determination and rectifi cation to 1.0. The subject was in sitting position 1 m far from the screen. The electrodes were placed after degreasing. The recording electrode was attached to the central occiput of subject (Oz) and the bilateral sides of it (O1, O2), the reference electrode was to the frontal pole (Fz) and Fpz was grounding. The band pass was 1–100 Hz, the stimulation frequency was 2 Hz, the analyzing time was 300 ms and the superposition was about 100 times.HAMD scores were delimited according to Davis JM. The total scores ≥35 were delimited as severe depression, the scores in the range of <35 and ≥21 as moderate depression, those <21 and ≥18 as milddepression, those <18 and ≥ 8 as depressive state and those <8 as no depressive state.Statistical methodAll of the research data were input in EXCEL Database. SPSS17.0 statistical software was adopted. The t test was used for the assessment of the measurement data. χ2 test was applied to the assessment of enumeration data. P<0.05 indicated the statistically signifi cant difference.RESULTSComparison of evoked potentials between the two groupsIn comparison between the two groups before treatment,Ⅰ, Ⅲ and Ⅴmain waves latency and interphase of BAEP in the depression group were all prolonged apparently, indicating the statistically signifi cant difference (P<0.05). P100 and N135 latency of VEP were prolonged, indicating the statistically signifi cant difference (P<0.05, Table1). Comparison of evoked potentials before and after treatment in the depression group After treatment, Ⅲ wave latency of BAEP was shortened apparently as compared with that before treatment, indicating the statistically significant difference (P<0.05). Ⅰ and Ⅴ latency and interphase did not change apparently before and after treatment. N75, P100 and N135 latency of VEP were shortened signifi cantly as compared with those before treatment, indicating the statistically significant difference (P<0.05). See Table 2.As compared with the moderate depression level [(25.80±3.87)] in HAMD score before treatment, HAMD score [(15.63±3.42)] indicated the mild or no depressive state after treatment. The clinical symptoms were improved apparently. The score difference was signifi cant (P<0.05).DISCUSSIONDepression is the mood disorder syndrome manifested as mental and motor retardation such as low mood, loss of interest in activities that they enjoy, lack of energy, etc. The evoked potential is one of the research index of neural electrophysiology and is the bioelectrical activity produced by various internal and external specific stimuli in the central nervous system. The evoked potential abnormality indicates the damage of neural pathways in the patients. The changes in evoked potentials in the patients of primary depression are relevant with trouble in sleeping, low mood, poor concentration and retarded thinking. It is deduced that VEP changes in primary depression may be the state index and BAEP be the attitude index [2-3].After acupuncture treatment, the main Ⅲ wave of BAEP and N75, P100 and N135 latencies were shortened significantly and the clinical symptoms were improved. Acupuncture presents its very large developing space in practice and deserves to be promoted because of its characteristics as safety, effectiveness and less side effects. The impact mechanism of acupuncture on evoked potentials has not been clarifi ed yet and needs a further study on it. REFERENCES[1] Guo JQ, Huang Y, Wang CQ, Chen JQ, Li GL, Wang SX.Curative effect observation of acupuncture combined withParoxethine on primary depression. Mod J Integr Tradit Chin Med West Med (Chin) 2010; 19(1): 910.[2] Gao CY, Gan JL, Niu F, Yang DD, Yang C. Characteristicsof variation of evoked potentials in patients with depression: two month follow up observation. Chin J ClinRehabil (Chin) 2005; 9(4): 3637, 47.[3] Xie LJ, Tang QS, Huo AR. Impacts of Yinao Jieyuformula on evoked potentials in the patients with primarydepression. J Tradit Chin Med (Chin) 2007; 48(4): 322324.(Editor: LIU Wan-ning Translator: WANG Fang)Table 1 Comparison of BAEP and VEP of the subjects between the two groups before treatment (x±s, ms) Groups CasesBAEP wave latency BAEP main wave interphase VEP wave latencyⅠⅢⅤⅠ-ⅢⅢ-ⅤN75P100N135 Depression40 1.68±0.10 1) 3.76±0.12 1) 5.80±0.24 1) 2.23±0.07 1) 2.21±0.26 1)67.65±1.86 1)93.52±2.93 1)129.10±7.5 1) Control40 1.56±0.12 3.60±0.16 5.47±0.17 2.14±0.03 1.91±0.0566.17±1.9290.46±2.66125.70±6.0 Note: compared with the control group, 1) P<0.05.Table 2 Comparison of BAEP and VEP of patients with depression before and after treatment (x±s, ms) Time CasesBAEP wave latency BAEP main wave interphase VEP wave latencyⅠⅢⅤⅠ-ⅢⅢ-ⅤN75P100N135 Before treatment40 1.68±0.10 3.76±0.12 5.80±0.24 2.23±0.07 2.21±0.2667.65±1.86 93.52±2.93 129.10±7.5 After treatment40 1.59±0.33 3.63±0.311) 5.50±0.26 2.19±0.03 2.03±0.2066.80±1.731)91.52±2.501)125.60±6.81) Note: compared with that before treatment 1) P<0.05.(Turn to page 45)Beijing: People ’s Medical Publishing House; 2007: 130154.[2]Shi XM. Acupuncture (Chin). 5th Edition. Beijing: ChinaPress of Traditional Chinese Medicine; 2002.(Editor: LIU Wan-ning Translator: ZHANG Yong-mei)[摘 要] 目的：观察针刺对原发性抑郁症患者脑干诱发电位的影响以及针刺的疗效。