补肾健脑针刺疗法联合舍曲林治疗老年抑郁症的效果：一项随机对照试验

doi:10.12114/j.issn.1007-9572.2024.0619

摘要/Abstract

摘要： 背景抑郁症在中医学属于情志病范畴，可用"肾脑相济"理论解释其病机。补肾健脑针刺疗法是否能用于治疗老年抑郁症，既往缺乏报道。目的探讨基于"肾脑相济"理论的补肾健脑针刺疗法联合舍曲林改善老年抑郁症患者情绪及认知功能的效果。方法本试验已在中国临床试验注册中心进行注册（注册号：ChiCTR2400081227）。以2023年3月—2024年3月北部战区总医院精神心理科收治的86例老年抑郁症患者为研究对象，依据随机数字表法分为观察组（n=43）和对照组（n=43）。对照组采用舍曲林治疗，观察组采用补肾健脑针刺联合舍曲林治疗，共治疗4周。治疗前和治疗后，采用17项汉密尔顿抑郁量表（HAMD-17）评估抑郁情绪；采用威斯康星卡片分类测验评估认知功能；检测血小板计数（PLT）、单核细胞计数（MONO）、中性粒细胞计数（NC）、淋巴细胞计数（LC），并计算系统免疫炎症指数（SII）、全身炎症反应指数（SIRI）。比较两组治疗前后的HAMD-17评分、认知功能、SII和SIRI，观察组治疗前后HAMD-17评分变化值、认知功能变化值与SII变化值、SIRI变化值的关系采用Pearson相关分析，比较两组的临床疗效。结果治疗后观察组HAMD-17评分低于对照组（P<0.05），威斯康星卡片分类测验正确应答百分比和概念化水平百分数高于对照组（P<0.05），SII和SIRI低于对照组（P<0.05）。观察组治疗前后的SII变化值与HAMD-17评分变化值呈线性正相关（r=0.536，P<0.05），与威斯康星卡片分类测验正确应答百分比（r=-0.621，P<0.05）和概念化水平百分数（r=-0.482，P<0.05）呈线性负相关；观察组治疗前后的SIRI变化值与HAMD-17评分变化值呈线性正相关（r=0.429，P<0.05），与威斯康星卡片分类测验正确应答百分比（r=-0.378，P<0.05）和概念化水平百分数（r=-0.434，P<0.05）呈线性负相关。观察组的临床疗效优于对照组（P<0.05）。结论补肾健脑针刺疗法可提高舍曲林治疗老年抑郁症的效果，其缓解抑郁情绪及认知功能的机制可能与改善免疫炎症有关。

关键词: 抑郁症, 老年人, 针刺, 舍曲林, 认知功能, 系统免疫炎症指数, 全身炎症反应指数

Abstract:

Background

Depression belongs to the category of emotional disorders in traditional Chinese medicine, and its pathogenesis can be explained by the theory of "kidney brain harmony". Whether kidney tonifying and brain strengthening acupuncture therapy can be used to treat elderly depression has not been reported in the past.

Objective

Exploring the effect of tonifying the kidney and strengthening the brain acupuncture therapy based on the theory of "kidney brain coordination" combined with sertraline on improving the emotional and cognitive functions of elderly depression patients.

Methods

This trial has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400081227). Eighty-six elderly patients with depression admitted to the Department of Mental Health and Psychology of the General Hospital of Northern Theater Command between March 2023 and March 2024 were selected as the research subjects, they were randomly divided into an observation group (n=43) and a control group (n=43). The patients in the control group were treated with sertraline alone, while the patients in the observation group were treated with kidney tonifying and brain strengthening acupuncture combined with sertraline. All patients were treated for 4 weeks. Before and after treatment, evaluate depressive mood using the 17 item Hamilton Depression Scale (HAMD-17), evaluate cognitive function using the Wisconsin Card Sorting Test, detect platelet count (PLT), mononuclear cell count (MONO), neutrophil count (NC), lymphocyte count (LC), and calculate systemic immune inflammation index (SII), systemic inflammatory response index (SIRI). Compare the HAMD-17 scores, cognitive function, SII and SIRI of the two groups before and after treatment. The relationship between the change values of HAMD-17 scores and cognitive function with SII and SIRI in the observation group was analyzed by Pearson correlation analysis, and the clinical efficacy of the two groups was compared.

Results

The HAMD-17 score in the observation group was lower than the control group after treatment (P<0.05). The percentage of correct responses and conceptualization level in the Wisconsin Card Sorting Test in the observation group after treatment was higher than that in the control group (P<0.05). The SII and SIRI of the observation group was lower than the control group after treatment (P<0.05). The changes in SII before and after treatment in the observation group were positively correlated with the changes in HAMD-17 score (r=0.536, P<0.05). The changes in SII were negatively correlated with the percentage of correct responses to the Wisconsin Card Sorting Test (r=-0.621, P<0.05) and the percentage of conceptualization level (r=-0.482, P<0.05), respectively. The change in SIRI score was positively correlated with the change in HAMD-17 score (r=0.429, P<0.05). The SIRI change values were negatively correlated with the percentage of correct responses to the Wisconsin Card Sorting Test (r=-0.378, P<0.05) and the percentage of conceptualization level (r=-0.434, P<0.05), respectively. The therapeutic effect of the observation group was better than the control group (P<0.05).

Conclusion

Kidney tonifying and brain strengthening acupuncture therapy can improve the effectiveness of sertraline in treating elderly depression, and its mechanism of alleviating depressive mood and cognitive function may be related to improving immune inflammation.

Key words: Depression, Aged, Acupuncture, Sertraline, Cognitive function, Systemic immune inflammation index, Systemic inflammatory response index

中图分类号:

R 749.41

李鲤,徐天朝,董晓梅,等. 补肾健脑针刺疗法联合舍曲林治疗老年抑郁症的效果：一项随机对照试验[J]. 中国全科医学, 2026, 29(11): 1399-1404. DOI: 10.12114/j.issn.1007-9572.2024.0619.
LI Li,XU Tianchao,DONG Xiaomei, et al. The Effect of Kidney Tonifying and Brain Strengthening Acupuncture Combined with Sertraline in the Treatment of Elderly Depression: a Randomized Controlled Trial[J]. Chinese General Practice, 2026, 29(11): 1399-1404. DOI: 10.12114/j.issn.1007-9572.2024.0619.

图/表 6

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组别	例数	性别（男/女）	婚姻状况（已婚/未婚/丧偶）	病程（±s，月）	BMI（±s，kg/m²）
对照组	43	18/25	37/2/4	8.00±1.44	22.3±2.7
观察组	43	19/24	39/0/4	7.53±1.36	22.2±2.7
χ²（t）值		0.047	2.053	1.556^a	0.173^a
P值		0.828	0.358	0.123	0.863

组别	例数	性别（男/女）	婚姻状况（已婚/未婚/丧偶）	病程（±s，月）	BMI（±s，kg/m²）
对照组	43	18/25	37/2/4	8.00±1.44	22.3±2.7
观察组	43	19/24	39/0/4	7.53±1.36	22.2±2.7
χ²（t）值		0.047	2.053	1.556^a	0.173^a
P值		0.828	0.358	0.123	0.863

组别	例数	治疗前	治疗后
对照组	43	28.2±2.0	17.3±2.9^a
观察组	43	27.5±1.9	13.6±3.4^a
t值		1.560	5.391
P值		0.122	<0.001

组别	例数	治疗前	治疗后
对照组	43	28.2±2.0	17.3±2.9^a
观察组	43	27.5±1.9	13.6±3.4^a
t值		1.560	5.391
P值		0.122	<0.001

组别	例数	正确应答百分比		概念化水平百分数
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	43	48.5±9.0	58.1±5.6^a	39.1±5.8	47.6±4.1^a
观察组	43	47.1±8.2	66.3±5.3^a	38.2±4.1	58.4±6.5^a
t值		0.765	7.044	0.814	9.148
P值		0.447	<0.001	0.418	<0.001