Abstract: Background Antidepressant treatment may be negatively impacted by sleep disorders.Escitalopram is a first-line drug for depression，and chiropractic therapy is a TCM treatment improving quality of sleep，but the effect of the combination of the two on depression has not been reported.Objective　To investigate the clinical effect and mechanism of escitalopram plus chiropractic therapy in the treatment of first-episode depression.Methods　One hundred and ten patients with first-episode depression who were hospitalized in the psychosomatic disorders，Huzhou Third People's Hospital from May 2018 to May 2020 were selected，and equally randomized into control group and observation group.Both groups received oral administration of lexapro （escitalopram oxalate） tablets，and the observation group additionally received chiropractic therapy.The Hamilton Rating Scale for Depression（HAMD）and Pittsburgh Sleep Quality Index（PSQI）were used to evaluate the depression state，and sleep quality，respectively，at baseline and 2，4 and 8 weeks after treatment.When the 8-week treatment ended，the overall efficacy was evaluated and expression levels of T-lymphocyte subsets were measured.The adverse reactions during treatment were recorded.Results The intervention method and intervention time did not have interaction on HAMD score and PSQI score（P>0.05）.But both of them produced significant main effect on HAMD score and PSQI score（P<0.05）.In both groups，the HAMD scores assessed three times after intervention were all decreased significantly compared to baseline，and showed a successive decline along with the treatment（P<0.05）.Similar changes in the PSQI score were also found （P<0.05）.The observation group had significantly lower mean HAMD score and PSQI score than control group at each post-intervention assessment time（P<0.05）.The overall response rate of the observation group was higher than that of control group（96.36% vs 83.64%） （P<0.05）.The observation group had lower post-intervention mean level of CD8+ and higher post-intervention mean levels of CD3+，CD4+ and CD4+/CD8+ ratio than the control group（P<0.05）.No significant difference in the incidence of adverse reactions was found between the two groups（P>0.05）.Conclusion　Esmetipram combined with chiropractic therapy could effectively improve the depressive symptoms and sleep quality of patients with first-episode depression，and its mechanism may be related to the regulation of T-lymphocyte level.

Key words: Depressive disorder；Manipulation, chiropractic；Escitalopram；Sleep disorders；T-lymphocyte subsets；Treatment outcome

摘要： 背景　睡眠障碍会对抗抑郁治疗产生负面影响，捏脊法作为中医推拿手法能有效提高睡眠质量，艾司西酞普兰是治疗抑郁症的一线药物，尚未见捏脊法与其联合治疗抑郁症的相关报道。目的　探讨艾司西酞普兰联合捏脊法治疗首发抑郁症患者的临床效果，并分析其作用机制。方法　选取2018年5月—2020年5月于湖州市第三人民医院心身障碍科病房住院的110例首发抑郁症患者为研究对象，采用随机数字表法将其分为对照组55例及观察组55例，对照组给予口服艾司西酞普兰片治疗，观察组在对照组治疗的基础上联合捏脊法。分别于治疗前、治疗2周后、治疗4周后、治疗8周后，采用汉密尔顿抑郁量表（HAMD）、匹兹堡睡眠质量指数（PSQI）评估两组患者抑郁状态及睡眠质量，治疗8周后比较两组患者治疗效果及T淋巴细胞亚群表达水平，记录治疗期间不良反应发生情况。结果　干预方法与干预时间对HAMD评分及PSQI评分不存在交互作用（P>0.05），干预方法及干预时间对HAMD评分及PSQI评分主效应均显著（P<0.05）。两组治疗2、4、8周后HAMD评分及PSQI评分均低于治疗前，两组治疗4、8周后HAMD评分及PSQI评分均低于治疗2周后，两组治疗8周后HAMD评分及PSQI评分均低于治疗4周后（P<0.05）；治疗2、4、8周后，观察组患者HAMD评分及PSQI评分均低于对照组（P<0.05）。治疗8周后观察组患者有效率为96.36%，高于对照组的83.64%（P<0.05）。治疗8周后，观察组患者CD8+水平低于对照组（P<0.05），CD3+、CD4+水平及CD4+/CD8+值均高于对照组（P<0.05）。治疗期间，两组患者不良反应发生率比较，差异无统计学意义（P>0.05）。结论　艾司西酞普兰联合捏脊法可有效改善首发抑郁症患者抑郁症状及睡眠质量，其作用机制可能与调控T淋巴细胞水平有关。

关键词: 抑郁症；手法, 捏脊；艾司西酞普兰；睡眠障碍；T淋巴细胞亚群；治疗结果