針刺治療運用在憂鬱症患者的臨床效益;
The Benefit from Whole Body Acupuncture in Major Depression

中國醫藥大學機構典藏 China Medical University Repository, Taiwan > 中醫學院 > 中西醫結合研究所 > 博碩士論文 > Item 310903500/333

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題名:	針刺治療運用在憂鬱症患者的臨床效益;The Benefit from Whole Body Acupuncture in Major Depression
作者:	鍾偉倫;Wei-Lun Chung
貢獻者:	中國醫藥大學：中西醫結合研究所碩士班
關鍵詞:	憂鬱症;針刺治療;major depression;acupuncture
日期:	2009-07-10
上傳時間:	2009-08-06 11:02:44 (UTC+8)
摘要:	(一)目的：本試驗的目的是使用隨機分派之對照、單盲試驗，比較施加針刺治療於標準抗鬱劑治療之上，對於患者的療效，包括: 臨床憂鬱症狀、睡眠品質和生活品質之改善程度，是否優於標準之抗鬱劑治療。 (二)重要性：針刺治療被運用在治療憂鬱症的療效研究，到目前為止仍尚未被確定，文獻回顧指出單純使用針刺治療憂鬱症的療效似乎有限，其中以結合中醫針刺治療與西醫標準抗鬱劑治療之文獻更少，雖然抗鬱劑的臨床療效已經獲得實證，仍然有約30~49%的病患在經歷足夠療程和劑量治療後，病情未能緩解，因此如何增加抗鬱劑療效成為很重要的臨床議題，現今的增效治療方式多半具有相當的副作用，因此以相對副作用較少的針刺治療加諸在標準抗鬱劑治療之上，當作增效療法，值得探討研究。 (三)材料與方法：本試驗總共納入了三十位住院的中度或重度的重鬱症病患，被平行分派到(1)抗鬱劑治療加上真針刺治療組(verum acupuncture)，共15人，全部完成試驗和，(2)抗鬱劑治療加上假針刺治療組(sham acupuncture)共15人，中有12人完成試驗，每人接受每週針刺治療兩次，維期八週的療程，並且每週接受臨床效益評估，使用漢氏憂鬱量表(17-item Hamilton Rating Scale for Depression簡稱HAMD-17)、貝氏憂鬱量表(Beck Depression Inventory簡稱BDI)和Clinical Global Impressions(CGI)量表評估臨床憂鬱症狀改善程度，另外每週使用Pittsburgh Sleep Quality Index (PSS)評估睡眠品質改善之程度，和每隔四週使用SF-36中文量表評估病患之生活品質的改變。 (四)主要成果：結果發現，在標準的抗鬱劑治療加上針刺治療(verum acupuncture)組和假針刺治療(sham acupuncture)組的比較，得到在三個主要治療指標方面，包括HAMD-17、BDI和CGI-I量表分數的改善程度 ; 和在次要治療指標方面，包括SF-36生活品質量表中的身體疼痛程度(bodily pain)、個人評估身體健康之程度(general health perceptions)、活力狀態(vitality)、心理健康狀態(mental health)和心理組成指標(mental component score)等五項指標的改善程度上，兩組達到統計差異(p< 0.05)，也就是說整體而言抗鬱劑治療加上針刺治療具有較優良的臨床療效。針刺治療相較於其他以藥物為主的增效治療，副作用較少，病患接受度較高，很值得日後進行更大規模，更為嚴謹的臨床試驗來證實針刺治療憂鬱症的臨床額外療效。關鍵詞：憂鬱症、針刺治療 Background: Depression is one of the most common mental health disorder. Up to 60% of patients do not gain full remission following a standard antidepressant treatment. Many patients only achieve partial response (e.g., 25%-49% reduction in symptoms) or continue to experience residual symptoms. This is of significant concern, as patients with residual symptoms have reduced functioning and a worse prognosis than those who achieve remission. There is still a need to improve the treatment of depression. A wide range of different augmentation and combination strategies are available, but most of them have dissatisfied adverse effects. There is a preference for patients with depression to seek other therapy, particularly use of complementary therapies. Acupuncture is a popular complementary and alternative medicine intervention suggested in the treatment of depression, but its efficacy is uncertain. We conducted a randomized single-blind placebo-controlled study to investigate the efficacy of acupuncture additionally applied to standard antidepressant therapy in major depression. Methods: We randomly included 30 inpatients with a major depressive episode in two different treatment groups: verum acupuncture and sham acupuncture group. Both groups were pharmacologically treated with one kind of freely selected standard antidepressant therapy. The verum group received acupuncture at specific points considered effective in the treatment of depression in addition to standard antidepressant therapy. Needle sensation of De Qi was required. The placebo sham group was treated in addition to standard antidepressant therapy with acupuncture at the same acupoints, inserted superficially, and needle sensation of De Qi was prohibited. Acupuncture was applied twice a week over a period of 8 weeks. Primary outcome measures were 17-item Hamilton Rating Scale for Depression (HAMD-17), Beck Depression Inventory(BDI), and Clinical Global Impressions-Improvement (CGI-I). Secondary outcome measures were Pittsburgh Sleep Quality Index (PSS) and health status of SF-36. All these scales were rated by an independent rater blind to verum/placebo conditions weekly over 8 weeks. Results: 3 of 15 pateints in placebo sham group and none of 15 pateints in verum group terminated before the completion of 8-week intervention. At the end of treatment period, verum acupuncture improved slightly more than placebo acupuncture not only in HAMD-17( p=0.043), BDI( p=0.029) and CGI-I( p=0.007) scores, but also in the following five components of SF-36: bodily pain( p=0.016), general health perceptions( p=0.044), vitality (p=0.003), mental health (p=0.002), and mental component scores (p=0.002). Conclusion: Acupuncture additionally applied to conventional standard antidepressant therapy has extra clinical benefits. It is worth further clinical trails of larger scale and stricter methodology because acupuncture augmentation causes less adverse effects and is more acceptable. Keyword: acupuncture; major depression
顯示於類別:	[中西醫結合研究所] 博碩士論文

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