基于头针的音乐疗法对卒中后抑郁疗效的静息态功能磁共振观察

doi:10.3969/j.issn.1006-9771.2021.03.006

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (3): 282-289.doi: 10.3969/j.issn.1006-9771.2021.03.006

基于头针的音乐疗法对卒中后抑郁疗效的静息态功能磁共振观察

刘研¹,巴赫²,赵邓³,刘丽³,李建飞³,王建³,李丽^1,³()

^1.山东中医药大学康复医学院，山东济南市 250000
^2.安徽医科大学中西医结合医学院，安徽合肥市 230000
^3.山东中医药大学第二附属医院，山东济南市 250000

收稿日期:2020-04-03 修回日期:2020-05-28 出版日期:2021-03-25 发布日期:2021-04-02
通讯作者: 李丽 E-mail:lily.jinan@163.com
作者简介:刘研(1995-)，男，汉族，山东聊城市人，硕士研究生，主要研究方向：脑卒中的中西医结合康复|李丽(1962-)，女，汉族，山东济南市人，主任医师，主要研究方向：脑卒中的中西医结合康复。
基金资助:
国家重点研发计划项目(2018YFC17060005);山东省中医药科技发展计划项目(2019-0238)

Effect of Music Therapy Based on Scalp Acupuncture on Post-stroke Depression: Study with Resting-state Functional Magnetic Resonance Imaging

Yan LIU¹,He BA²,Deng ZHAO³,Li LIU³,Jian-fei LI³,Jian WANG³,Li LI^1,³()

^1.Rehabilitation College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, China
^2.School of Integrative Medicine of Anhui Medical University, Hefei, Anhui 230000, China
^3.The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, China

Received:2020-04-03 Revised:2020-05-28 Published:2021-03-25 Online:2021-04-02
Contact: Li LI E-mail:lily.jinan@163.com
Supported by:
National Key R & D Program(2018YFC17060005);Shandong Traditional Chinese Medicine Technology Development Program(2019-0238)

摘要/Abstract

摘要： 目的

采用静息态功能磁共振(rs-fMRI)观察音乐疗法结合头针对卒中后抑郁(PSD)患者脑功能的影响。

方法

2018年12月至2019年11月，山东中医药大学第二附属医院康复科PSD患者40例随机分为对照组和观察组，各20例，两组均在常规康复的基础上接受头针治疗，观察组在留针时接受音乐疗法治疗，共4周。治疗前后采用汉密尔顿抑郁量表(HAMD-17)、匹兹堡睡眠质量指数(PSQI)和改良Barthel指数(MBI)进行评定，并行rs-fMRI检测，记录低频振幅值(ALFF)。治疗结束后4周，对有疗效的患者进行电话随访，采用HAMD-17进行评定。

结果

两组各剔除3例。治疗4周后，两组HAMD-17、PSQI和MBI评分均显著改善(|t| > 11.446, P < 0.001)，观察组各项评分均优于对照组(|t| > 2.314, P < 0.05)；治疗后，观察组双侧楔叶、双侧舌回，右侧眶额叶皮质、右侧前扣带回和右侧颞中回ALFF增高；对照组右侧舌回、右侧角回和右侧枕叶外侧沟ALFF增高。共成功随访29例，末次随访时HAMD-17评分仍较治疗前显著降低(t > 13.558, P < 0.001)。

结论

音乐疗法可有效加强头针对PSD的治疗效果，改善睡眠，提高生活自理能力，疗效能较长时间维持。可能与激活情感环路重要脑区眶额皮质、颞中回，以及初级视觉皮质有关。

关键词: 卒中后抑郁, 音乐疗法, 头针, 功能磁共振成像, 低频振幅

Abstract: Objective

To observe the effects of music therapy combined with scalp acupuncture on post-stroke depression (PSD) using resting-state functional magnetic resonance imaging (rs-fMRI).

Methods

From December, 2018 to November, 2019, 40 patients with PSD from Rehabilitation Department of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group (n = 20) and observation group (n = 20). Both groups received routine rehabilitation and scalp acupuncture, while the observation group received music therapy as acupuncture, for four weeks. They were assessed with Hamilton Depression Scale (HAMD-17), Pittsburgh Sleep Quality Index (PSQI) and modified Barthel Index (MBI) before and after treatment, and scanned with rs-fMRI to obtain amplitude of low-frequency fluctuation (ALFF). The patients with definite improvement were followed up with HAMD-17 through telephone four weeks after treatment.

Results

There were three cases dropped down in each group. The scores of HAMD-17, PSQI and MBI improved in both groups (|t| > 11.446,P < 0.001), and improved more in the observation group than in the control group (|t| > 2.314, P < 0.05). ALFF of bilateral wedge lobe, bilateral lingual gyrus, right orbitofrontal cortex, right anterior cingulate gyrus and right middle temporal gyrus increased in the observation group, and it increased in the right lingual gyrus, right angular gyrus and lateral groove of right occipital lobe in the control group. A total of 29 patients were followed up successfully, and the HAMD-17 scores were still less than that before treatment (t > 13.558, P < 0.001).

Conclusion

Music therapy can further alleviate depression under scalp acupuncture in patients with PSD for a long time after treatment, and improve sleep and activities of daily living, which may relate with the activation of the emotional circuit, such as orbitofrontal cortex and the middle temporal gyrus, and the primary visual cortex.

Key words: post-stroke depression, music therapy, scalp acupuncture, functional magnetic resonance imaging, amplitude of low-frequency fluctuation

中图分类号:

R743.3

刘研,巴赫,赵邓,刘丽,李建飞,王建,李丽. 基于头针的音乐疗法对卒中后抑郁疗效的静息态功能磁共振观察[J]. 《中国康复理论与实践》, 2021, 27(3): 282-289.

Yan LIU,He BA,Deng ZHAO,Li LIU,Jian-fei LI,Jian WANG,Li LI. Effect of Music Therapy Based on Scalp Acupuncture on Post-stroke Depression: Study with Resting-state Functional Magnetic Resonance Imaging[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 282-289.

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组别	n	性别(男/女, n)	年龄(岁)	病程(月)	病变性质(出血/梗死, n)
对照组	17	4/13	57.76±6.02	11.53±2.27	7/10
观察组	17	7/10	58.18±5.25	12.18±1.81	9/8
χ²/t值		1.209	0.213	0.919	0.472
P值		0.271	0.833	0.365	0.492

组别	n	治疗前	治疗后	t值	P值
对照组	17	16.94±2.11	10.06±2.84	12.116	< 0.001
观察组	17	17.17±1.70	7.29±3.50	14.092	< 0.001
t值		0.358	-2.531
P值		0.723	0.016

组别	n	治疗前	治疗后	t值	P值
对照组	17	15.29±1.96	8.71±2.73	11.446	< 0.001
观察组	17	15.35±3.26	6.47±2.90	11.891	< 0.001
t值		0.064	-2.314
P值		0.950	0.027

组别	n	治疗前	治疗后	t值	P值
对照组	17	41.29±10.76	61.29±2.61	-12.385	< 0.001
观察组	17	42.24±6.05	70.59±9.55	-18.632	< 0.001
t值		0.189	2.664
P值		0.851	0.012

组别	n	治疗前	治疗后	治疗后4周	t值^a	P值^a	t值^b	P值^b
对照组	14	17.64±1.45	10.50±2.86	9.43±2.59	10.939	< 0.001	13.558	< 0.001
观察组	15	17.40±1.68	7.47±3.52	6.20±2.68	13.090	< 0.001	16.362	< 0.001
t值		-0.415	-2.529	-3.294
P值		0.681	0.018	0.003

基于头针的音乐疗法对卒中后抑郁疗效的静息态功能磁共振观察

Effect of Music Therapy Based on Scalp Acupuncture on Post-stroke Depression: Study with Resting-state Functional Magnetic Resonance Imaging

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簇	Brodman脑区	体素大小	MNI坐标			t值
簇	Brodman脑区	体素大小	X	Y	Z	t值
观察组簇1	17/18/19	91	24	-66	-7	5.971
观察组簇2	10/11/45/47	117	31	37	5	5.860
观察组簇3	24/46/48	114	14	17	28	6.104
观察组簇4	21/22/41	68	50	-51	17	5.949
对照组簇1	18/19/39	113	-26	-70	-19	5.688
对照组簇2	3/4	92	-48	-21	43	5.678

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