| 引用本文: |
肖慧琼,李冬凤,梁小丽,张雪花,谢莉,周志强,刘学军,李新纯.氯氮平联合穴位埋线法对精神分裂症顽固性幻听患者的代谢影响及临床疗效[J].湖南中医药大学学报,2020,40(8):981-986[点击复制] |
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| 氯氮平联合穴位埋线法对精神分裂症顽固性幻听患者的代谢影响及临床疗效 |
| 肖慧琼,李冬凤,梁小丽,张雪花,谢莉,周志强,刘学军,李新纯 |
| (湖南中医药大学临床医学院, 湖南 长沙 410007) |
| 摘要: |
| 目的 研究氯氮平联合穴位埋线对精神分裂症顽固性幻听患者的代谢影响，并探讨临床疗效。方法 符合纳入标准的30例健康人作为对照组；60例精神分裂症顽固性幻听患者随机分为氯氮平组（药物组）和穴位埋线联合氯氮平组（针药组），每组30例，患者均接受6周治疗。采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)、听幻觉量表(auditory hallucinations rating scale,AHRS)、临床疗效总评量表(clinical global impression,CGI)评定各组疗效，采用ELISA法检测各组血清中细胞因子的含量，并且通过UPLC-MS/MS技术检测血清中内源性代谢产物的变化。结果 治疗前，药物组与针药组患者PANSS、AHRS、CGI相关评分差异均无统计学意义(P>0.05)；治疗后，两组患者3种量表评分均较治疗前有所降低(P<0.05)，除了药物组的CGI病情严重程度一项治疗前后差异无统计学意义(P>0.05)，且治疗后针药组3种量表评分均较药物组降低(P<0.05)。治疗前，药物组和针药组血清中IL-1β、IL-6、TNF-α浓度较对照组升高，而IL-2、IL-8浓度较对照组降低，差异均有统计学意义(P<0.05)，药物组和针药组比较只有IL-1β的差异有统计学意义(P<0.05)；治疗后，针药组和药物组血清中IL-1β、IL-6、TNF-α水平较治疗前降低，IL-2、IL-8水平较治疗前升高，且差异均有统计学意义（P<0.05），而药物组与针药组相比只有IL-8差异有统计学意义（P<0.05）。代谢组学分析表明，与对照组相比，药物组和针药组体内代谢物发生明显变化，发现有4个差异代谢物（柠檬酸、豆蔻酸、胱氨酸、丝氨酸），且两种方案治疗后4个差异代谢物均出现不同程度变化。结论 精神分裂症顽固性幻听患者体内存在着代谢异常，氯氮平联合穴位埋线疗法有助于维持人体内细胞因子的水平和调节物质代谢的平衡，临床疗效尚佳，可临床推广应用。 |
| 关键词: 精神分裂症 顽固性幻听 氯氮平 穴位埋线 代谢组学 |
| DOI：10.3969/j.issn.1674-070X.2020.08.013 |
| 投稿时间：2019-11-13 |
| 基金项目:湖南省科技创新平台与人才计划（2018SK7002）；湖南省自然科学基金（2019JJ80096，2019JJ80028，2019JJ80025）；湖南省中医药科研计划项目（201842，201939，201924）；湖南省卫生健康委科研计划课题（C2019038）。 |
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| Metabolic Effects and Clinical Efficacy of Clozapine Combined with Acupoint Catgut-Embedding in the Treatment of Schizophrenia Auditory Hallucination |
| XIAO Huiqiong,LI Dongfeng,LIANG Xiaoli,ZHANG Xuehua,XIE Li,ZHOU Zhiqiang,LIU Xuejun,LI Xinchun |
| (Clinical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, China) |
| Abstract: |
| Objective To observe the metabolic effect of clozapine combined with acupoint catgut-embedding on patients with intractable hallucinations of schizophrenia, and to explore the clinical efficacy. Methods In line with the inclusion criteria, 30 healthy people were enrolled as normal group (HC). 60 patients with intractable hallucinations of schizophrenia were randomly divided into a clozapine group (drug group) and acupoint catgut-embedding combined with clozapine group (acupoint-drug group), with 30 cases in each group. The patients were treated for 6 weeks. The scores of positive and negative syndrome scale (PANSS), auditory hallucinations rating scale (AHRS), clinical global impression (CGI) were determined, and contents of serum cytokines in each group were tested by ELISA. Through UPLC-MS/MS technology, the changes of endogenous metabolites in serum were analyzed. Results Before treatment, there were no significant difference in PANSS, AHRS and CGI scores between the drug group and acupuncture-drug group (P>0.05). After treatment, the scores of all three scales were reduced (P<0.05). Except for the severity of CGI in the drug group, there was no difference before and after treatment (P>0.05), and the scores of the three scales in the acupuncture-drug group were lower than those in the drug group after treatment (P<0.05). Before treatment, the level of IL-1β, IL-6, TNF-α were increased in the drug group and acupuncture-drug group than those in the control group, while the level of IL-2, IL-8 were decreased when compared with the control group. The differences were statistically significant (P<0.05). But only IL-1β had statistically significant difference between the drug group and the acupuncture-drug group (P<0.05). After treatment, the level of IL-1β, IL-6, TNF-α turned to decrease and the level of IL-2, IL-8 turned to increase both in the acupuncture-drug group and the drug group, and the difference was statistically significant (P<0.05). But only IL-1β had statistically significant difference between the drug group and the acupuncture-drug group (P<0.05). Metabolomics analysis showed that compared with the control group, the metabolites in the drug group and the acupuncture-drug group changed significantly. Four differential metabolites (citric acid, myristic acid, cystine, serine) were found, and the four differential metabolites changed to varying degrees after treatment with the two regimens. Conclusion There are metabolic abnormalities in patients with intractable hallucinations of schizophrenia. Clozapine combined with acupoint catgut-embedding can help maintain the level of cytokines in the body and regulate the balance of substance metabolism. The clinical effect is good, and it can be applied and promoted clinically. |
| Key words: schizophrenia intractable hallucinations clozapine acupoint catgut-embedding metabolomics |
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