| BackgroundDepression is one of the most common mental disorders in populations, It is reported that the female prevalence ratio is 1.5-3times as the male. As competition becomes more intense and psychological pressure becomes more serious, the incidence of female depression is gradually increasing which seriously affects women’s physical and mental health, work and the quality of life. So more attention is paid to the research on pathogenesis and treatment of depression.With the rapid development of imaging technology, especially functional magnetic resonance imaging technology,we can analyze activities related to brain function and the neural pathways in patients with depression, and it can serves as a means to study the the treatment mechanism, so the functional brain imaging study of depression is developing fast over the world.Modern medicine for the treatment of female depression include antidepressants> hormone replacement therapy、psychological therapy、external such as electro-convulsive therapy, Transcranial Magnetic Stimulation and so on. Various methods of treatment have been repoted which have a certain role on the depression, but drugs have addiction and side effects,the effect of the psychological therapy and external theraphy are less stable.The disease belongs to the Chinese medicine"stagnation"、"hysteria" and other areas.Bo’s abdominal acupuncture in the treatment of depression has unique advantages, such as fast-good effect, safe and painless.This research is further proof of the exact effect of the Bo-Shi treatment of this disease, and we expect to explor the mechanism of abdominal acupuncture for treatment of depression in the women.Objective1. We use Bo’s abdominal acupuncture for treatment of depression in women. The research is further observation on clinical effect and safety of the abdominal acupuncture. 2. We adopt the functional magnetic resonance imaging(fMRI)which is the advanced techniques at present to observe changes in brain activity before and after the abdominal acupuncture, and disscuss the mechanism of Bo’s abdominal acupuncture for treatment of depression in women.MethodWe select 19 outpatients in Gynecological department of Guangdong TCM Hospital from Dec.2010 to Mar.2011 that meet the criteria as patients group, and select 19 health volunteers who have the same age distribution as the controlled group. The two group both recept the brain functional magnetic resonance imaging(fMRI)scan in the resting state, and the patients group need the fMRI scan again after the abdominal acupuncture treatment which lasting 4 weeks. We use SPM (statistical parametric mapping) to analize the fMRI data to study the changes of brain functional imaging between the patients group and the control group, and to expolre the imaging changes before and after the abdominal acupuncture treatment in the patients group.We use Self-rating Depression Scale (SDS) and Montgomery-Asberg Depression Scale (MADRS) to assess the improved degree of the clinical symptoms before therapy, each week after therapy and the follow-up period, mealwhile observe the safety index, record the adverse events.ResultI. The evaluation and analysis of curative effect of the abdominal acupuncture:The study indicates that the effect of Bo’s abdominal acupuncture for treatment of women with depression is satisfactory, with the total effective rate of 88.89%.1. Both MADRS and SDS scores have significantly difference after 4 weeks abdo minal acupuncture with the one before the treatment(P<0.05). Both two scale score s are gradually declined after the treatment in each week. The scores begin to decrease after the 1st week treatment, and the dow nward trend is the most obvious after the 2nd week treatment, then the clinical symptoms haves makedly improved after the 4th week. Each week after the treatment the two scale scores have statistically signi ficant difference with the one before the treatment(P<0.05).2. The changes of MADRS and SDS scores are follows:the scores after 1st week treatment has statistically signifant difference with theone before the treatmen t(P<0.05), the scores after the 2nd week treatment has statistically significant difference with the 1st week scores 05),but the 3rd week scores has not signifant difference with the 2nd week scores(P>0.05), and the 4th week scores continues todecline, whi ch has statistically signifant difference with the 3rd week scores(P<0.05).3. The reaserch also shows that the abdominal acupuncture have effect on impr oving the four SDS factors. Each factor scores after four week treatment has stat istically significant difference with the one before the treatment(P<0.05). The effect in improving depressive mood disorder an d the somatic symtoms is most obvious.4. Both MADRS and SDS scores in the follow-up period have not statistically s ignificant difference with the scores after the four week treatment(f>0.05), whic h suggests that the acupuncture effect is still relatively stable at the follow-up period. II. fMRI analysisThis research use fMRI to studies the spontaneous brain activity charicteristics in female depression under resting state and the changes in brain activities caused by the abdominal atcupuncture, combined with Regional homogeneity (ReHo) to analyze the date, and to look for the brain imaging mechanism of the abdominal acupuncture treatment with the women in depression.The result are as follows:1. The brain areas which the ReHo is significantly increased in resting state in depression compared to controls are:left superior frontal gyrus, left middle frontal gyrus, left frontal lobe, right superior frontal gyrus, left middle temporal gyrus, right middle temporal gyrus, left anterior cingulate, left cerebellum posterior lobe, right cerebellum posterior lobe, left precentral gyrus, left nucleus. (P<0.05). The brain areas which the ReHo is significantly decreased in resting state in depression compared to controls are:left inferior frontal gyrus, right superior frontal gyrus, left precentral gyrus, right precentral gyrus, right superior temporal gyrus, left thalamus, left inferior parietal lobule, right limbic lobe(P<0.05).2. In patients group which the acupuncture treatment is effective for them, t he brain areas which the ReHo have statistically significantly difference after the four week treatment with the one before the treatment(the former) are:left s uperior frontal gyrus, left middle frontal gyrus, left inferior frontal gyrus, left cerebellum posterior lobe, right cerebellum posterior lobe, left precentral gyrus, left nucleus, left inferior parietal lobule. (P<0.05), which indicates that the above-mentioned brain areas funtion have been significant improved; The brain areas which the ReHo have not statistically significant differences after the four week treatment with the one before the treatment (the latter) are:left frontal lobe, right superior frontal gyrus, left middle frontal gyrus, right middle temporal gyrus,right superior temporal gyrus, left anterior ci ngulate, left postcentral gyrus, rightprecentral gyrus, left thamalus, right limbic lobe, which indicates thatthe latter brain areas function have not obvious change s after the treatment.3. There are two ineffective cases in this reaserch, the brain areas which the ReHo change statistically significantdifference after the four week treatment than before the treatment in the ineffective cases are:left cerebellum posterior lobe, right cerebellum posterior lobe, right precentral gyrus, right superior temporal gyrus, which indicates that the above-mentioned brain areas function have improved after the treatment,but the ReHo of other brain areas which have significant difference with the controlled group who recept fMRI in the same period have not change, because the number of ineffecitve cases is few, it needs to increase the sample size for insight.Conclusion1. Bo’s abdominal acupuncture is an effective method for women with depression concluding fast-good effect, painless and few adverse reactions, and can be easily accepted by patients, furthermore, this therapy has relatively standardized perscription and operations. These advantages indicates that Bo’s abdominal acupuncture has good prospects in clinical promotion.2. By using resting-state fMRI techniques and ReHo method, this study shows that there are multiple brain functional in female depression mainly for limbic-cortex-striatum-pallidum-thalamus ganglia circuitry, and it suggests that these dysfunctional regions play a importance role in mechanism of female depression.3. The ReHo in some of the brain areas have been changed after the abdominal acupuncture, which implicates that these brain areas function can be improved by the abdominal acupuncture treatment. The major improved areas are frontal lobe and cerebellum region, so we speculate that the mechanism of the abdominal acupuncture for treatment in women with depression may be through improving the levels of the blood oxygen and the metabolism of these brain areas. |
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