针灸治疗中风后抑郁的研究进展

Research Progress of Acupuncture and Moxibustion in Treating Post-Stroke Depression

摘要: 中风后抑郁(post-stroke depression, PSD)，作为脑血管事件后最常见的神经精神并发症，发病率达30%~50%，其临床表现为持续情绪低落、认知功能障碍及躯体化症状，可导致神经功能缺损加重、康复进程延缓及死亡率上升2.3倍。现代医学多采用选择性5-羟色胺再摄取抑制剂联合康复训练治疗，但存在药物起效延迟、胃肠道反应、性功能障碍及多药联用风险等局限性，患者治疗依从性不足40%。传统中医基于“形神共调”理论，通过辨证施治实现个体化干预，其中针灸疗法因具有多靶点调控优势受到广泛关注。针刺可通过调节下丘脑–垂体–肾上腺轴(HPA轴)功能、促进脑源性神经营养因子(BDNF)表达、改善海马区神经元突触可塑性等途径实现抗抑郁效应。本文系统综述近五年PSD针灸治疗机制及临床研究进展，为优化治疗方案提供循证依据，同时指出当前研究在标准化方案制定、长期随访数据收集等方面存在的不足，强调未来需开展多中心大样本研究以完善证据体系。

Abstract: Post stroke depression (PSD), as the most common neuropsychiatric complication after cerebrovascular events, has an incidence rate of 30%~50%. Its clinical manifestations are persistent depression, cognitive dysfunction and somatization symptoms, which can lead to aggravation of neurological impairment, delay of rehabilitation process and increase of mortality by 2.3 times. Modern medicine often uses selective serotonin reuptake inhibitors combined with rehabilitation training for treatment, but there are limitations such as delayed drug onset, gastrointestinal reactions, sexual dysfunction, and risks of multi drug combination therapy. Patient treatment compliance is less than 40%. Traditional Chinese medicine, based on the theory of “coordination of body and spirit”, achieves individualized intervention through syndrome differentiation. Among them, acupuncture and moxibustion therapy is widely concerned because it has the advantage of multi target regulation. Acupuncture can achieve antidepressant effects by regulating the function of the hypothalamic pituitary adrenal axis (HPA axis), promoting the expression of brain-derived neurotrophic factor (BDNF), and improving synaptic plasticity of hippocampal neurons. This paper systematically reviews the treatment mechanism and clinical research progress of PSD acupuncture and moxibustion in the past five years to provide evidence based basis for optimizing the treatment plan. At the same time, it points out the shortcomings of current research in the formulation of standardized plans, long-term follow-up data collection, etc., and emphasizes the need to carry out multi center large sample research in the future to improve the evidence system.