| 引用本文:袁善方1，王艳2，唐启盛1，黄世敬3，尹洪娜4，林安基5，孙文军1.补益心脾法降低心脾两虚型抑郁障碍患者自杀意念的队列研究[J].世界中医药,2023,(19):. |
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| 补益心脾法降低心脾两虚型抑郁障碍患者自杀意念的队列研究 |
| Nourishing the Heart and Spleen in Reducing Suicidal Ideation of Patients with Major Depressive Disorder(Deficiency of Heart and Spleen)：A Cohort Study |
| 投稿时间：2023-02-03 |
| DOI：10.3969/j.issn.1673-7202.2023.19.014 |
| 中文关键词: 中药 补益心脾法 心脾两虚 抑郁 自杀意念 多中心 前瞻性队列研究 临床疗效 |
| English Keywords:Chinese medicine Nourishing the heart and spleen Deficiency of heart and spleen Major depressive disorder Suicidal ideation Multiple centers Prospective cohort study Clinical effect |
| 基金项目:国家中医药行业专项（201507001）；首发科研专项（首发2022-2-7035）；国家中医药管理局岐黄学者项目（10400633210001）；北京自然科学基金项目（7222274）；第五批全国中医临床优秀人才项目，中华中医药学会求实项目（2022-QNQSDEP-14）；教育部工程研究中心培育项目（BZYSY-2022-GCYJZXQX-09）；云南省区域中医（针灸）诊疗中心建设项目 |
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| 中文摘要: |
| 目的：探究补益心脾法对伴自杀意念的抑郁障碍（MDD）的临床疗效。方法：2017年1月至2018年4月招募全国13家中医、中西医结合及精神专科医院符合纳入标准的MDD患者366例作为研究对象，按治疗方案自然形成中医、西医与中西医结合治疗3个队列,并根据中药暴露时间(TCM-ET)分为高、中、低3个水平。间隔3个月随访,以蒙哥马利-阿斯伯格抑郁评定量表(MARDS)评估患者抑郁症状变化及终点事件发生情况。结果：中医、西医、中西医结合治疗队列的2年自杀意念发生率分别为39.0%、49.1%、29.0%。在自杀意念发生率的多因素比较上，以西医队列为参照，中医队列自杀意念发生率降低28.1%(HR=0.719,95%CI为0.476～1.087,P>0.05)，差异无统计学意义。中西医队列自杀意念发生率降低42.1%(HR=0.579,95%CI为0.373～0.899,P<0.01)。中医队列中，以低水平TCM-ET为参照，中水平TCM-ET自杀意念发生率降低22.2%(HR=0.778,95%CI为0.404～1.500,P>0.05)，差异无统计学意义，高水平TCM-ET自杀意念发生率降低66.6%(HR=0.394,95%CI为0.167～0.931,P<0.05)。中西医队列中，以低水平TCM-ET为参照，中水平TCM-ET自杀意念发生率降低70.3%（HR=0.419,95%CI为0.189～0.927,P<0.05），高水平TCM-ET自杀意念发生率降低83.1%（HR=0.217,95%CI为0.094～0.501,P<0.01）。结论：补益心脾法中医治疗与西医治疗具有同等的疗效，中西医结合治疗可更好降低心脾两虚型MDD患者自杀意念发生率；中、高水平TCM-ET对降低心脾两虚型MDD患者自杀意念的临床疗效与低水平TCM-ET相比更为显著。 |
| English Summary: |
| To observe the clinical effect of nourishing the heart and spleen on major depressive disorder(MDD)with suicidal ideation.Methods:From January 2017 to April 2018，366 MDD patients(deficiency of heart and spleen) in 13 hospitals including traditional Chinese medicine(TCM) hospitals，integrated Chinese and Western medicine hospitals and psychiatric hospitals were taken as the study subjects in this cohort.Three cohort groups(TCM，Western medicine，and integrated Chinese and Western medicine) were formed naturally according to treatment regime，and they were divided into high，medium and low levels based on the TCM exposure time(TCM-ET).The follow-up interval was 3 months，and the Montgomery-Asberg Depression Rating Scale(MADRS) was used in the follow-up to assess the dynamic status of MDD patients and the occurrence of the endpoint events.Results:The 2-year incidence of suicidal ideation of MDD patients in the TCM，Western medicine，and integrated Western and Chinese medicine cohorts was 39.0%，49.1%，and 29.0%，respectively.In the multifactorial comparison of suicidal ideation，compared with the condition in Western medicine cohort，the risk of suicidal ideation was reduced by 28.1%(HR=0.719，95%CI 0.476 to 1.087，P>0.05) in TCM cohort，and by 42.1%(HR=0.579，95%CI 0.373 to 0.899，P<0.01) in integrated Chinese and Western medicine cohort.In TCM cohort，compared with the condition under low-level TCM-ET，the risk of suicidal ideation was reduced by 22.2%(HR=0.778，95%CI 0.404 to 1.500，P>0.05) under medium-level TCM-ET，and by 66.6%(HR=0.394，95%CI 0.167 to 0.931，P<0.05) under high-level TCM-ET.In integrated Chinese and Western medicine cohort，compared with the condition under low-level TCM-ET，the risk of suicidal ideation was lowered by 70.3%(HR=0.419，95%CI 0.189 to 0.927，P<0.05) with medium-level TCM-ET，and by 83.1%(HR=0.217，95%CI 0.094 to 0.501，P<0.01) with high-level TCM-ET.Conclusion:Western medicine and TCM method of nourishing the heart and spleen present the same effect，and integrated Chinese and Western medicine is more significant in reducing the suicidal ideation of MDD patients(deficiency of heart and spleen).Compared with low-level TCM-ET，medium-level and high-level TCM-ETs are more clinically effective in reducing the suicidal ideation. |
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