[Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial].

To observe the curative effect of Shugan Tiaoshen (soothing liver and regulating mind) acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSD), and to explore its mechanism.Ninety patients of PSD were randomly divided into an acupuncture+rTMS combination group (30 cases), a rTMS combination group (30 cases, 1 case dropped off) and a western medication group (30 cases, 1 case dropped off). The western medication group was treated with escitalopram oxalate tablets, 10 mg orally each time, once a day; on the basis of the treatment in the western medication group, the rTMS combination group was additionally given rTMS, and the frequency was 20 Hz, 20 min each time, once a day, 5 times a week; on the basis of the treatment in the rTMS combination group, the acupuncture+rTMS combination group was additionally treated with Shugan Tiaoshen acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Yintang (GV 24+), Shenting (GV 24), etc. for 40 min each time, once a day, weekly 5 times, and each group was treated for 4 weeks. Before and after treatment, the scores of Hamilton depression scale-17 (HAMD-17), Montreal cognitive assessment scale (MoCA), Pittsburgh sleep quality index (PSQI) were observed, and serum levels of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were detected in each group.After treatment, the HAMD-17 scores in the three groups were lower than those before treatment (P<0.01), and the PSQI scores in the acupuncture+rTMS combination group and the rTMS combination group were lower than those before treatment (P<0.01); the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were lower than those in the western medication group (P<0.05), and the PSQI score in the acupuncture+rTMS combination group was lower than that in the rTMS combination group (P<0.05). After treatment, the MoCA scores and serum BDNF levels in the acupuncture+rTMS combination group and the rTMS combination group were higher than those before treatment (P<0.01), and the serum 5-HT levels in the three groups were higher than those before treatment (P<0.01); and the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were higher than those in the western medication group (P<0.05), and which in the acupuncture+rTMS combination group were higher than those in the rTMS combination group (P<0.05).On the basis of western medication escitalopram oxalate, the addition of Shugan Tiaoshen acupuncture combined with rTMS therapy can effectively improve cognitive function and sleep quality in patients with PSD, and the effect is better than that of western medication alone or rTMS combined with western medication. Its mechanism of action may be related to the increase of peripheral serum 5-HT and BDNF levels.目的：观察疏肝调神法针刺联合重复经颅磁刺激（rTMS）治疗脑卒中后抑郁（PSD）的疗效，并探讨其作用机制。方法：将90例PSD患者随机分为针刺+rTMS联合组（30例）、rTMS联合组（30例，脱落1例）和西药组（30例，脱落1例）。西药组予草酸艾司西酞普兰片，每次口服10 mg，每日1次；在西药组治疗基础上，rTMS联合组加用rTMS，频率20 Hz，每次20 min，每日1次，每周5次；在rTMS联合组治疗基础上，针刺+rTMS联合组加用疏肝调神法针刺，穴取百会、四神聪、印堂、神庭等，每次40 min，每日1 次，每周5次，各组均治疗4周。于治疗前后，观察各组汉密尔顿抑郁量表（HAMD-17）、蒙特利尔认知评估量表（MoCA）、匹兹堡睡眠质量指数（PSQI）评分，检测各组患者血清5-羟色胺（5-HT）、脑源性神经营养因子（BDNF）含量。结果：治疗后，各组患者HAMD-17评分较治疗前降低（P<0.01），针刺+rTMS联合组、rTMS联合组PSQI评分较治疗前降低（P<0.01），且针刺+rTMS联合组、rTMS联合组以上指标均低于西药组（P<0.05），针刺+rTMS联合组PSQI评分低于rTMS联合组(P<0.05）。治疗后，针刺+rTMS联合组、rTMS联合组MoCA评分及血清BDNF含量较治疗前升高（P<0.01），各组患者血清5-HT含量较治疗前升高（P<0.01），且针刺+rTMS联合组、rTMS联合组以上指标均高于西药组（P<0.05），针刺+rTMS联合组高于rTMS联合组（P<0.05）。结论：在西药草酸艾司西酞普兰片治疗基础上，疏肝调神法针刺联合rTMS治疗可以有效改善PSD患者认知功能和睡眠质量，效果优于单纯西药或rTMS联合西药治疗，推测其作用机制可能与提高外周血清5-HT和BDNF含量有关。.