The Clinical Efficacy And Neuroendocrine Mechanism Of Electroacupuncture On Occupational Noise-induced Hearing Loss Patients With Depressive Symptoms

ObjectivesFrom three aspects of the epidemiological investigation,clinical efficacy evaluation and action mechanism,the dissertation aims to investigate the clinical characteristics,make an evaluation on the effectiveness of acupuncture and explore the possible mechanism of acupuncture for treatment on occupational noise-induced hearing loss(NIHL)patients with depressive symptoms.Firstly,the purpose of research one were:(1)a epidemiological investigation of clear(ONIHL)incidence rate of depressive symptoms and to explore the influencing factors of patients with ONIHL complicated with nerve;(2)clear the immune indexes in patients with primary depressive symptoms change,to explore its possible mechanisms in the pathogenesis of ONIHL;(3)to explore the characteristics of TCM with the disease of other syndromes in patients with primary depressive symptoms;Second,the purpose of research one was to curative effect evaluation to evaluate the effect of acupuncture on ONIHL patients accompanied with depressive symptoms,depressive symptoms,tinnitus,hearing level and degree of sleep disorder treatment.Finally,the mechanism of acupuncture was studied in research three: fouce on the HPA axis and inflammatory cytokine,a neuroendocrine immune pathway,we studied the regulatory effect of acupuncture on related neuroimmune indexes,and explored the mechanism of its action.The three studies are interrelated and gradually deepened.The research one was to illustrate the severity of depressive symptoms in patients with ONIHL.It needs early prevention and treatment.In addition,the research one was to analyze the TCM syndrome elements of the subjects,and lay the foundation for the study of the acupuncture Interfering program.In the research two,electroacupuncture was used as a treatment method,and the clinical efficacy of electroacupuncture on the treatment of the disease was analyzed.The research three is based on research two and research one.We analyzed the changes of neuroimmunological parameters selected by research one and discussed the possible mechanism of electroacupuncture effect.MethodsResearch one: Clinical characteristics of depressive symptoms in NIHL Patients1.220 occupational NIHL Patients and 200 healthy People without hearing loss were involved in this cross-sectional study.Depressive symptoms were assessed by Hamilton Depression Scale(HAMD).Sleep quality was assessed by the Pittsburgh Sleep Quality Index(PSQI).Tinnitus intensity was evaluated by Tinnitus Handicap Inventory(THI).After adjusted for socio-demographic variables,we compared the incidence of depression,anxiety,sleep disorders and the scores of those questionnaire scales.2.According to the HAMD scores,220 occupational NIHL Patients were divided into two groups: depression and no depression group,collecting basic demographic data such as gender,age,educational level,marital status and disease related information such as duration of ONIHL,auditory thresholds,noise level,and years of working,HAMD scores,THI scores and PSQI scores.The incidence of depression and its risk factors were analyzed.3.The blood from 220 occupational NIHL patients and 50 healthy people were withdrawn.Serum and salivary cortisol levels,blood routine test,lymphocyte subsets,humeral immunity related indicators and inflammatory cytokines levels were detected.The differences between the three groups were compared.4.61 occupational NIHL patients with depressive symptoms as the research object,collect the the chinese medicine four diagnostic information,to explore the core pathogenesis and syndromes distribution of TCM such as disease location,relevant major disease and syndrome factors.Research two: Clinical efficacy of acupuncture in the treatment of NIHL Patients with depressive symptoms.Using clinical randomization,60 patients were randomly divided into electroacupuncture treatment group and waiting list group.The two groups both received basic treatment such as improvement of the ear circulation and the neurotropic nerve treatment.On the basis of routine treatment,Electroacupuncture treatment group was treated with electroacupuncture.Carpoint’s: Baihui,shenting,Taichong,Hegu,Neiguan,taixi.The frequency of electroacupuncture stimulation was selected as 2/100 Hz density alternating wave.Treatment time and frequency was 30 min and three times a week at intervals of 1 day and 4 weeks for continuous treatment.Before and after treatment,the hearing was detected and the scale was evaluated.The outcome of depression and anxiety were evaluated by the scores of HAMD,SDS,SAS and HAMA scale.The score of PSQI scale was used as an evaluation index for the improvement of sleep state,the score of the THI scale was used to evaluate the improvement of the tinnitus degree in the two groups.Pure-tone audiometry was used to assessment of hearing.Research three: Study on the neuroendocrine mechanism of acupuncture in the treatment of NIHL patients with depressive symptoms.Patients and interventions were the same as those mentioned in research two.The blood and saliva of all the patients were collected before and after treatment,and the cort,IL-6 and TNF-a were measured.Significant differences were determined between the two groups with respect to basal serum and saliva cort,serum IL-6,TNF-a levels.Relationship between the reduction in HAM-D scores and the changes in the IL-6,TNFalpha levels was analyzed.ResultsResearch one: Clinical characteristics of depressive symptoms in NIHL Patients1.The scores of HAMD and PSQI scale in NIHL Patients were significantly higher than those without hearing loss,NIHL Patients have a higher Prevalence of anxiety and sleep disorders than those without hearing loss(P<0.05).The prevalence of depressive symptoms in patients with NIHL was 27.7%,and the prevalence of depressive symptoms in People without hearing loss was 5%,the difference between two groups was statistically significant(P<0.05).2.The scores of PSQI and THI,duration of occupational NIHL all had a Positive association with HAMD scores,the longer the course of ONIHL,the higher the THI score and PSQI score,the higher the risk of depression.(P< 0.05).3.NIHL Patients with depressive symptoms had higher serum cortisol and morning salivary cortisol and night salivary cortisol levels,the inflammatory cytokines IL-6 and TNF-a level than People without hearing loss and NIHL patients without depressive symptoms,the difference was statistically significant(P<0.05).4.From high to low,major syndrome factors were Qi Stagnation(77.1%),Qi deficiency(72.1%),blood stasis(61.4%),sperm loss(59.6%),fever(54.1%),yin deficiency(42.6%),blood(37.7).%)and Phlegm syndrome(29.5%);the disease-location of five-zang basic syndrome from high to low is the heart(86.9%),liver(77.1%),kidney(62.3%),spleen(39.3%),lung(21.3%);the deficiency of empirical distributions of the situation is: the deficiency(8.2%),Positive(13.1%),deficiency C(78.7%).Research two: Clinical efficacy of acupuncture in the treatment of NIHL Patients with depressive symptoms.1.After the treatment,the total effective rate of electroacupuncture group was 82.1%,and the total effective rate of the waiting list group was10.3%.There was a significant difference in the effective rate between the two groups(P<0.05).From the HAMD score,the total score of HAMD,weight and cognitive impairment in the waiting list group were significantly improved,while the total score of HAMD and the scores of each sub factor in electroacupuncture group were significantly decreased compared with those before treatment,the difference was statistically significant(P<0.05).In addition,the SDS score in the electro acupuncture treatment group decreased significantly compared with before treatment,while the SAS and HAMA total score and two factor scores decreased significantly after electro acupuncture treatment,while the waiting list group did not improve significantly(P>0.05).2.After treatment,the sleep disorder in the electroacupuncture group was significantly improved,while the PSQI score in the waiting list group was not significantly improved.It shows that electroacupuncture has a good effect on sleep disorder(P<0.05).In addition,there was statistically significant correlation between the reduction in PSQI scores and the changes in the total score of HAMD,somatization,retardation factor and sleep factor score(r=0.617,r =0.269,P =0.000;P =0.030;P =0.000;r =0.449,r =0.325,P = 0.008).3.After treatment,the total score of THI in the two groups was improved.The waiting list group showed a decrease in the functional score,while the electro acupuncture group showed a decrease in the emotional score.However,there was no difference in the total score of THI between the two groups(P>0.05).4.The verbal frequency audition in left ear had no obvious improvement after treatment in the two groups,but frequency audition in l right ear and the high frequency audition damage were significantly higher than those before treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).Research three: Study on the neuroendocrine mechanism of acupuncture in the treatment of NIHL patients with depressive symptoms.1.There was no significant improvement in both saliva cort and serum cort before and after treatment in the two groups(P>0.05).After treatment,the levels of serum IL-6 and TNF-a were significantly lower than those before treatment in the electroacupuncture group(P<0.05),while there was no significant difference in the levels of inflammatory factors in the waiting group.There was a significant difference between the two groups(P<0.05).2.There was statistically significant correlation between the reduction in HAMD total scores and the changes in the IL-6,TNF-a levels(r =0.0.450,P =0.016;r =0.376,P =0.049),and the changes in TNF-a levels was positively correlated with the reduction of sleep disorder factor score(r=0.701,P=0.000).The the changes in IL-6 was positively correlated with the change of anxiety /somatization score(r =0.481,P=0.010).Conclusion1.The prevalence of depressive symptoms in occupational NIHL patients was much higher than people without hearing loss.Duration of the hearing loss,sleep quality and tinnitus severity were the risk factors for occupational NHIL Patients with depressive symptoms.2.Occupational NIHL patients with depressive symptoms had HPA axis hyperactivity and higher inflammatory reaction than those without depressive symptoms,and the positively correlation was determined between the SDS scores and the mean levels of cortisol,TNF-a and IL-6.3.Electroacupuncture can improve the anxiety,depressive symptoms and sleep disorder in Occupational NIHL patients with depressive symptoms,but there was no obvious effective on the improvement of tinnitus and deafness.4.Electroacupuncture was shown not to reduce the cortisol level,but it could reduce inflammatory cytokines TNF-a and IL-6 levels.Electroacupuncture cause significant changes in the activity of the immune system may be one of the mechanisms of antidepressant treatment by acupuncture.