針刺干預(yù)抑郁的臨床評(píng)價(jià)與中樞機(jī)制研究進(jìn)展

余云進(jìn),馮軍,張榮,唐純志,史亞飛

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針刺干預(yù)抑郁的臨床評(píng)價(jià)與中樞機(jī)制研究進(jìn)展

余云進(jìn)1,2,馮軍1,張榮2,唐純志2,史亞飛2

(1.廣州中醫(yī)藥大學(xué)深圳醫(yī)院,深圳 518033;2.廣州中醫(yī)藥大學(xué),廣州 510006)

回顧了近10余年來(lái)在國(guó)際期刊發(fā)表的針刺干預(yù)抑郁癥的相關(guān)研究文獻(xiàn),探討針刺治療抑郁的臨床和機(jī)制研究中所取得的成果與發(fā)展方向。資料顯示,針刺干預(yù)抑郁具有肯定的療效與獨(dú)特的優(yōu)勢(shì),針刺干預(yù)抑郁癥的研究在近些年取得了重要進(jìn)展,尤其是在HPA軸、神經(jīng)遞質(zhì)、信號(hào)通路、炎癥反應(yīng)和基因表達(dá)等方面。但具體機(jī)制尚不清楚,針刺對(duì)抑郁的研究有待進(jìn)一步完善。

針刺療法;電針;抑郁;綜述;研究進(jìn)展

據(jù)世界衛(wèi)生組織報(bào)道,抑郁癥每年奪走近80萬(wàn)人的生命,是15～29歲年齡段個(gè)體的第二大死因[1]。近年來(lái),社會(huì)生活的不良外界壓力所導(dǎo)致的心理與精神障礙不斷增多,我國(guó)抑郁癥患病率亦逐年升高,嚴(yán)重阻礙了人民群眾的身心健康及社會(huì)發(fā)展。抑郁癥發(fā)病機(jī)制復(fù)雜,病因尚未清楚,針刺干預(yù)在防治抑郁癥中具有優(yōu)勢(shì)。當(dāng)前按照國(guó)際標(biāo)準(zhǔn)嚴(yán)格進(jìn)行的針刺抗抑郁研究呈快速上升趨勢(shì),顯示出進(jìn)行有效的針刺防治抑郁癥的臨床療效評(píng)價(jià)與機(jī)制研究愈發(fā)受到學(xué)者們的關(guān)注?，F(xiàn)將近10年來(lái)發(fā)表在國(guó)際期刊上的文獻(xiàn)概述如下。

1 臨床研究

1.1 對(duì)單純性抑郁的臨床研究

Chen J等[2]采用隨機(jī)對(duì)照試驗(yàn)對(duì)105例單純抑郁患者治療,針刺組和電針組的抑郁和焦慮自評(píng)量表總分均低于鹽酸帕羅西汀片治療組,表明針刺(電針)均能明顯改善抑郁和焦慮癥狀。Sun H等[3]通過(guò)對(duì)75例排除了其他精神病史和嚴(yán)重軀體癥狀疾病的單純抑郁患者進(jìn)行治療,在治療6周后,電針組與氟西汀組的抑郁量表評(píng)分均降低至少50%,電針組93%的抑郁患者有較大的改善。Meta分析對(duì)20例涉及2000名重度抑郁癥(major depressive disorder, MDD)患者相對(duì)較高質(zhì)量的臨床試驗(yàn)研究,通過(guò)分析評(píng)分后發(fā)現(xiàn)針刺干預(yù)在改善和減少M(fèi)DD患者抑郁行為的效果與抗抑郁藥相當(dāng)[4]。據(jù)此,針刺對(duì)臨床上單純抑郁的治療療效肯定。

1.2 對(duì)抑郁并病的臨床研究

抑郁并病是抑郁癥臨床中常見(jiàn)的表現(xiàn)形式,多是由自身其他疾病應(yīng)激所引起的情緒變化產(chǎn)生的抑郁。針刺干預(yù)在治療抑郁癥并病對(duì)比西藥具有一定優(yōu)勢(shì)。

卒中后抑郁癥(post stroke depression, PSD)在臨床中是最為常見(jiàn)的,氟西汀目前仍舊是常用的抗抑郁藥之一,介于其易產(chǎn)生不良反應(yīng)及副作用,作為安全且具有良好療效的針刺治療則十分值得推廣。Qian X等[5]對(duì)PSD患者的治療實(shí)行臨床單雙盲隨機(jī)對(duì)照試驗(yàn),通過(guò)6周的治療,發(fā)現(xiàn)針刺組和氟西汀治療組都能緩解抑郁癥狀,氟西汀組出現(xiàn)的不良反應(yīng)高于單純的重度抑郁癥,而針刺引起的不良反應(yīng)較少。Zhang ZJ等[4]對(duì)15例涉及1700名的PSD患者的實(shí)驗(yàn)研究進(jìn)行了Meta分析,發(fā)現(xiàn)針刺療法治療要優(yōu)于PSD常規(guī)治療。Li M等[6]運(yùn)用調(diào)神開(kāi)竅法治療PSD,相比氟西汀治療,針刺治療與氟西汀的療效相當(dāng)且無(wú)明顯不良反應(yīng)。

妊娠期抑郁也是抑郁并病常見(jiàn)類型之一,對(duì)母嬰造成嚴(yán)重危害,但妊娠期抑郁癥患者可接受的治療方法非常局限。Manber R等[7]對(duì)61例妊娠期重度抑郁患者進(jìn)行8周的針刺治療,顯示針刺治療的有效應(yīng)答率達(dá)到69%,而這些有效應(yīng)答的患者在產(chǎn)后10周的抑郁評(píng)分則明顯低于無(wú)有效反應(yīng)者。針刺治療可能是對(duì)妊娠期抑郁的一種安全可行的治療方式。

創(chuàng)傷后應(yīng)激障礙(post-traumatic stress disorder, PTSD)是因發(fā)生或者接觸到創(chuàng)傷性事件所受應(yīng)激而產(chǎn)生的精神障礙,迄今為止,尚沒(méi)有一種專門用于治療PTSD的最佳方法,針灸可能是治療PTSD的一種值得推廣的新穎選擇。Engel CC等[8]通過(guò)臨床治療對(duì)比,發(fā)現(xiàn)針刺對(duì)PTSD具有良好的治療效果,探討了針刺PTSD的效應(yīng)及其價(jià)值。Wang Y等[9]對(duì)138例PTSD患者進(jìn)行治療發(fā)現(xiàn),與帕羅西汀組相比,針刺組在治療6周和12周時(shí),漢密爾頓焦慮量表評(píng)分減少率分別上升35.5%、24.5%,證明電針對(duì)PTSD治療選擇的可行性。

1.3 針?biāo)幉⒂弥委熞钟舭Y的研究

當(dāng)前治療抑郁癥的方式較為單一,針?biāo)幉⒂玫难芯窟\(yùn)用可能是治療抑郁癥的重要有效手段。段冬梅等[10]對(duì)95例輕度或重度抑郁癥患者進(jìn)行治療研究,數(shù)據(jù)結(jié)果表明,氟西汀組治療總有效率為77.3%,而電針加氟西汀治療組為78.3%。劉蘭英等[11]對(duì)41例抑郁癥患者治療,通過(guò)6周的治療觀察,發(fā)現(xiàn)氟西汀單用治療的患者一周后開(kāi)始出現(xiàn)不良反應(yīng)且持續(xù)很長(zhǎng)一段時(shí)間,而電針結(jié)合氟西汀治療組表現(xiàn)的不良反應(yīng)相對(duì)減少。Chan YY等[12]分析了13項(xiàng)研究,結(jié)果顯示針刺結(jié)合抗抑郁藥物治療抑郁癥的應(yīng)答率平均值達(dá)到76.8%,明顯高于單用抑郁藥的50.8%。提示針?biāo)幉⒂眯Ч谩?/p>

2 機(jī)制研究

2.1 對(duì)神經(jīng)內(nèi)分泌系統(tǒng)的研究

下丘腦-垂體-腎上腺軸(HPA)在神經(jīng)內(nèi)分泌系統(tǒng)的組成中占了非常重要的地位,參與了應(yīng)激反應(yīng)[13]。近些年的理論認(rèn)為,慢性應(yīng)激下HPA軸的失調(diào)是導(dǎo)致抑郁癥的重要因素,HPA軸可能是應(yīng)激反應(yīng)和抑郁癥狀最終的共同通路[14-15]。Le JJ等[16]研究數(shù)據(jù)表明,電針可以通過(guò)調(diào)節(jié)HPA軸起抗抑郁作用,抑郁癥大鼠的下丘腦室旁核(CRH)、血漿促腎上腺皮質(zhì)激素(ATCH)和血清皮質(zhì)酮(CORT)表達(dá)增加,在電針百會(huì)和印堂穴后降低,而CRH、ACTH和CORT都為HPA軸的活指標(biāo)。抑郁大鼠中HPA軸的失調(diào)亦可導(dǎo)致海馬神經(jīng)細(xì)胞紊亂,在針刺干預(yù)后也可以得到改善[17]。

2.2 對(duì)神經(jīng)遞質(zhì)及受體等的研究

有研究認(rèn)為,神經(jīng)遞質(zhì)5-羥色氨(5-HT)與壓力和情緒異常行為密切相關(guān),并在抑郁癥的發(fā)病進(jìn)程中起主要作用[18-19]。Park H等[20]研究發(fā)現(xiàn),抑郁大鼠的前額葉皮質(zhì)中的5-HIAA/5-HT比率增加,在針刺神門穴后均得到了下調(diào)。Duan D等[21]研究表明,電針后抑郁大鼠腦中5-HT含量能隨著5-HT1A受體表達(dá)的改變得到調(diào)節(jié)。Wu YY等[22]通過(guò)電針治療利血平誘導(dǎo)的抑郁大鼠,最終抑郁大鼠的中縫背核5-HT得到了上調(diào)。針刺治療能顯著調(diào)節(jié)5-HT的表達(dá)而改善抑郁行為。單胺類神經(jīng)遞質(zhì)多巴胺(Dopamine, DA)系統(tǒng)功能的紊亂也是影響抑郁癥發(fā)病的重要因素,其中DA代謝產(chǎn)物3，4-二羥笨乙酸（DOPAC）與DA水平比值的表達(dá)反映了DA代謝水平及其系統(tǒng)的變化,針刺神門穴能增加抑郁大鼠海馬和前額葉皮質(zhì)中下調(diào)的DOPAC/DA比值[23]。另外的研究也證實(shí),抑郁小鼠海馬的DA水平顯著下降而在針刺三陰交穴治療后得到恢復(fù),說(shuō)明針刺對(duì)腦中DA代謝具有調(diào)節(jié)作用[24]。這也表明了針刺干預(yù)可通過(guò)調(diào)節(jié)DA及其代謝產(chǎn)生抗抑郁作用。此外,Lee B等[25]開(kāi)展了針刺對(duì)肽類神經(jīng)遞質(zhì)的影響,發(fā)現(xiàn)針刺內(nèi)關(guān)可以顯著增加慢性皮質(zhì)酮給藥造成的抑郁大鼠的下丘腦室旁核神經(jīng)肽Y(NPY)免疫組化表達(dá),提示針刺干預(yù)可以通過(guò)調(diào)節(jié)NPY起到抗抑郁作用。甘丙肽(Gal)與神經(jīng)遞質(zhì)及其活性有著密切的關(guān)聯(lián),參與影響了抑郁癥的發(fā)展。Mo Y等[26]研究發(fā)現(xiàn)抑郁大鼠中的Gal水平發(fā)生了降低,在針刺治療后Gal含量增加,大鼠的抑郁行為也得到了有效改善。綜上,抑郁癥機(jī)體中的神經(jīng)遞質(zhì)及其受體發(fā)生了改變,針刺對(duì)其變化具有趨于正常化的調(diào)節(jié)作用。

2.3 對(duì)炎癥反應(yīng)的研究

一直以來(lái),炎癥反應(yīng)被認(rèn)為是抑郁癥發(fā)病的重要因素,許多炎癥相關(guān)疾病都會(huì)表現(xiàn)抑郁行為。相關(guān)研究認(rèn)為,炎癥細(xì)胞因子產(chǎn)生的促炎細(xì)胞因子能激活巨噬細(xì)胞,對(duì)抑郁癥狀有幫助改善作用[27]。針刺治療抑郁癥具有多靶點(diǎn)的特征,針刺對(duì)抑郁的干預(yù)作用機(jī)制可能與炎癥途徑相關(guān)。Wang Y等[28]通過(guò)對(duì)抑郁大鼠的KEGG途徑基因分析,發(fā)現(xiàn)差異基因中的Toll樣受體、TNF信號(hào)通路和NF-kB表達(dá)在抑郁大鼠中下調(diào),而針刺治療可以調(diào)節(jié)這種改變。Liu Y等[29]觀察抑郁癥患者白介素的變化,發(fā)現(xiàn)白細(xì)胞介素-6(IL-6)在抑郁癥患者的表達(dá)升高,經(jīng)針?biāo)幝?lián)用治療后,抗炎因子IL-4和IL-10相比藥物治療組顯著提高,而針?biāo)幝?lián)用治療的抑郁評(píng)分則顯著降低,表明針刺能通過(guò)調(diào)節(jié)促炎細(xì)胞因子和抗炎細(xì)胞因子的平衡起抗抑郁作用。Song C等[30]臨床研究揭示,針刺能通過(guò)降低抑郁患者的IL-1b起抗炎作用,還能增加TNF-a,恢復(fù)Th1和Th2之間的平衡。Lu J等[31]實(shí)驗(yàn)數(shù)據(jù)顯示,抑郁大鼠海馬和前額葉皮層以及血清細(xì)胞因子中的IL-1b、IL-6和TNF-a顯著增加,而在針刺治療后降低。此外,有研究發(fā)現(xiàn)針刺干預(yù)能顯著抑制抑郁大鼠NF-kB的活化而產(chǎn)生抗抑郁治療效果,認(rèn)為針刺的抗抑郁效應(yīng)可能是通過(guò)調(diào)節(jié)腦區(qū)NF-kB的炎癥介質(zhì)介導(dǎo)的[32]。

2.4 對(duì)神經(jīng)營(yíng)養(yǎng)因子的研究

神經(jīng)膠質(zhì)源神經(jīng)營(yíng)養(yǎng)因子(GDNF)濃度的變化是抑郁癥的發(fā)病的重要因素之一[33],電針治療能有效調(diào)節(jié)抑郁癥患者血清中GDNF的濃度,改善相關(guān)的抑郁行為[3]。腦源性神經(jīng)營(yíng)養(yǎng)因子(BDNF)對(duì)神經(jīng)元的可塑性及生長(zhǎng)發(fā)育具有促進(jìn)作用。Duan DM等[34]發(fā)現(xiàn)電針能逆轉(zhuǎn)抑郁大鼠BDNF下調(diào),海馬的神經(jīng)元可塑性也得到了調(diào)節(jié)。另外的研究發(fā)現(xiàn),電針能通過(guò)miRNA神經(jīng)營(yíng)養(yǎng)因子信號(hào)通路促進(jìn)神經(jīng)營(yíng)養(yǎng)和抑制神經(jīng)元的異常凋亡[35]。表明,針刺能通過(guò)調(diào)節(jié)中樞神經(jīng)系統(tǒng)內(nèi)的神經(jīng)營(yíng)養(yǎng)因子表達(dá)來(lái)改善相關(guān)的抑郁癥狀。

2.5 對(duì)信號(hào)傳導(dǎo)通路的研究

目前認(rèn)為,眾多的信號(hào)通路與抑郁癥的發(fā)病有關(guān),包括環(huán)磷腺苷(cAMP)、絲裂原活化蛋白激酶(MAPK)、蛋白激酶A(PKA)、胞外信號(hào)調(diào)節(jié)激酶(ERK)等。針刺經(jīng)穴可以通過(guò)介導(dǎo)相關(guān)的信號(hào)通路及靶點(diǎn)起抗抑郁作用。Duan DM等[34]觀察到抑郁大鼠海馬中的cAMP反應(yīng)元件結(jié)合蛋白(CREB)的表達(dá)量顯著減少,在針刺后能得到有效調(diào)節(jié)。Jiang H[36]等認(rèn)為PKA/cAMP信號(hào)通路是針刺起抗抑郁療效的關(guān)鍵因素,因?yàn)獒槾棠孓D(zhuǎn)了抑郁大鼠海馬PKA-a和p-CREB表達(dá)的下調(diào)。針刺還能逆轉(zhuǎn)抑郁大鼠腺苷酸環(huán)化酶(AC)-cAMP-PKA的下調(diào),說(shuō)明AC-cAMP-PKA信號(hào)通路也在針刺抗抑郁起效中是至關(guān)重要的[37]。ERK信號(hào)通路對(duì)腦內(nèi)突觸有重要影響,對(duì)抑郁癥的發(fā)生和治療的研究具有重要價(jià)值。Zhang X等[38]通過(guò)針刺治療觀測(cè)抑郁大鼠信號(hào)分子p-ERK1/2的表達(dá),證明了針刺具有調(diào)節(jié)相關(guān)信號(hào)而發(fā)揮抗抑郁的作用。Li W等[39]發(fā)現(xiàn)抑郁大鼠的ERK表達(dá)得到抑制,電針治療能使抑郁大鼠的行為學(xué)得到改善且ERK得到激活。Prkc和Mapt蛋白是MARK信號(hào)通路中十分重要的蛋白。Yang X等[40]研究表明,抑郁大鼠海馬的Prkc表達(dá)提高和Mapt表達(dá)水平下降在通過(guò)電針治療都能有效逆轉(zhuǎn),證明了針刺能通過(guò)MARK信號(hào)通路發(fā)揮抗抑郁效應(yīng)。近年,還有通過(guò)研究抑郁大鼠基因轉(zhuǎn)錄的方式,發(fā)現(xiàn)針刺可能通過(guò)Toll樣受體、TNF和NF-kB信號(hào)通路途徑起到抗抑郁效果[41]。

2.6 對(duì)海馬神經(jīng)元的研究

海馬與情緒、學(xué)習(xí)、行為和記憶密切相關(guān),是抑郁癥發(fā)病和防治的關(guān)鍵。電針能調(diào)節(jié)存在于神經(jīng)細(xì)胞中的海馬差異蛋白改善大鼠的抑郁癥狀,還能調(diào)節(jié)海馬相關(guān)基因表達(dá)來(lái)調(diào)節(jié)抑郁癥[42-43]。谷氨酸轉(zhuǎn)運(yùn)蛋白功能障礙可直接影響谷氨酸的傳播,從而影響情緒。Luo D等[44]發(fā)現(xiàn)神經(jīng)膠質(zhì)谷氨酸轉(zhuǎn)運(yùn)蛋白2陽(yáng)性細(xì)胞數(shù)、蛋白質(zhì)及mRNA的表達(dá)在抑郁大鼠中降低,電針治療后升高。Xu J等[45]發(fā)現(xiàn)電針能增強(qiáng)抑郁大鼠海馬中p-ERK1/2和p-P38/P38蛋白的表達(dá)而改善抑郁癥狀。抑郁大鼠的海馬相關(guān)病變及行為學(xué)改變?cè)卺槾毯蟮玫秸{(diào)節(jié),表明針刺可能通過(guò)海馬相關(guān)蛋白作用于抑郁癥。

2.7 對(duì)腧穴的選擇

腧穴的選擇是針刺治療病癥的最重要因素,不同的腧穴所起的針刺效應(yīng)具有很大的差異性。百會(huì)和印堂是在針刺干預(yù)抑郁癥的研究中較常用的腧穴,多項(xiàng)取得成果的研究均選擇了這兩個(gè)腧穴[17,26,28,34-36,39-40,45]。還有實(shí)驗(yàn)選用電針百會(huì)和印堂治療抑郁大鼠,以研究腧穴對(duì)抑郁大鼠的海馬突觸可塑性變化的作用,結(jié)果顯示百會(huì)和印堂穴能通過(guò)調(diào)節(jié)海馬相關(guān)通路信號(hào)分子的表達(dá)改善抑郁癥[46]。針刺三陰交和神門對(duì)抑郁大鼠DA有代謝調(diào)節(jié)作用[24];針刺合谷和太沖能增加海馬和皮質(zhì)層中的EAAT2起抗抑郁作用[44];相比針刺非穴位,針刺內(nèi)關(guān)穴顯著改善了大鼠的焦慮和快感缺失等抑郁樣行為,抑郁大鼠的腦室旁核的下降也得到了逆轉(zhuǎn)[47]。

針刺干預(yù)抑郁癥腧穴選擇的特定研究相對(duì)來(lái)說(shuō)仍比較少,不同的腧穴對(duì)抑郁癥作用的具體機(jī)制亦不明確。今后的研究對(duì)穴位的選擇也是我們所需要關(guān)注的。

3 思考與展望

抑郁癥的發(fā)病率愈發(fā)提高,其造成的社會(huì)負(fù)擔(dān)不斷加重,研究有效的治療方式已然成為亟待解決的問(wèn)題。作用單一、靶點(diǎn)明確的西藥治療存在不良反應(yīng)較多及易復(fù)發(fā)的弊端,而多層次、多靶點(diǎn)、無(wú)明顯的臨床依賴性的中醫(yī)藥防治手段具有一定的潛力和優(yōu)勢(shì),有望成為重要的治療方式。針刺干預(yù)抑郁的研究在近些年取得了重要進(jìn)展,尤其是近幾年,對(duì)針刺干預(yù)抑郁癥的神經(jīng)遞質(zhì)及其信號(hào)傳導(dǎo)通路、炎癥反應(yīng)和基因方面的研究獲得了許多成果,這對(duì)揭示針刺治療抑郁癥的作用途徑具有重要作用。

由于抑郁癥的發(fā)病機(jī)制尚未完全清楚,針刺干預(yù)抑郁的臨床和機(jī)制研究工作仍受到很多局限。例如臨床試驗(yàn)的樣本量和試驗(yàn)方法等影響因素有待探討,作用穴位與手法效應(yīng)的評(píng)價(jià)較缺乏等?；A(chǔ)研究方面,動(dòng)物實(shí)驗(yàn)的機(jī)制研究相對(duì)單一,多停留在單個(gè)腦區(qū)(如海馬、下丘腦、杏仁核)的定性與定量分析,尚缺乏不同腦區(qū)及神經(jīng)元核團(tuán)間的神經(jīng)聯(lián)系的研究,中樞調(diào)控部位具體定位與靶點(diǎn)遠(yuǎn)未達(dá)成共識(shí)。目前的研究結(jié)果還未出現(xiàn)非常肯定的與針刺效應(yīng)間線性對(duì)應(yīng)的“金指標(biāo)”。其次,由于情志內(nèi)傷病因的長(zhǎng)期性與持續(xù)性,必然導(dǎo)致抑郁癥形成是一個(gè)動(dòng)態(tài)演變過(guò)程。目前多數(shù)研究仍停留在某一階段或節(jié)點(diǎn)的表現(xiàn)和機(jī)制,缺少整體考量。非常有必要研究不同應(yīng)激源、不同強(qiáng)度、不同持續(xù)時(shí)間下針刺效應(yīng)的變化過(guò)程,這對(duì)清晰描述針刺對(duì)抑郁癥的防治效應(yīng)及作用靶點(diǎn)均具有重要意義。

綜上,由于中樞腦機(jī)制本身的復(fù)雜性,抑郁癥的發(fā)病率愈發(fā)增高。因此,針刺干預(yù)抑郁的研究仍有很大空間,在未來(lái)需多結(jié)合先進(jìn)的神經(jīng)生物技術(shù),結(jié)合多學(xué)科、多機(jī)制進(jìn)行研究,用系統(tǒng)的方法開(kāi)展臨床試驗(yàn)。

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Research Advances in the Clinical Assessment of Acupuncture Intervention in Depression and the Central Mechanism

-1,2,1,2,-2,-2.

1.,518033,; 2.,510006,

This article reviews related research literature on acupuncture intervention in depression published in international journals in recent more than 10 years and explore achievements in and the development direction of clinical and mechanism studies on acupuncture treatment for depression. The data show that acupuncture has a definite therapeutic effect and unique advantage in its intervention in depression. In recent years, studies on acupuncture intervention in depression made important progress, especially in the HPA axis, neurotransmitters, signaling pathways, inflammatory reactions and gene expressions. But the specific mechanisms are still unclear. Studies on acupuncture for depression remain to be further improved.

Acupuncture therapy; Electroacupuncture; Depression; Review; Research advance

1005-0957(2019)03-0349-06

R246.6

A

10.13460/j.issn.1005-0957.2019.03.0349

2018-07-20

國(guó)家自然科學(xué)基金項(xiàng)目(81573912);深圳市福田區(qū)公益科技項(xiàng)目(FTW2015003);廣州中醫(yī)藥大學(xué)高水平大學(xué)建設(shè)資助項(xiàng)目(A1-AFD018171Z11032)

余云進(jìn)(1993—),男,2017級(jí)碩士生,Email:616782948@qq.com

史亞飛(1976—),男,研究員,博士生導(dǎo)師,博士,Email:446750173@qq.com