摘要
目的:观察疏肝散郁法(丹栀逍遥散加减)治疗卒中后抑郁(PSD)患者的临床疗效,并对其作用机制进行探讨。方法:选择PSD患者148例,随机分为观察组与对照组各74例,对照组口服草酸艾司西酞普兰10 mg·d^-1,观察组在对照组的基础上加用丹栀消遥散加减3 g/次,2次/日。4周为1个疗程。比较两组患者汉密尔顿抑郁量表(HAMD)评分,神经递质功率,5-羟色胺(5-HT),去甲肾上腺素(NE)水平以及炎症因子水平的变化。结果:观察组临床疗效明显优于对照组(Z=2. 97,P<0. 05),且总有效率明显高于对照组(87. 84%,74. 32%,χ^2=4. 40,P<0. 05)。两组患者HAMD评分均随治疗时间的推移而下降(P<0. 05),观察组HAMD评分整体水平明显低于对照组(P<0. 05)。脑涨落图仪测定两组患者6种神经递质的功率均随治疗时间延长而升高(P<0. 05),观察组6种神经递质功率升高幅度均明显大于对照组(P<0. 05),观察组6种神经递质功率整体水平及升高幅度均明显高于对照组(P<0. 05)。两组患者5-HT和NE水平均随治疗时间延长而升高(P<0. 05),观察组5-HT和NE整体水平及升高幅度明显高于对照组(P<0. 05)。两组患者肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β),白细胞介素-6(IL-6)水平均随治疗时间延长而下降(P<0. 05),观察组TNF-α,IL-1β,IL-6整体水平及下降幅度明显低于对照组(P<0. 05)。结论:在应用传统抗抑郁药物的同时,加用丹栀逍遥散加减治疗PSD,疗效更明显,其作用机制可能与其抑制炎症因子表达有关,需要进一步深入地研究。
Objective: To observe the clinical efficiency of the liver soothing method( modified Danzhi Xiaoyaosan) in the treatment of post-stroke depression( PSD),and explore its mechanism. Method: A total of148 patients with PSD were randomly divided into study group and control group,with 74 cases in each group.Control group received Escitalopram Oxalate,10 mg·d^-1. Study group received Shugan granule 3 g,twice a day,in addition to the therapy of control group. One course of treatment of 4 weeks. Hamilton depression scale( HAMD) score, neurotransmitter power, 5-hydroxytryptamine( 5-HT), noradrenalin( NE) levels and inflammatory factors were compared between the two groups. Result: The clinical efficacy of study group was significantly better than that of control group( Z = 2. 97,P< 0. 05),and the total effective rate in study group was significantly higher than that of control group( 87. 84%,74. 32%,χ^2= 4. 40,P< 0. 05). HAMD scores in both groups decreased in the process of treatment( P< 0. 05). HAMD score in study group was reduced more significantly than that in control group( P< 0. 05). The overall levels of HAMD score in study group was significantly lower than that in control group( P< 0. 05). The power and overall levels of 6 kinds of neurotransmitters in both group were increased in the process of treatment( P< 0. 05). The power of 6 kinds of neurotransmitters in study group were increased more significantly than that in control group( P< 0. 05). The levels of 5-HT and NE in both groups increased in the process of treatment( P< 0. 05). The overall levels of 5-HT and NE in study group were significantly higher than those in control group( P< 0. 05). Tumor necrosis factor-α( TNF-α),interleukin-1 beta( IL-1β) and interleukin-6( IL-6) levels in both groups decreased in the process of treatment( P< 0. 05). TNF-α,IL-1β and IL-6 levels in study group were decreased more significantly than those in control group( P< 0. 05). Conclusion: Modified Danzhi Xiaoyaosan combined with traditional antidepressants has a more significant curative effect in the treatment of PSD. The mechanism may be related to the inhibition of the expressions of inflammatory factors. Further studies shall be conducted.
作者
江利敏
刘向哲
JIANG Li-min;LIU Xiang-zhe(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2019年第3期108-113,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家中医药行业科研专项(201507001-12)
关键词
丹栀逍遥散加减
疏肝散郁法
卒中后抑郁
神经递质
炎症因子
作用机制
modified Danzhi Xiaoyaosan
liver soothing method
post-stroke depression
neurotransmitter
inflammatory factor
mechanism
作者简介
第一作者:江利敏,硕士,副主任医师,从事脑血管病及神经心理方面的研究,E—mail:jlmay2004@126.com;通信作者:刘向哲,博士,教授,主任医师,研究生导师,从事脑血管病防治研究,E-mail:liuxiangzhe@163.com.
