解郁通络法对脑卒中后抑郁患者神经递质水平的影响
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摘要
目的:观察解郁通络法治疗卒中后抑郁(PSD)患者的临床疗效及对神经递质的调节作用。方法:共选择125例符合要求的PSD患者作为研究对象,采用SAS软件,按随机数字表法分为观察组63例和对照组62例。两组患者均口服盐酸舍曲林片,25～50 mg/次,2次/d。对照组口服舒肝解郁胶囊,2粒/次,2次/d;观察组内服解郁通络汤,1剂/d。两组疗程均为连续治疗6周。进行治疗前后汉密尔顿抑郁量表-17(HAMD-17),患者健康问卷-9项(PHQ-9),美国国立卫生研究院卒中量表(NHISS),中医证候评分和日常生活活动能力量表(ADL)评分,检测治疗前后5-羟色胺(5-HT),去甲肾上腺素(NE),多巴胺(DA)脑源性神经营养因子(BDNF),血清S100-β蛋白(S100-β)和神经元烯醇化酶(NSE)水平。结果:观察组临床疗效优于对照组(Z=2. 384,P <0. 01);观察组患者HAMD-17和PHQ-9评分均低于对照组(P <0. 01);观察组HAMD-17评分情况轻于对照组(Z=2. 266,P <0. 05),观察组PHQ-9评分情况轻于对照组(Z=2. 817,P <0. 01);观察组患者的NHISS,中医证候评分均低于对照组(P <0. 01),ADL评分高于对照组(P <0. 01);观察组血清5-HT,DA和NE水平均高于对照组(P <0. 01);观察组血清S100-β和NSE水平均低于对照组(P <0. 01),BDNF水平高于对照组(P <0. 01)。结论:在心理治疗和SSRI治疗的基础上,给予PSD患者服用解郁通络汤,可进一步的减轻患者抑郁程度,缓解抑郁症状,还能减轻神经功能缺损程度和提高日常生活活动能力,调节神经递质表达,促进了脑神经组织的修复,临床可取的一定疗效。
Objective: To observe the clinical efficacy of Jieyu Tongluo decoction on post-stroke depression( PSD) and its regulatory effect on neurotransmitter. Method: One hundred and twenty-five patients with PSD were randomly divided into control group( 62 cases) and observation group( 63 cases) by random number table. Both groups got psychological support,health education,and sertraline hydrochloride tablets,25-50 mg/time,2 times/days. Patients in control group got Shugan Jieyu capsules,2 grains/time,2 times/days.Patients in observation group got Jieyu Tongluo decoction,1 dose/day. And a course of treatment was 6 weeks.Before and after treatment,hamilton depression scale( HAMD-17),patient health questionnaire-9( PHQ-9),national institutes of health stroke scale( NHISS),traditional Chinese medicine( TCM) syndrome and activity of daily living scale( ADL) were scored. And levels of 5-serotonin( 5-HT),norepinephrine( NE),dopamine( DA),brain-derived neurotrophic factor( BDNF),serum S100-β and neuron enolase( NES) were detected.Result: By rank sum test,after treatment,the clinical efficacy of observation group was superior to that in control group( Z = 2. 384,P < 0. 01). Scores of HAMD-17 and PHQ-9 were lower than those in control group( P <0. 01). Score of HAMD-17 was lower than that in control group( Z = 2. 266,P < 0. 05),and score of PHQ-9 was lower than that in control group( Z = 2. 817,P < 0. 05). And scores of NHISS,TCM syndromes,serum S100 βand neuron enolase( NES) were lower than those in control group( P < 0. 01),while levels of ADL,5-HT,DA,NE and BDNF were all higher than those in control group( P < 0. 01). Conclusion: In addition to psychotherapy and SSRI,Jieyu Tongluo decoction can relieve degree of depression,depressive symptoms and degree of neurologic impairment,increase activities of daily living,regulate neurotransmitter expression,and improve the reparation of cranial nerve tissue,with obvious clinical effects,and is worthy to be used in clinic.
Objective: To observe the clinical efficacy of Jieyu Tongluo decoction on post-stroke depression( PSD) and its regulatory effect on neurotransmitter. Method: One hundred and twenty-five patients with PSD were randomly divided into control group( 62 cases) and observation group( 63 cases) by random number table. Both groups got psychological support,health education,and sertraline hydrochloride tablets,25-50 mg/time,2 times/days. Patients in control group got Shugan Jieyu capsules,2 grains/time,2 times/days.Patients in observation group got Jieyu Tongluo decoction,1 dose/day. And a course of treatment was 6 weeks.Before and after treatment,hamilton depression scale( HAMD-17),patient health questionnaire-9( PHQ-9),national institutes of health stroke scale( NHISS),traditional Chinese medicine( TCM) syndrome and activity of daily living scale( ADL) were scored. And levels of 5-serotonin( 5-HT),norepinephrine( NE),dopamine( DA),brain-derived neurotrophic factor( BDNF),serum S100-β and neuron enolase( NES) were detected.Result: By rank sum test,after treatment,the clinical efficacy of observation group was superior to that in control group( Z = 2. 384,P < 0. 01). Scores of HAMD-17 and PHQ-9 were lower than those in control group( P <0. 01). Score of HAMD-17 was lower than that in control group( Z = 2. 266,P < 0. 05),and score of PHQ-9 was lower than that in control group( Z = 2. 817,P < 0. 05). And scores of NHISS,TCM syndromes,serum S100 βand neuron enolase( NES) were lower than those in control group( P < 0. 01),while levels of ADL,5-HT,DA,NE and BDNF were all higher than those in control group( P < 0. 01). Conclusion: In addition to psychotherapy and SSRI,Jieyu Tongluo decoction can relieve degree of depression,depressive symptoms and degree of neurologic impairment,increase activities of daily living,regulate neurotransmitter expression,and improve the reparation of cranial nerve tissue,with obvious clinical effects,and is worthy to be used in clinic.
引文
[1]中国医师协会神经内科医师分会神经心理与情感障碍专业委员会.卒中后抑郁临床实践的中国专家共识[J].中国卒中杂志,2016,11(8):685-693.
[2]李莹,李光校.中国脑卒中患者抑郁患病率meta分析[J].中国公共卫生,2015,31(7):968-972.
[3]朱天碧,姜懿纳,陈乃宏.卒中后抑郁的相关研究进展[J].中药新药与临床药理,2016,27(5):731-735.
[4]王慧慧,张百霞,叶小彤,等.基于“中药作用机理辅助解析系统”的四逆散抗抑郁作用机制研究[J].中国中药杂志,2015,40(19):3723-3728.
[5]唐汉平,任浩,杨良锋.疏肝活血法治疗卒中后抑郁症临床观察[J].中国中医急症,2011,20(3):356-356.
[6]李庆丽,王贵贤,王艳捷,等.解郁通络方对脑卒中后抑郁神经免疫炎症指标的影响[J].中国实验方剂学杂志,2018,24(6):204-209.
[7] Murakami T, Hama S, Yamashita H, et al.Neuroanatomic pathways associated with poststroke affective and apathetic depression[J]. Am J Geriatr Psychiatry,2013,21(9):840-847.
[8]王丽.天麻素片联合盐酸帕罗西汀对老年脑卒中后焦虑抑郁患者血清BDNF,IGF-1浓度的影响[J].中国老年学杂志,2017,37(21):5403-5405.
[9]尚文鹏,孙晓路.右佐匹克隆联合舍曲林治疗脑梗死后抑郁的临床疗效及对血清S100β和脑源性神经营养因子的影响[J].中国临床研究,2016,29(10):1359-1361.
[10]中华中医药学会.中医内科常见病诊疗指南·中医病症部分[M].北京:中国中医药出版社,2008:144-149.
[11]全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383.
[12]李奎成,唐丹,刘晓艳,等.国内Barthel指数和改良Barthel指数应用的回顾性研究[J].中国康复医学杂志,2009,24(8):737-740.
[13]张明圆.精神科评定量表手册[M]. 2版.长沙:湖南科学技术出版社,1998:35-39.
[14]郑培,薛蓉.脑卒中患者并发抑郁的临床研究进展[J].国际神经病学神经外科学杂志,2017,44(4):420-423.
[15] Loubinoux I,Kronenberg G,Endres M,et al. Poststroke depression:mechanisms,translation and therapy[J]. J Cell Mol Med,2012,16(9):1961-1969.
[16] JI X W, WU C L, WANG X, et al. Monoamine neurotransmitters and fibroblast growth factor-2 in the brains of rats with post-stroke depression[J]. Exp Ther Med,2014,8(1):159-164.
[17]何浪,邵宏元.脑卒中后抑郁与病灶部位相关性研究进展[J].中华老年心脑血管病杂志,2016,18(10):1115-1117.
[18]张国平,王莉莉,王海燕.脑卒中后抑郁与神经功能缺损关系研究[J].中国现代神经疾病杂志,2016,16(5):271-274.
[19]史宇,杨冬冬,黄国志,等.卒中后抑郁发病机制及相关影响因素[J].实用医学杂志,2016,32(6):867-869.
[20]赵美英,王润青,刘威,等.血清瘦素,NSE及S100-β水平与卒中后抑郁关系的前瞻性巢式病例对照研究[J].解放军医学杂志,2015,40(3):226-230.
[21]林于雄,吴松鹰,林菊珊.卒中后抑郁中医易患因素的Logistic多元回归分析[J].福建中医药,2017,48(6):40-41.
[2]李莹,李光校.中国脑卒中患者抑郁患病率meta分析[J].中国公共卫生,2015,31(7):968-972.
[3]朱天碧,姜懿纳,陈乃宏.卒中后抑郁的相关研究进展[J].中药新药与临床药理,2016,27(5):731-735.
[4]王慧慧,张百霞,叶小彤,等.基于“中药作用机理辅助解析系统”的四逆散抗抑郁作用机制研究[J].中国中药杂志,2015,40(19):3723-3728.
[5]唐汉平,任浩,杨良锋.疏肝活血法治疗卒中后抑郁症临床观察[J].中国中医急症,2011,20(3):356-356.
[6]李庆丽,王贵贤,王艳捷,等.解郁通络方对脑卒中后抑郁神经免疫炎症指标的影响[J].中国实验方剂学杂志,2018,24(6):204-209.
[7] Murakami T, Hama S, Yamashita H, et al.Neuroanatomic pathways associated with poststroke affective and apathetic depression[J]. Am J Geriatr Psychiatry,2013,21(9):840-847.
[8]王丽.天麻素片联合盐酸帕罗西汀对老年脑卒中后焦虑抑郁患者血清BDNF,IGF-1浓度的影响[J].中国老年学杂志,2017,37(21):5403-5405.
[9]尚文鹏,孙晓路.右佐匹克隆联合舍曲林治疗脑梗死后抑郁的临床疗效及对血清S100β和脑源性神经营养因子的影响[J].中国临床研究,2016,29(10):1359-1361.
[10]中华中医药学会.中医内科常见病诊疗指南·中医病症部分[M].北京:中国中医药出版社,2008:144-149.
[11]全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383.
[12]李奎成,唐丹,刘晓艳,等.国内Barthel指数和改良Barthel指数应用的回顾性研究[J].中国康复医学杂志,2009,24(8):737-740.
[13]张明圆.精神科评定量表手册[M]. 2版.长沙:湖南科学技术出版社,1998:35-39.
[14]郑培,薛蓉.脑卒中患者并发抑郁的临床研究进展[J].国际神经病学神经外科学杂志,2017,44(4):420-423.
[15] Loubinoux I,Kronenberg G,Endres M,et al. Poststroke depression:mechanisms,translation and therapy[J]. J Cell Mol Med,2012,16(9):1961-1969.
[16] JI X W, WU C L, WANG X, et al. Monoamine neurotransmitters and fibroblast growth factor-2 in the brains of rats with post-stroke depression[J]. Exp Ther Med,2014,8(1):159-164.
[17]何浪,邵宏元.脑卒中后抑郁与病灶部位相关性研究进展[J].中华老年心脑血管病杂志,2016,18(10):1115-1117.
[18]张国平,王莉莉,王海燕.脑卒中后抑郁与神经功能缺损关系研究[J].中国现代神经疾病杂志,2016,16(5):271-274.
[19]史宇,杨冬冬,黄国志,等.卒中后抑郁发病机制及相关影响因素[J].实用医学杂志,2016,32(6):867-869.
[20]赵美英,王润青,刘威,等.血清瘦素,NSE及S100-β水平与卒中后抑郁关系的前瞻性巢式病例对照研究[J].解放军医学杂志,2015,40(3):226-230.
[21]林于雄,吴松鹰,林菊珊.卒中后抑郁中医易患因素的Logistic多元回归分析[J].福建中医药,2017,48(6):40-41.
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