止颤汤合柴胡加龙骨牡蛎汤治疗帕金森病抑郁的临床观察
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摘要
目的:观察止颤汤合柴胡加龙骨牡蛎汤对帕金森病(PD)抑郁患者的临床疗效。方法:选择肝肾阴虚兼肝气郁结型PD伴抑郁患者76例,随机分为治疗组38例和对照组38例。两组患者均接受抗帕金森病西医常规治疗,对照组患者加服止颤汤,治疗组患者加服止颤汤合柴胡加龙骨牡蛎汤,两组治疗周期均为12周。比较两组患者的中医证候疗效及治疗前后的中医证候积分;于治疗前及治疗4周、8周、12周后,采用蒙哥马利抑郁量表(MADRS)、汉密尔顿抑郁量表(HAMD)评价患者的抑郁程度,采用统一帕金森病综合量表(UPDRS)评价两组患者的临床疗效。结果:治疗后,治疗组的中医证候疗效总有效率为88.89%,对照组为75.76%,治疗组的疗效优于对照组(P<0.05);两组患者的中医证候积分均显著降低(P<0.01),且治疗组患者的积分低于对照组(P<0.01)。治疗4周、8周、12周后,两组患者的MADRS、HAMD评分均显著降低(P<0.05,P<0.01),且治疗组患者的评分均明显低于对照组(P<0.05,P<0.01)。治疗前后,两组患者的UPDRS评分比较,差异均无统计学意义(P>0.05)。结论:止颤汤合柴胡加龙骨牡蛎汤治疗肝肾阴虚兼肝气郁结型PD伴抑郁患者具有较好的疗效,可明显改善患者的抑郁状态。
Objective: To observe the clinical efficacy of Zhichan Decoction combined with Chaihu Plus Longgu Muli Decoction in the treatment of Parkinson's disease(PD) with depression. Methods: Seventy-six PD patients with depression of liver-kidney yin deficiency and liver-qi stagnation type were selected and randomly divided into the treatment group(38 cases) and the control group(38 cases). The patients in both groups were treated with conventional anti-Parkinson therapy of western medicine. On the basis of above treatment,the patients in the control group were orally treated with Zhichan Decoction,and the patients in the treatment group were orally treated with Zhichan Decoction combined with Chaihu Plus Longgu Muli Decoction,with a course of 12 weeks. The efficacy of Chinese medical syndrome and the score of Chinese medical syndrome before and after treatment were compared between the two groups. Before treatment and 4 weeks,8 weeks,12 weeks after treatment,the degree of depression was evaluated by Montgomery-Asberg depression rating scale( MADRS) and Hamilton depression scale( HAMD),and the clinical efficacy was evaluated by unified Parkinson's disease rating scale( UPDRS). Results: After treatment,the total effective rate on Chinese medical syndrome in the treatment group was 88.89%,and that in the control group was 75. 76%. The efficacy of the treatment group was better than that of the control group( P<0.05). After treatment,the score of Chinese medical syndrome was significantly decreased in the two groups( P<0.01),and the score in the treatment group was lower than that in the control group( P<0.01). After 4-,8-and 12-week treatment,the scores of MADRS and HAMD were significantly decreased in the two groups( P<0.05,P<0.01),and the scores in the treatment group were significantly lower than those in the control group( P<0.05,P<0.01). Before and after treatment,there was no statistically significant difference on the UPDRS score between the two groups( P>0.05). Conclusion: Zhichan Decoction combined with Chaihu Plus Longgu Muli Decoction shows good efficacy on PD patients with depression of liver-kidney yin deficiency and liver-qi stagnation type,and can significantly improve the depression of patients.
Objective: To observe the clinical efficacy of Zhichan Decoction combined with Chaihu Plus Longgu Muli Decoction in the treatment of Parkinson's disease(PD) with depression. Methods: Seventy-six PD patients with depression of liver-kidney yin deficiency and liver-qi stagnation type were selected and randomly divided into the treatment group(38 cases) and the control group(38 cases). The patients in both groups were treated with conventional anti-Parkinson therapy of western medicine. On the basis of above treatment,the patients in the control group were orally treated with Zhichan Decoction,and the patients in the treatment group were orally treated with Zhichan Decoction combined with Chaihu Plus Longgu Muli Decoction,with a course of 12 weeks. The efficacy of Chinese medical syndrome and the score of Chinese medical syndrome before and after treatment were compared between the two groups. Before treatment and 4 weeks,8 weeks,12 weeks after treatment,the degree of depression was evaluated by Montgomery-Asberg depression rating scale( MADRS) and Hamilton depression scale( HAMD),and the clinical efficacy was evaluated by unified Parkinson's disease rating scale( UPDRS). Results: After treatment,the total effective rate on Chinese medical syndrome in the treatment group was 88.89%,and that in the control group was 75. 76%. The efficacy of the treatment group was better than that of the control group( P<0.05). After treatment,the score of Chinese medical syndrome was significantly decreased in the two groups( P<0.01),and the score in the treatment group was lower than that in the control group( P<0.01). After 4-,8-and 12-week treatment,the scores of MADRS and HAMD were significantly decreased in the two groups( P<0.05,P<0.01),and the scores in the treatment group were significantly lower than those in the control group( P<0.05,P<0.01). Before and after treatment,there was no statistically significant difference on the UPDRS score between the two groups( P>0.05). Conclusion: Zhichan Decoction combined with Chaihu Plus Longgu Muli Decoction shows good efficacy on PD patients with depression of liver-kidney yin deficiency and liver-qi stagnation type,and can significantly improve the depression of patients.
引文
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[2] HUGHES A J,DANIEL S E,KILFORD L,et al. Accuracy of clinical diagnosis of Parkison’s disease:a clinico- pathological study of 100 cases[J].J Neurol Neurosurg Psychiatry,1992,55(3):181- 184.
[3] WERMUTH L,BECH P. Depression in Parkinson’s disease—a review[J].Acta Neurol Scand,2006,114(5):360.
[4] 李文涛,李如奎. 加味止颤汤治疗帕金森病42例[J].陕西中医,2012,33(5):549- 551.
[5] 蔡丽,刘毅,李文涛. 止颤汤联合西药治疗帕金森病43例随机双盲对照研究[J].江苏中医药,2017,49(11):33- 35.
[6] 张莺,沈叶静,胡炜,等. 角调音乐疗法结合柴胡加龙骨牡蛎汤加减治疗气郁质失眠48例临床观察[J].中医杂志,2017,58(18):1577- 1580.
[7] 吴雪丽,李贻奎. 柴胡加龙骨牡蛎汤加减治疗长期依赖西药助眠患者1例[J].中医杂志,2016,57(22):1976- 1977.
[8] 王雅君,李国宏. 柴胡加龙骨牡蛎汤加减辨治脑卒中后抑郁[J].吉林中医药,2017,37(5):466- 468.
[9] 美国精神科学会. DSM- IV分类与诊断标准[S].庞天鉴,译. 西安:杨森科学研究委员会中国分会,2001:28- 31.
[10] 陈湘君. 中医内科学[M].上海:上海科学技术出版社,2007.
[11] HOEHN M M,YAHR M D. Parkinsonism:onset,progression,and mortality[J].Neurology,1967,57(Suppl 3):S11- S26.
[12] 郑筱萸. 中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002.
[13] 王永炎,鲁兆麟. 中医内科学[M].北京:人民卫生出版社,1999.