柴胡疏肝散加味治疗脑卒中后焦虑障碍的临床疗效及其对心率变异性的影响
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摘要
目的观察柴胡疏肝散加味治疗脑卒中后焦虑障碍患者临床疗效及其对心率变异性(HRV)的影响。方法根据纳入、排除标准选取2015年9月-2017年2月于湖南中医药大学第二附属医院脑病门诊及住院部诊断为脑卒中后焦虑障碍的患者90例,随机分为中药组(45例)和对照组(45例)。对照组口服氢溴酸西酞普兰片,中药组在对照组基础上加用柴胡疏肝散加味,两组均治疗6周。比较两组治疗前、治疗2周、治疗4周、治疗6周汉密尔顿焦虑量表(HAMA)、精神性焦虑因子、躯体性焦虑因子评分,治疗后临床疗效,治疗前、治疗6周HRV[时域指标:24 h内全部窦性心律(NN)R-R间期标准差(SDNN),24 h内每5 min NN R-R间期平均值标准差(SDANN),24 h内相邻R-R间期差值的均方根(RMSSD),24 h内相邻NN R-R间期差值>50 ms占百分比(PNN50)。频域指标:低频功率(LF),高频功率(HF),LF/HF]。结果治疗方法与时间在HAMA评分及其因子评分上存在交互作用(P<0.05);时间在HAMA评分及其因子评分上主效应显著(P<0.05);治疗方法在HAMA评分、精神性焦虑因子评分上主效应显著(P<0.05);治疗方法在躯体性焦虑因子评分上主效应不显著(P>0.05)。治疗4、6周中药组患者HAMA评分、精神性焦虑因子评分低于对照组(P<0.05)。治疗2、4、6周两组患者HAMA评分、精神性焦虑因子评分低于治疗前(P<0.05),治疗4、6周两组患者躯体性焦虑因子评分低于治疗前(P<0.05)。中药组患者临床疗效优于对照组(P<0.05)。治疗6周,中药组患者SDNN、SDANN、PNN50、HF高于对照组(P<0.05);治疗6周,中药组患者LF、LF/HF低于对照组(P<0.05)。结论柴胡疏肝散加味治疗脑卒中后焦虑障碍疗效确切,可改善HRV。
Objective To investigate the clinical efficacy of modified Chaihushugan powder and its impact on heart rate variability(HRV) among patients with post-stroke anxiety disorders. Methods According to the inclusion and exclusion criteria of this study, we recruited 90 outpatients and inpatients with post-stroke anxiety disorders from Departmentof Encephalopathy, the Second Affiliated Hospital of Hunan University of Chinese Medicine from September 2015 to February 2017 and randomized them into Chinese medicine group(45 patients) receiving oral administration of citalopram hydrobromide combined with modified chaihushugan powder and the control group(45 patients) receiving oral administration of citalopram hydrobromide. Both groups were treated for 6 weeks. Comparisons were made between the groups in the aspects of total score of Hamilton Anxiety Scale(HAMA) and scores of its mental anxiety and somatic anxiety factors before treatment, at 2, 4, 6 weeks after treatment, clinical outcome after treatment, status of HRV[time-domain indicators: SDNN(standard deviation of NN intervals calculated over a 24-hour period), SDANN(standard deviation of the average NN intervals calculated over 5 minutes within a 24-hour period), RMSSD(the root mean square of adjacent R-R interval difference within 24 hours), PNN50(the percentage of adjacent NNR-R interval difference >50 ms within 24 hours); frequency-domain indicators: low frequency(LF), high frequency(HF), LF/HF] before treatment, and at 6 weeks after treatment. Results Treatment method and duration had interaction effect on HAMA total score and its two factors' scores(P<0.05); treatment duration exerted significant main effect on HAMA total score and scores of its two factors(P<0.05); treatment method produced significant main effect on HAMA total score and mental anxiety factor score(P<0.05); but did not produce significant main effect on somatic anxiety factor score(P>0.05). Chinese medicine group demonstrated much lower HAMA total score and mental anxiety factor score both at 4, 6 weeks after treatment compared with the controls(P<0.05). Compared with before treatment, HAMA total score and mental anxiety factor score decreased significantly in both groups at 2, 4, 6 weeks after treatment(P<0.05), while the somatic anxiety factor score only declined substantially in both groups at 4, 6 weeks after treatment(P<0.05). The clinical efficacy of the Chinese medicine group was better than that of the control group(P<0.05). At 6 weeks after treatment, compared with the controls, the SDNN, SDANN, PNN50 and HF were all higher(P<0.05) while LF and LF/HF were lower in the Chinese medicine group(P<0.05). Conclusion Modified Chaihushugan powder showed certain effect on post-stroke anxiety disorders as well as improved the HRV.
Objective To investigate the clinical efficacy of modified Chaihushugan powder and its impact on heart rate variability(HRV) among patients with post-stroke anxiety disorders. Methods According to the inclusion and exclusion criteria of this study, we recruited 90 outpatients and inpatients with post-stroke anxiety disorders from Departmentof Encephalopathy, the Second Affiliated Hospital of Hunan University of Chinese Medicine from September 2015 to February 2017 and randomized them into Chinese medicine group(45 patients) receiving oral administration of citalopram hydrobromide combined with modified chaihushugan powder and the control group(45 patients) receiving oral administration of citalopram hydrobromide. Both groups were treated for 6 weeks. Comparisons were made between the groups in the aspects of total score of Hamilton Anxiety Scale(HAMA) and scores of its mental anxiety and somatic anxiety factors before treatment, at 2, 4, 6 weeks after treatment, clinical outcome after treatment, status of HRV[time-domain indicators: SDNN(standard deviation of NN intervals calculated over a 24-hour period), SDANN(standard deviation of the average NN intervals calculated over 5 minutes within a 24-hour period), RMSSD(the root mean square of adjacent R-R interval difference within 24 hours), PNN50(the percentage of adjacent NNR-R interval difference >50 ms within 24 hours); frequency-domain indicators: low frequency(LF), high frequency(HF), LF/HF] before treatment, and at 6 weeks after treatment. Results Treatment method and duration had interaction effect on HAMA total score and its two factors' scores(P<0.05); treatment duration exerted significant main effect on HAMA total score and scores of its two factors(P<0.05); treatment method produced significant main effect on HAMA total score and mental anxiety factor score(P<0.05); but did not produce significant main effect on somatic anxiety factor score(P>0.05). Chinese medicine group demonstrated much lower HAMA total score and mental anxiety factor score both at 4, 6 weeks after treatment compared with the controls(P<0.05). Compared with before treatment, HAMA total score and mental anxiety factor score decreased significantly in both groups at 2, 4, 6 weeks after treatment(P<0.05), while the somatic anxiety factor score only declined substantially in both groups at 4, 6 weeks after treatment(P<0.05). The clinical efficacy of the Chinese medicine group was better than that of the control group(P<0.05). At 6 weeks after treatment, compared with the controls, the SDNN, SDANN, PNN50 and HF were all higher(P<0.05) while LF and LF/HF were lower in the Chinese medicine group(P<0.05). Conclusion Modified Chaihushugan powder showed certain effect on post-stroke anxiety disorders as well as improved the HRV.
引文
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[12]陈灏珠.关于心率变异性的研究[J].中华内科杂志,1995,34(5):291-292.CHEN H Z.Study on heart rate variability[J].Chinese Journal of Internal Medicine,1995,34(5):291-292.
[13]张亚林,赵靖平,杨德森,等.广泛性焦虑患者单胺递质、神经内分泌及免疫的动态观察[J].中华精神科杂志,2000,33(4):200-202.DOI:10.3760/j:issn:1006-7884.2000.04.002.ZHANG Y L,ZHAO J P,YANG D S,et al.Dynamic observation of monoamine neurotransmitters,neuroendocrine and immunity in patients with generalized anxiety disorder[J].Chinese Journal of Psychiatry,2000,33(4):200-202.DOI:10.3760/j:issn:1006-7884.2000.04.002.
[14]钟意娟,王家同.焦虑症患者心率变异性频谱分析的研究[J].中国行为医学科学,2004,13(3):55-56.DOI:10.3760/cma.j.issn.1674-6554.2004.03.025.ZHONG Y J,WANG J T.A study of power spectral analysis of heart rate variability in anxiety neurosis[J].Chinese Journal of Behavioral Medical Science,2004,13(3):55-56.DOI:10.3760/cma.j.issn.1674-6554.2004.03.025.
[15]张晋碚,黄兴兵,关念红,等.广泛性焦虑症与抑郁症患者免疫、内分泌及单胺递质的对照研究[J].中华精神科杂志,2004,37(4):211-214.DOI:10.3760/j:issn:1006-7884.2004.04.005.ZHANG J B,HUANG X B,GUAN N H,et al.A controlled study of serum immunological,endocrinological and monoamine transmitter levels in patients with generalized anxiety disorder and major depression[J].Chinese Journal of Psychiatry,2004,37(4):211-214.DOI:10.3760/j:issn:1006-7884.2004.04.005.
[16]刘三运,王建明,朱志扬,等.通痹舒心颗粒对ACS伴焦虑抑郁病人hs-CRP、NT-pro BNP及心率变异性的影响[J].中西医结合心脑血管病杂志,2016,14(2):124-128.DOI 10.3969/j.issn.1672-1349.2016.02.005.LIU S Y,WANG J M,ZHU Z Y,et al.Effect of Tongbi Shuxin Granule on hs-CRP,NT-pro BNP and heart rate variability in ACS patients with anxiety and depression[J].Chinese Journal of Integrated Traditional Chinese and Western Medicine for Cardiovascular and Cerebrovascular Diseases,2016,14(2):124-128.DOI:10.3969/j.issn.1672-1349.2016.02.005.
[2]项志清,何艳玲,张明园.世界生物精神病学会联合会(WFSBP)关于焦虑障碍、强迫症和创伤后应激障碍的药物治疗指南[J].中国心理卫生杂志,2003,17(7):485-507.DOI:10.3321/j.issn:1000-6729.2003.07.021.XIANG Z Q,HE Y L,ZHANG M Y.Treatment guidelines for anxiety,obsessive-compulsive and posttraumatic stress disorders of WFSBP(translation)[J].Chinese Journal of Mental Health,2003,17(7):485-507.DOI:10.3321/j.issn:1000-6729.2003.07.021.
[3]饶明俐.中国脑血管病防治指南(试行版)[M].北京:人民卫生出版社,2007.RAO M L.China cerebrovascular disease prevention and treatment guidelines:the trial edition[M].Beijing:People's Medical Publishing House,2007.
[4]陈方彦.CCMD-3中国精神障碍分类与诊断标准[M].济南:山东科学技术出版社,2001.CHEN F Y.CCMD-3 classification and diagnostic criteria of mental disorders in China[M].Jinan:Shandong Science and Technology Press,2001.
[5]国家中医药管理局.中医病症诊断疗效标准[M].南京:南京大学出版社,1994.
[6]张长青,方向华,刘宏军,等.首发脑梗死患者卒中后抑郁与卒中部位的关系[J].中国神经精神疾病杂志,2009,35(3):148-151.DOI:10.3969/j.issn.1002-0152.2009.03.006.ZHANG C Q,FANG X H,LIU H J,et al.The relationship between poststroke depression and stroke lesions[J].Chinese Journal of Neuropsychiatric Diseases,2009,35(3):148-151.DOI:10.3969/j.issn.1002-0152.2009.03.006.
[7]FORD C E,MALLEY D,BATEMAN A,et al.Selection and visualisation of outcome measures for complex post-acute acquired brain injury rehabilitation interventions[J].Neuro Rehabilitation,2016,39(1):65-79.DOI:10.3233/NRE-161339.
[8]SCH?TTKE H,GIABBICONI C M.Post-stroke depression and poststroke anxiety:prevalence and predictors[J].Int Psychogeriatr,2015,27(11):1805-1812.DOI:10.1017/S1041610215000988.
[9]CHUN H Y,WHITELEY W N,CARSON A,et al.Anxiety after stroke:time for an intervention[J].Int J Stroke,2015,10(5):655-656.DOI:10.1111/ijs.12493.
[10]BALDWIN D S,ANDERSON I M,NUTT D J,et al.Evidencebased guidelines for the pharmacological treatment of anxiety disorders:recommendations from the British Association for Psychopharmacology[J].J Psychopharmacol,2005,19(6):567-596.DOI:10.1177/0269881105059253.
[11]FRUEHWALD S,GATTERBAUER E,REHAK P,et al.Early fluoxetine treatment of post-stroke depression--a three-month double-blind placebo-controlled study with an open-label longterm follow up[J].J Neurol,2003,250(3):347-351.DOI:10.1007/s0041500310143.
[12]陈灏珠.关于心率变异性的研究[J].中华内科杂志,1995,34(5):291-292.CHEN H Z.Study on heart rate variability[J].Chinese Journal of Internal Medicine,1995,34(5):291-292.
[13]张亚林,赵靖平,杨德森,等.广泛性焦虑患者单胺递质、神经内分泌及免疫的动态观察[J].中华精神科杂志,2000,33(4):200-202.DOI:10.3760/j:issn:1006-7884.2000.04.002.ZHANG Y L,ZHAO J P,YANG D S,et al.Dynamic observation of monoamine neurotransmitters,neuroendocrine and immunity in patients with generalized anxiety disorder[J].Chinese Journal of Psychiatry,2000,33(4):200-202.DOI:10.3760/j:issn:1006-7884.2000.04.002.
[14]钟意娟,王家同.焦虑症患者心率变异性频谱分析的研究[J].中国行为医学科学,2004,13(3):55-56.DOI:10.3760/cma.j.issn.1674-6554.2004.03.025.ZHONG Y J,WANG J T.A study of power spectral analysis of heart rate variability in anxiety neurosis[J].Chinese Journal of Behavioral Medical Science,2004,13(3):55-56.DOI:10.3760/cma.j.issn.1674-6554.2004.03.025.
[15]张晋碚,黄兴兵,关念红,等.广泛性焦虑症与抑郁症患者免疫、内分泌及单胺递质的对照研究[J].中华精神科杂志,2004,37(4):211-214.DOI:10.3760/j:issn:1006-7884.2004.04.005.ZHANG J B,HUANG X B,GUAN N H,et al.A controlled study of serum immunological,endocrinological and monoamine transmitter levels in patients with generalized anxiety disorder and major depression[J].Chinese Journal of Psychiatry,2004,37(4):211-214.DOI:10.3760/j:issn:1006-7884.2004.04.005.
[16]刘三运,王建明,朱志扬,等.通痹舒心颗粒对ACS伴焦虑抑郁病人hs-CRP、NT-pro BNP及心率变异性的影响[J].中西医结合心脑血管病杂志,2016,14(2):124-128.DOI 10.3969/j.issn.1672-1349.2016.02.005.LIU S Y,WANG J M,ZHU Z Y,et al.Effect of Tongbi Shuxin Granule on hs-CRP,NT-pro BNP and heart rate variability in ACS patients with anxiety and depression[J].Chinese Journal of Integrated Traditional Chinese and Western Medicine for Cardiovascular and Cerebrovascular Diseases,2016,14(2):124-128.DOI:10.3969/j.issn.1672-1349.2016.02.005.