柴胡疏肝汤对肝气郁结型卒中后抑郁患者疗效及血清神经递质、神经功能恢复的影响
|
摘要
目的:研究柴胡疏肝汤加减对肝气郁结型卒中后抑郁患者疗效及血清神经递质、神经功能恢复的影响。方法:选取符合纳入标准的肝气郁结型卒中后抑郁患者,随机分为对照组和观察组,每组40例。对照组给予艾司西酞普兰治疗,观察组给予艾司西酞普兰联合柴胡疏肝汤治疗,疗程为4周。评价患者治疗前后抑郁程度(HAMD评分)、神经功能缺损程度(NIHSS评分)、日常生活能力(MBI评分)和中医症候评分,检测脑源性神经营养因子(BDNF)含量、5-羟色胺(5-HT)和去甲肾上腺素(NE)含量,评价临床疗效。结果:治疗后,观察组HAMD评分、NIHSS评分低于对照组,MBI评分高于对照组(P <0. 05);观察组血清BDNF、5-HT和NE含量均高于对照组(P <0. 05),观察组中医症候评分低于对照组(P <0. 05);观察组总有效率高于对照组(P <0. 05)。结论:柴胡疏肝汤治疗肝气郁结型卒中后抑郁,疗效确切,能够显著改善患者抑郁症状,促进神经功能恢复,提高生活质量,其机制可能与上调血清BDNF、5-HT和NE水平有关。
Objective: To study the effect of modified Chaihu Shugan Decoction on post-stroke depression with liver-qi stagnation and its effect on serum neurotransmitter and nerve function recovery. Methods: 80 cases of post-stroke depression with liver-qi stagnation were randomly divided into the control group( n = 40) and the observation group( n = 40). The control group was treated with Escitalopram; on which basis,the observation group was also treated with modified Chaihu Shugan Decoction. The treatment course was 4 weeks. The degree of depression( HAMD score),the degree of nerve function defect( NIHSS score),daily living ability( MBI score) and TCM syndrome integral were evaluated before and after the treatment. The contents of brain derived neurotrophic factor( BDNF),5-serotonin( 5-HT) and norepinephrine( NE) were measured and the curative effect was evaluated. Results: After the treatment,HAMD score and NIHSS score were lower,and MBI score was higher in the observation group than those in the control group( P < 0. 05). The serum levels of BDNF,5-HT,and NE were higher in the observation group than those in the control group( P < 0. 05). The TCM syndrome integral was lower in the observation group than that in the control group( P < 0. 05). The total effective rate was higher in the observation group than that in the control group( P < 0. 05). Conclusion:Modified Chaihu Shugan Decoction is effective for post-stroke depression with liver-qi stagnation. It can significantly improve the depressive symptoms,promote the recovery of nerve function and improve the quality of life,which may be related to the up-regulation of serum levels of BDNF,5-HT,and NE.
Objective: To study the effect of modified Chaihu Shugan Decoction on post-stroke depression with liver-qi stagnation and its effect on serum neurotransmitter and nerve function recovery. Methods: 80 cases of post-stroke depression with liver-qi stagnation were randomly divided into the control group( n = 40) and the observation group( n = 40). The control group was treated with Escitalopram; on which basis,the observation group was also treated with modified Chaihu Shugan Decoction. The treatment course was 4 weeks. The degree of depression( HAMD score),the degree of nerve function defect( NIHSS score),daily living ability( MBI score) and TCM syndrome integral were evaluated before and after the treatment. The contents of brain derived neurotrophic factor( BDNF),5-serotonin( 5-HT) and norepinephrine( NE) were measured and the curative effect was evaluated. Results: After the treatment,HAMD score and NIHSS score were lower,and MBI score was higher in the observation group than those in the control group( P < 0. 05). The serum levels of BDNF,5-HT,and NE were higher in the observation group than those in the control group( P < 0. 05). The TCM syndrome integral was lower in the observation group than that in the control group( P < 0. 05). The total effective rate was higher in the observation group than that in the control group( P < 0. 05). Conclusion:Modified Chaihu Shugan Decoction is effective for post-stroke depression with liver-qi stagnation. It can significantly improve the depressive symptoms,promote the recovery of nerve function and improve the quality of life,which may be related to the up-regulation of serum levels of BDNF,5-HT,and NE.
引文
[1]姚杰,刘晓林,桂中豪.脑卒中后抑郁的病因机制及相关治疗的研究进展[J].医学综述,2018,24(4):728-731.
[2] ZHANG Y,JIANG H,YUE Y,et al. The protein and mRNA expression levels of glial cell line-derived neurotophic factor in past stroke depression and major depression disorder[J]. Sci Rep,2017,7(1):8674.
[3]胡会婷,王敏忠.艾司西酞普兰治疗脑卒中后抑郁及对患者神经功能认知功能的影响[J].河北医学,2018,24(2):325-328.
[4]江国华,朴泉宇,符昱.养血清脑颗粒联合氟西汀治疗老年脑卒中后抑郁患者的疗效及对神经功能缺损程度的影响[J].中国老年学杂志,2018,38(3):522-524.
[5]庄丽华,詹松华,孔营楠.基于肝主疏泄理论的中风后抑郁中医康复治疗研究进展[J].中西医结合心脑血管病杂志,2018,16(2):179-182.
[6]中华神经科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):279.
[7]中华医学会精神分会.中国精神障碍分类与诊断标准(CCMD-3)[M].济南:山东科学技术出版社,2001:60.
[8]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[M].北京中医药大学学报,1996,19(1):55-56.
[9]毕晓莹.神经内科疾病的精神心理障碍[M].上海:科学技术出版社,2015:2-3.
[10]郝伟,于欣.精神病学[M]. 7版.北京:人民卫生出版社,2011:115-116.
[11]王拥军.神经病学临床评定量表[M].北京:中国友谊出版公司,2005:14.
[12] NABAVI S F,DEAN O M,TURNER A,et al. Oxidative stress and poststroke depression possible therapeutic role of polyphenols?[J]. Curr Med Chem,2015,22:343-351.
[13]梁迪赛.加味四逆散联合音乐疗法对脑卒中后合并抑郁症状患者的情感和肢体运动障碍的疗效观察[J].世界中西医结合杂志,2016,11(8):1053-1056.
[14]舒建中,唐军,李陈瑜,等.解郁安神颗粒合盐酸帕罗西汀片治疗缺血性脑中风后抑郁症的临床分析[J].中国实验方剂学杂志,2016,22(13):177-181.
[15]陈小敏,周小莉,丁砚兵.柴胡疏肝散联合低频重复经颅磁刺激治疗脑卒中后抑郁临床观察[J].湖北中医杂志,2017,39(10):23-24.
[16]齐艳红,刘苹.黛力新对脑卒中后抑郁患者临床症状及神经递质的影响[J].贵阳中医学院学报,2015,37(3):49-52.
[17]刘文,姜爱钟,林福军.氟哌噻吨美利曲辛片与多塞平治疗脑卒中后抑郁的临床疗效及对神经介质水平的影响[J].中西医结合心脑血管病杂志,2017,15(24):3201-3203.
[18]刘德芳,邓燕春,梁汝沛,等.养血清脑饮协定方联合盐酸帕罗西汀片治疗老年脑卒中后抑郁的临床效果及对血清5-HT、IL-1、Hcy水平的影响[J].陕西中医,2018,39(1):47-49.
[19]周荣,吴志敏,胡万华.柴胡疏肝散联合西药预防脑卒中后抑郁30例临床观察[J].江苏中医药,2017,49(11):36-38.
[20]王冠超,肖伟,章显宝,等.通督治郁针法对脑卒中后抑郁患者血清5-HT,NE和BDNF水平影响的研究[J].甘肃中医学院学报,2015,32(2):58-62.
[2] ZHANG Y,JIANG H,YUE Y,et al. The protein and mRNA expression levels of glial cell line-derived neurotophic factor in past stroke depression and major depression disorder[J]. Sci Rep,2017,7(1):8674.
[3]胡会婷,王敏忠.艾司西酞普兰治疗脑卒中后抑郁及对患者神经功能认知功能的影响[J].河北医学,2018,24(2):325-328.
[4]江国华,朴泉宇,符昱.养血清脑颗粒联合氟西汀治疗老年脑卒中后抑郁患者的疗效及对神经功能缺损程度的影响[J].中国老年学杂志,2018,38(3):522-524.
[5]庄丽华,詹松华,孔营楠.基于肝主疏泄理论的中风后抑郁中医康复治疗研究进展[J].中西医结合心脑血管病杂志,2018,16(2):179-182.
[6]中华神经科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):279.
[7]中华医学会精神分会.中国精神障碍分类与诊断标准(CCMD-3)[M].济南:山东科学技术出版社,2001:60.
[8]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[M].北京中医药大学学报,1996,19(1):55-56.
[9]毕晓莹.神经内科疾病的精神心理障碍[M].上海:科学技术出版社,2015:2-3.
[10]郝伟,于欣.精神病学[M]. 7版.北京:人民卫生出版社,2011:115-116.
[11]王拥军.神经病学临床评定量表[M].北京:中国友谊出版公司,2005:14.
[12] NABAVI S F,DEAN O M,TURNER A,et al. Oxidative stress and poststroke depression possible therapeutic role of polyphenols?[J]. Curr Med Chem,2015,22:343-351.
[13]梁迪赛.加味四逆散联合音乐疗法对脑卒中后合并抑郁症状患者的情感和肢体运动障碍的疗效观察[J].世界中西医结合杂志,2016,11(8):1053-1056.
[14]舒建中,唐军,李陈瑜,等.解郁安神颗粒合盐酸帕罗西汀片治疗缺血性脑中风后抑郁症的临床分析[J].中国实验方剂学杂志,2016,22(13):177-181.
[15]陈小敏,周小莉,丁砚兵.柴胡疏肝散联合低频重复经颅磁刺激治疗脑卒中后抑郁临床观察[J].湖北中医杂志,2017,39(10):23-24.
[16]齐艳红,刘苹.黛力新对脑卒中后抑郁患者临床症状及神经递质的影响[J].贵阳中医学院学报,2015,37(3):49-52.
[17]刘文,姜爱钟,林福军.氟哌噻吨美利曲辛片与多塞平治疗脑卒中后抑郁的临床疗效及对神经介质水平的影响[J].中西医结合心脑血管病杂志,2017,15(24):3201-3203.
[18]刘德芳,邓燕春,梁汝沛,等.养血清脑饮协定方联合盐酸帕罗西汀片治疗老年脑卒中后抑郁的临床效果及对血清5-HT、IL-1、Hcy水平的影响[J].陕西中医,2018,39(1):47-49.
[19]周荣,吴志敏,胡万华.柴胡疏肝散联合西药预防脑卒中后抑郁30例临床观察[J].江苏中医药,2017,49(11):36-38.
[20]王冠超,肖伟,章显宝,等.通督治郁针法对脑卒中后抑郁患者血清5-HT,NE和BDNF水平影响的研究[J].甘肃中医学院学报,2015,32(2):58-62.