舒肝颗粒治疗围绝经期肝郁气滞型抑郁症的疗效观察
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摘要
目的:观察舒肝颗粒治疗围绝经期抑郁(肝郁气滞证)的临床疗效及对性激素和炎症因子的影响。方法:将120例患者随机按数字表法分为对照组和观察组各60例。两组患者均口服替勃龙片,2. 5 mg/次,1次/d;对照组口服氟哌噻吨美利曲辛片,1片/次,早晨及中午各1次。观察组在对照组治疗的基础上口服舒肝颗粒,1袋/次,2次/d。两组疗程均为连续治疗8周。主要疗效指标采用汉密尔顿抑郁量表17项(HAMD-17),抑郁自评量表(SDS)和艾森克人格问卷(EPQ);次要疗效指标采用焦虑自评量表(SAS),肝郁气滞证评分、改良Kupperman(KI)评分,并检测促卵泡刺激素(FSH),促黄体生成素(LH),雌二醇(E2),5-羟色胺(5-HT),脑源性神经营养因子(BDNF),白细胞介素-1β(IL~(-1)β),IL-6和肿瘤坏死因子-α(TNF-α)水平。于治疗前后各评价1次。结果:治疗后观察组临床抑郁疗效优于对照组(Z=2. 038,P <0. 05);观察组患者围绝经期综合征疗效优于对照组(Z=2. 316,P <0. 05);观察组患者HAMD-17,SDS和EPQ-N评分均低于对照组(P <0. 01),EPQ-E评分高于对照组(P <0. 01);观察组患者的SAS,KI和肝郁气滞证评分均低于对照组(P <0. 01);观察组患者FSH和LH水平均低于对照组,E2和BDNF水平均高于对照组(P <0. 01);观察组患者血清5-HT水平高于对照组,IL~(-1)β,IL-6和TNF-α水平均低于对照组(P <0. 01)。结论:舒肝颗粒可减轻围绝经期抑郁肝郁气滞证患者的、焦虑及围绝经期症状,并具有调节性激素、减轻炎症反应和调节5-HT和BDNF作用,临床疗效优于单纯的西医治疗。
Objective: To observe the clinical efficacy of Shugan granule on perimenopausal depressive disorder( stagnation of liver Qi and Qi stagnation) and its effect on sex hormone and inflammatory factors.Method: One hundred and twenty patients were randomly divided into control group( 60 cases) and observation group( 60 cases) by random number table. Both groups got Tibolone tablets,2. 5 mg/time,1 time/day. Patients in control group got flupentixol and melitracen tablets once every morning and noon,1 tablet/time. In addition to the therapy of control group,patients in observation group got Shugan granule,1 pack/time,2 times/days. And a course of treatment was 8 weeks. Main indexes were graded by Hamilton depression scale( HAMD-17),self-rating depression scale( SDS) and Eysenck Personality Questionnaire( EPQ). And secondary indexes were scored by self-rating anxiety scale( SAS),stagnation of liver Qi and Qi stagnation,improved kupperman( KI),levels of follicle stimulating hormone( FSH),luteinizing hormone( LH),estradiol( E2),5-serotonin( 5-HT),brain derived neurotrophic factor( BDNF),interleukin-1β( IL~(-1)β),IL-6 and tumor necrosis factor-α( TNF-α) before and after treatment. Result: By rank sum test,the clinical efficacy on depressed and perimenopausal syndrome in observation groups was better than that in control group( Z = 2. 038,P < 0. 05,Z = 2. 316,P < 0. 05). Scores of HAMD-17,SDS,EPQ-N,SAS,KI and stagnation of liver qi and qi stagnation were lower than those in control group( P < 0. 01),whereas score of EPQ-E was higher than that in control group( P < 0. 01). And levels of FSH,LH,IL~(-1)β,IL-6 and TNF-α were lower than those in control groups( P < 0. 01). Levels of E2,BDNF and 5-HT were higher than those in control groups( P < 0. 01). Conclusion: Shugan granule can relieve depression,inquietude and symptoms caused by perimenopausal syndrome, regulate sex hormone, 5-HT, BDNF and inflammatory reaction,with a better clinical effect than pure western medicine treatment.
Objective: To observe the clinical efficacy of Shugan granule on perimenopausal depressive disorder( stagnation of liver Qi and Qi stagnation) and its effect on sex hormone and inflammatory factors.Method: One hundred and twenty patients were randomly divided into control group( 60 cases) and observation group( 60 cases) by random number table. Both groups got Tibolone tablets,2. 5 mg/time,1 time/day. Patients in control group got flupentixol and melitracen tablets once every morning and noon,1 tablet/time. In addition to the therapy of control group,patients in observation group got Shugan granule,1 pack/time,2 times/days. And a course of treatment was 8 weeks. Main indexes were graded by Hamilton depression scale( HAMD-17),self-rating depression scale( SDS) and Eysenck Personality Questionnaire( EPQ). And secondary indexes were scored by self-rating anxiety scale( SAS),stagnation of liver Qi and Qi stagnation,improved kupperman( KI),levels of follicle stimulating hormone( FSH),luteinizing hormone( LH),estradiol( E2),5-serotonin( 5-HT),brain derived neurotrophic factor( BDNF),interleukin-1β( IL~(-1)β),IL-6 and tumor necrosis factor-α( TNF-α) before and after treatment. Result: By rank sum test,the clinical efficacy on depressed and perimenopausal syndrome in observation groups was better than that in control group( Z = 2. 038,P < 0. 05,Z = 2. 316,P < 0. 05). Scores of HAMD-17,SDS,EPQ-N,SAS,KI and stagnation of liver qi and qi stagnation were lower than those in control group( P < 0. 01),whereas score of EPQ-E was higher than that in control group( P < 0. 01). And levels of FSH,LH,IL~(-1)β,IL-6 and TNF-α were lower than those in control groups( P < 0. 01). Levels of E2,BDNF and 5-HT were higher than those in control groups( P < 0. 01). Conclusion: Shugan granule can relieve depression,inquietude and symptoms caused by perimenopausal syndrome, regulate sex hormone, 5-HT, BDNF and inflammatory reaction,with a better clinical effect than pure western medicine treatment.
引文
[1]李瑞霞,马敏,肖喜荣,等.40~55岁社区妇女围绝经期症状和焦虑、抑郁症状评分及相关因素分析[J].复旦学报:医学版,2017,44(1):27-33.
[2]Borkoles E,Reynolds N,Thompson D R,et al.The role of depressive symptomatology in peri-and postmenopause[J].Maturitas,2015,81(2):306-310.
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[4]姚济白,李建梅,杨希,等.舒肝颗粒异病同治机理探析[J].云南中医中药杂志,2017,38(4):27-29.
[5]侯玉涛,林亚明.舒肝颗粒组方抗抑郁机制研究进展[J].实用中医药杂志,2014(11):1071-1079.
[6]赵爱民,翟文静.舒肝颗粒在女性更年期综合征治疗中的应用及疗效观察[J].中医临床研究,2013,24(5):34-35.
[7]谢正,张志娟,于俊丽,等.舒肝颗粒在选择性5-羟色胺再摄取抑制剂应用中的减毒增效作用观察及机理探究[J].中华中医药学刊,2018,36(4):852-856.
[8]宋志宇,庞剑月,隋净净,等.舒肝颗粒治疗更年期焦虑症的机制研究[J].中药药理与临床,2013,29(3):183-185.
[9]汤光花,陈永新,张瑞岭.舒肝颗粒对抑郁大鼠海马神经元凋亡、脑组织caspase-3蛋白及外周血中细胞因子水平的影响[J].中国老年学杂志,2018,38(1):52-54.
[10]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:162-163.
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[13]钱铭怡,武国城,朱荣春,等.艾森克人格问卷简式量表中国版(EPQ-RSC)的修订[J].心理学报,2000,32(3):317-323.
[14]叶香,陈燕,翟宇,等.围绝经期综合征患者抑郁焦虑症状的研究及其与脑源性神经营养因子的关系[J].中国妇幼保健,2015,30(3):397-398.
[15]杨兰,刘保庚,张培浩,等.调冲解郁汤治疗围绝经期抑郁症60例临床观察[J].中国实验方剂学杂志,2015,21(12):182-185.
[16]陈崇泽.氟哌噻吨美利曲辛片致不良反应文献分析[J].药物评价研究,2013,36(5):397-400.
[17]谢实.血清性激素与5-羟色胺在女性围绝经期抑郁患者体内的表达[J].西南军医,2013,15(1):11-12.
[18]陈素平.加味甘麦大枣汤治疗围绝经期伴初发重度抑郁患者疗效及对神经递质和炎症因子水平的影响[J].现代中西医结合杂志,2018,27(20):2196-2198,2202.
[19]李永超,彭亮,王高华,等.炎性因子、皮质醇,5-羟色胺与抑郁严重程度关系的初步研究[J].国际精神病学杂志,2015,42(6):6-9.
[2]Borkoles E,Reynolds N,Thompson D R,et al.The role of depressive symptomatology in peri-and postmenopause[J].Maturitas,2015,81(2):306-310.
[3]索兰宏,于红娟.解郁方配合心理干预及八段锦功法对围绝经期患者抑郁症状的改善作用[J].长春中医药大学学报,2016,32(1):131-133.
[4]姚济白,李建梅,杨希,等.舒肝颗粒异病同治机理探析[J].云南中医中药杂志,2017,38(4):27-29.
[5]侯玉涛,林亚明.舒肝颗粒组方抗抑郁机制研究进展[J].实用中医药杂志,2014(11):1071-1079.
[6]赵爱民,翟文静.舒肝颗粒在女性更年期综合征治疗中的应用及疗效观察[J].中医临床研究,2013,24(5):34-35.
[7]谢正,张志娟,于俊丽,等.舒肝颗粒在选择性5-羟色胺再摄取抑制剂应用中的减毒增效作用观察及机理探究[J].中华中医药学刊,2018,36(4):852-856.
[8]宋志宇,庞剑月,隋净净,等.舒肝颗粒治疗更年期焦虑症的机制研究[J].中药药理与临床,2013,29(3):183-185.
[9]汤光花,陈永新,张瑞岭.舒肝颗粒对抑郁大鼠海马神经元凋亡、脑组织caspase-3蛋白及外周血中细胞因子水平的影响[J].中国老年学杂志,2018,38(1):52-54.
[10]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:162-163.
[11]中华医学会精神科分会.中国精神疾病分类方案与诊断标准(CCMD-3)[M].3版.济南:山东科学技术出版社,2001:103-104.
[12]中华中医药学会.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:144-145.
[13]钱铭怡,武国城,朱荣春,等.艾森克人格问卷简式量表中国版(EPQ-RSC)的修订[J].心理学报,2000,32(3):317-323.
[14]叶香,陈燕,翟宇,等.围绝经期综合征患者抑郁焦虑症状的研究及其与脑源性神经营养因子的关系[J].中国妇幼保健,2015,30(3):397-398.
[15]杨兰,刘保庚,张培浩,等.调冲解郁汤治疗围绝经期抑郁症60例临床观察[J].中国实验方剂学杂志,2015,21(12):182-185.
[16]陈崇泽.氟哌噻吨美利曲辛片致不良反应文献分析[J].药物评价研究,2013,36(5):397-400.
[17]谢实.血清性激素与5-羟色胺在女性围绝经期抑郁患者体内的表达[J].西南军医,2013,15(1):11-12.
[18]陈素平.加味甘麦大枣汤治疗围绝经期伴初发重度抑郁患者疗效及对神经递质和炎症因子水平的影响[J].现代中西医结合杂志,2018,27(20):2196-2198,2202.
[19]李永超,彭亮,王高华,等.炎性因子、皮质醇,5-羟色胺与抑郁严重程度关系的初步研究[J].国际精神病学杂志,2015,42(6):6-9.