礞石滚痰汤辅助治疗颅脑损伤后躁狂型精神障碍痰火扰神证19例临床观察
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摘要
目的观察礞石滚痰汤辅助治疗颅脑损伤(TBI)后躁狂型精神障碍痰火扰神证的临床疗效。方法37例TBI后躁狂型精神障碍痰火扰神证患者按随机数字表法分为治疗组(19例)和对照组(18例),并选取同时期健康管理中心15例健康体检者作为正常组。治疗组与对照组均给予西医常规基础治疗,治疗组加用礞石滚痰汤口服或鼻饲,每日1剂,两组疗程均为7天。观察两组治疗前后神经行为量表(NRS)评分、中医证候积分;治疗组与对照组治疗前后和正常组采用酶联免疫吸附法检测血浆中S-100B蛋白(S-100B)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)和脑源性神经营养因子(BDNF)水平变化。结果治疗前治疗组和对照组患者血浆S-100B、TNF-α、NSE水平均高于正常组,BDNF水平低于正常组(P <0. 05)。与对照组比较,治疗组治疗后NRS评分、中医证候积分及血浆S-100B、TNF-α、NSE水平明显降低,血浆BDNF水平显著升高(P <0. 05)。结论礞石滚痰汤辅助治疗TBI后躁狂型精神障碍痰火扰神证可提高临床疗效,其作用机制可能与降低血浆中S-100B、TNF-α、NSE水平,升高BDNF水平有关。
Objective To investigate the clinical effects of Mengshi Guntan Decoction( 礞石滚痰汤,MGD) on manic agitation with phlegm-fire disturbing mind syndrome following traumatic brain injury( TBI). Methods A total of 37 patients with manic agitation with phlegm-fire disturbing mind syndrome following TBI were recruited and randomly assigned into a treatment group( 19 cases) and a control group( 18 cases). Fifteen healthy subjects from physical examination center were selected as normal group. Both patients groups received the conventional western medicine treatment. In addition,the treatment group received oral administration or nasal feeding of MGD,once a day for 7 days. The neurobehavioural rating scale( NRS) scores,traditional Chinese medicine( TCM) syndrome scores were observed before and after treatment. The levels of S-100 B protein( S-100 B),tumor necrosis factor alpha( TNF-α),neuron-specific enolase( NSE) and brain derived neurotrophic factor( BDNF) were detected with enzyme-linked immunosorbent assay( ELISA) for both treated groups before and after treatment as well as the normal group. Results Before treatment,plasma S-100 B,TNF-α and NSE levels of the two TBI groups of agitation were higher than those of the normal group( P < 0. 05),while BDNF level was lower than that of the normal group( P <0. 05). After treatment,compared with those of the control group,the NRS scores,the TCM syndrome scores,plasma S-100 B,TNF-α and NSE level was significantly decreased( P < 0. 05),while BDNF levels of the treatment group were significantly increased( P < 0. 05). Conclusion Mengshi Guntan Decoction in the adjuctive treatment of manic agitation with phlegm-fire disturbing mind syndrome following TBI could improve clinical effects,its mechanism may be associated with decrease of plasma level of S-100 B,TNF-α,NSE and increase of level of BDNF.
Objective To investigate the clinical effects of Mengshi Guntan Decoction( 礞石滚痰汤,MGD) on manic agitation with phlegm-fire disturbing mind syndrome following traumatic brain injury( TBI). Methods A total of 37 patients with manic agitation with phlegm-fire disturbing mind syndrome following TBI were recruited and randomly assigned into a treatment group( 19 cases) and a control group( 18 cases). Fifteen healthy subjects from physical examination center were selected as normal group. Both patients groups received the conventional western medicine treatment. In addition,the treatment group received oral administration or nasal feeding of MGD,once a day for 7 days. The neurobehavioural rating scale( NRS) scores,traditional Chinese medicine( TCM) syndrome scores were observed before and after treatment. The levels of S-100 B protein( S-100 B),tumor necrosis factor alpha( TNF-α),neuron-specific enolase( NSE) and brain derived neurotrophic factor( BDNF) were detected with enzyme-linked immunosorbent assay( ELISA) for both treated groups before and after treatment as well as the normal group. Results Before treatment,plasma S-100 B,TNF-α and NSE levels of the two TBI groups of agitation were higher than those of the normal group( P < 0. 05),while BDNF level was lower than that of the normal group( P <0. 05). After treatment,compared with those of the control group,the NRS scores,the TCM syndrome scores,plasma S-100 B,TNF-α and NSE level was significantly decreased( P < 0. 05),while BDNF levels of the treatment group were significantly increased( P < 0. 05). Conclusion Mengshi Guntan Decoction in the adjuctive treatment of manic agitation with phlegm-fire disturbing mind syndrome following TBI could improve clinical effects,its mechanism may be associated with decrease of plasma level of S-100 B,TNF-α,NSE and increase of level of BDNF.
引文
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[14]颜晓华,杨于嘉,刘苡.黄芩甙对新生鼠脑血肿继发脑水肿的治疗研究[J].小儿急救医学,2004,11(4):221-223.
[15]王艳春,张忠艳,姜小卓.中药黄芩的药理及应用[J].中外医疗,2009,28(13):158.
[16]田燕泽,秘效媛,朴香兰.沉香的化学成分、药理活性与临床应用研究进展[J].中央民族大学学报(自然科学版),2010,19(1):77-81.
[17]韩亚亮,刘萍,何新荣,等.石菖蒲挥发油的基本成分及其药理作用研究进展[J].中国药物应用与监测,2011,8(2):120-124.
[18]KHANDAKER GM,ZIMBRON J,LEWIS G,et al. Prenatal maternal infection,neurodevelopment and adult schizophrenia:a systematic review of population-based studies[J]. Psychol Med,2013,43(2):239-257.
[19]ERBAGCI AB,HERKEN H,KOYLUOGLU O,et al. Serum IL-1 beta,s IL-2R,IL-6,IL-8 and TNF-alpha in schizophrenic patients,relation with symptomatology and responsiveness to risperidone treatment[J]. Mediators Inflamm,2001,10(3):109-115.
[20]许烨勍,叶尘宇,沈瑜君,等.血清脑源性神经营养因子与精神分裂症症状及认知功能的关系[J].中国神经精神疾病杂志,2011,37(7):425-427.
[2]孙秀彬,辛涛,薛付忠,等.颅脑损伤患者继发躁狂型精神障碍的多因素分析[J].中国神经精神疾病杂志,2013,39(1):1-5.
[3]ARCINIEGAS DB,TOPKOFF J,SILVER M. Neuropsychiatric aspects of traumatic brain injury[J]. Curr Treat Options Neurol,2000,2(2):169-186.
[4]彭璠,陈泽奇,罗杰坤.礞石滚痰丸治疗脑外伤并发躁狂型精神障碍疗效观察[J].中国中医药信息杂志,2010,17(6):79-80.
[5]中华医学会精神科分会.中国精神障碍分类与诊断标准[M]. 3版.济南:山东科学技术出版社,2001:45.
[6]国家中医药管理局.中医病证诊断疗效标准[S].北京:中国医药科技出版社,2012:34-35.
[7]LEVIN HS,HIGH WM,GOETHE KE,et al. The neurobehavioural rating scale:assessment of the behavioural sequelae of head injury by the clinician[J]. JNNP,1987,50(2):183-193.
[8]王忠诚.王忠诚神经外科学[M].武汉:湖北科学技术出版社,2005:381.
[9]陈彦伊,王东生,朱惠彬,等.菖芩Ⅰ号联合西医治疗重型颅脑损伤临床研究[J].中国中医药信息杂志,2017,24(6):17-21.
[10]杨超,狄剑秋.中西医结合治疗脑外伤后精神障碍疗效观察[J].现代中西医结合杂志,2012,21(28):3127-3128.
[11]段英杰,刘兴波,莫莉.大黄对大鼠实验性创伤性脑水肿的影响[J].辽宁医学院学报,2008,29(1):23-30.
[12]张秋菊,张长伟,汪骏,等.大黄水提物的促智作用研究[J].中药材,2001,24(10):728-730.
[13]ZHOU QB,JIN YL,JIA Q,et al. Baicalin attenuates brain edema in a rat model of intracerebral hemorrhage[J]. Inflamm,2014,37(1):107-115.
[14]颜晓华,杨于嘉,刘苡.黄芩甙对新生鼠脑血肿继发脑水肿的治疗研究[J].小儿急救医学,2004,11(4):221-223.
[15]王艳春,张忠艳,姜小卓.中药黄芩的药理及应用[J].中外医疗,2009,28(13):158.
[16]田燕泽,秘效媛,朴香兰.沉香的化学成分、药理活性与临床应用研究进展[J].中央民族大学学报(自然科学版),2010,19(1):77-81.
[17]韩亚亮,刘萍,何新荣,等.石菖蒲挥发油的基本成分及其药理作用研究进展[J].中国药物应用与监测,2011,8(2):120-124.
[18]KHANDAKER GM,ZIMBRON J,LEWIS G,et al. Prenatal maternal infection,neurodevelopment and adult schizophrenia:a systematic review of population-based studies[J]. Psychol Med,2013,43(2):239-257.
[19]ERBAGCI AB,HERKEN H,KOYLUOGLU O,et al. Serum IL-1 beta,s IL-2R,IL-6,IL-8 and TNF-alpha in schizophrenic patients,relation with symptomatology and responsiveness to risperidone treatment[J]. Mediators Inflamm,2001,10(3):109-115.
[20]许烨勍,叶尘宇,沈瑜君,等.血清脑源性神经营养因子与精神分裂症症状及认知功能的关系[J].中国神经精神疾病杂志,2011,37(7):425-427.