柴胡疏肝汤加减治疗肝气郁结型卒中后抑郁疗效及对患者血清神经递质、神经功能恢复的影响
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摘要
目的:探讨肝气郁结型卒中后抑郁(PSD)应用柴胡疏肝汤加减治疗的临床效果及对患者血清神经递质、神经功能恢复的影响。方法:选取2016年4月至2017年4月在天津中医药大学第一附属医院收治的86例肝气郁结型PSD患者,采用随机数字表法均分为两组。对照组(43例)予以氟西汀治疗,观察组(43例)采取柴胡疏肝汤加减治疗。记录比较两组临床疗效,治疗前后血清单胺类和氨基酸类神经递质水平及神经功能指标变化,不良反应发生情况。结果:观察组治疗6周后总有效率为95.4%(41/43),较对照组81.4%(35/43)明显升高(P<0.05)。与本组治疗前相比,两组治疗后血清多巴胺(DA),5-羟色胺(5-HT),去甲肾上腺素(NE)及甘氨酸(Gly)水平均显著升高(P<0.01),天冬氨酸(Asp),谷氨酸(Glu)水平均显著降低(P<0.01);并以观察组改善更显著(P<0.01)。与本组治疗前比较,两组治疗后血清神经元烯醇化酶(NSE)水平,美国国立卫生研究院卒中量表(NIHSS)评分均显著降低(P<0.01),血清脑源性神经营养因子(BDNF)水平均显著升高(P<0.01);且以观察组改善更显著(P<0.01)。两组均未见明显不良反应/事件。结论:肝气郁结型PSD应用柴胡疏肝汤加减治疗更能有效改善患者症状,调节机体神经递质表达,促进神经功能恢复,疗效显著且安全可靠。
Objective: To investigate the clinical effect of Chaihu Shugan Tang in treating the liver-Qi stagnation type of post-stroke depression( PSD) and on serum nerve transmitters and nerve function recovery.Method: Totally 86 cases of the liver-Qi stagnation type of the liver-Qi PSD treated in our hospital from April 2016 to April 2017 were selected and divided into two groups with the random number table. The control group( 43 cases) was treated with modified fluoxetine,and the observation group( 43 cases) was treated with modified Chaihu Shugan Tang. The clinical efficacy,the levels of serum monoamine and amino acid neurotransmitters,the changes of neurological function and the incidence of adverse reactions were recorded and compared between the two groups. Result: The total effective rate in the observation group was 95. 4%( 41/43) after 6 weeks of treatment,which was significantly higher than 81. 4%( 35/43) in the control group( P < 0. 05). Compared with those before the treatment,serum dopamine( DA),5-hydroxytryptamine( 5-HT),norepinephrine( NE) and glycine( Gly) levels all increased significantly in the two groups after the treatment( P < 0. 01),and the levels of aspartic acid( Asp) and glutamic acid( Glu) decreased significantly( P < 0. 01); the improvement of the observation group was more significant( P < 0. 01). Compared with before the treatment,the levels of serum neuron enolase( NSE) and National Institutes of Health Stroke Scale( NIHSS) significantly decreased after the treatment in two groups( P < 0. 01). The level of serum brain derived neurotrophic factor( BDNF) increased significantly( P < 0. 01); the improvement of observation group was more significant( P < 0. 01). There was no obvious adverse reaction in the two groups. Conclusion: The application modified Chaihu Shugan Tang can effectively alleviate symptoms of cases of the liver-Qi stagnation type of the liver-Qi PSD,regulate neurotransmitter expression,and promote the recovery of neurological function,with a significant efficacy and safety.
Objective: To investigate the clinical effect of Chaihu Shugan Tang in treating the liver-Qi stagnation type of post-stroke depression( PSD) and on serum nerve transmitters and nerve function recovery.Method: Totally 86 cases of the liver-Qi stagnation type of the liver-Qi PSD treated in our hospital from April 2016 to April 2017 were selected and divided into two groups with the random number table. The control group( 43 cases) was treated with modified fluoxetine,and the observation group( 43 cases) was treated with modified Chaihu Shugan Tang. The clinical efficacy,the levels of serum monoamine and amino acid neurotransmitters,the changes of neurological function and the incidence of adverse reactions were recorded and compared between the two groups. Result: The total effective rate in the observation group was 95. 4%( 41/43) after 6 weeks of treatment,which was significantly higher than 81. 4%( 35/43) in the control group( P < 0. 05). Compared with those before the treatment,serum dopamine( DA),5-hydroxytryptamine( 5-HT),norepinephrine( NE) and glycine( Gly) levels all increased significantly in the two groups after the treatment( P < 0. 01),and the levels of aspartic acid( Asp) and glutamic acid( Glu) decreased significantly( P < 0. 01); the improvement of the observation group was more significant( P < 0. 01). Compared with before the treatment,the levels of serum neuron enolase( NSE) and National Institutes of Health Stroke Scale( NIHSS) significantly decreased after the treatment in two groups( P < 0. 01). The level of serum brain derived neurotrophic factor( BDNF) increased significantly( P < 0. 01); the improvement of observation group was more significant( P < 0. 01). There was no obvious adverse reaction in the two groups. Conclusion: The application modified Chaihu Shugan Tang can effectively alleviate symptoms of cases of the liver-Qi stagnation type of the liver-Qi PSD,regulate neurotransmitter expression,and promote the recovery of neurological function,with a significant efficacy and safety.
引文
[1]刘丹,赖学章,韩永凯,等.卒中后抑郁患者的认知功能与血浆同型半胱氨酸水平的关系[J].中国康复医学杂志,2013,28(1):47-50.
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[3]Broomfield N M,Quinn T J,Abdul-Rahim A H,et al.Depression and anxiety symptoms post-stroke/TIA:prevalence and associations in cross-sectional data from a regional stroke registry[J].BMC Neurol,2014,14(1):198.
[4]魏海燕,成勇.卒中后抑郁的发病机制研究进展[J].神经损伤与功能重建,2014,9(4):335-336.
[5]孙觊,马涤辉.卒中后抑郁的发病机制[J].吉林医学,2009,30(1):83-85.
[6]郭怡菁,杨玲俐,隋毓秀,等.卒中后抑郁的发病机制[J].中国卒中杂志,2007,2(11):912-915.
[7]刘建兵,马芳菲,解燕昭,等.自拟中药复元方治疗卒中后抑郁疗效观察[J].现代中西医结合杂志,2016,25(06):620-622.
[8]王媛媛,李东.通窍解郁方治疗脑卒中后抑郁患者60例[J].光明中医,2014,29(3):513-514.
[9]邹义,李花,陈安,等.柴疏四君汤治疗肝郁脾虚型卒中后抑郁症疗效观察[J].西部中医药,2016,29(11):4-7.
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[11]中华医学会精神科学会.中国精神疾病分类方案诊断标准[M].济南:山东科学技术出版社,2000:180-182.
[12]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,2012:33-34.
[13]陈东,高维滨,张倩.项针对脑卒中后假性球麻痹疗效及其血液流变学影响[J].上海针灸杂志,2011,30(4):223-224.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国中医药出版社,2002:88-89.
[15]Dwyer H K.Screening,diagnosis,and treatment of post-stroke depression.[J].J Neurosci Nurs,2014,46(3):135-141.
[16]YAN Y M,FAN W T,LIU L,et al.The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine[J].Neural Regen Res,2013,8(19):1765-1772.
[17]赵立波,徐露,车坷科,等.氟西汀对卒中后抑郁模型大鼠脑组织中5-HT、NE及NGF表达的影响[J].中国药房,2013,24(21):1939-1941.
[18]马玉峰,韩刚,邢佳,等.柴胡疏肝散对肝气郁结证大鼠前额叶及海马单胺类神经递质的影响[J].北京中医药,2016,35(12):1129-1133.
[19]陈贺华,刘勇,沈晓明.柴胡疏肝散加味治疗卒中后抑郁的临床观察与机制分析[J].辽宁中医杂志,2013,40(1):112-114.
[20]张喆,赵静洁,王永志,等.柴胡疏肝散药理作用及机制研究进展[J].中国中医药信息杂志,2017,24(9):128-131.
[21]陆小华,马骁,王建,等.赤芍的化学成分和药理作用研究进展[J].中草药,2015,46(4):595-602.
[22]江晋渝,马庆庆,宋芳,等.红花注射液对急性脑梗死患者神经功能及血清IL-6、IL-10水平的影响[J].中国中医基础医学杂志,2014,20(10):1350-1352,1366.
[23]张颖,陈宇霞,黄世敬.柴胡及柴胡类复方的抗抑郁研究现状[J].世界中西医结合杂志,2014,9(9):985-988.
[24]周天,李辉,凃中一,等.石菖蒲不同极性部位对抑郁模型小鼠抗抑郁效应及其机制[J].医药导报,2016,35(4):327-330.
[25]张小飞,詹娟娟,吴司琪,等.当归挥发油提取工艺优化及其乳化芳香水成分分析[J].中国实验方剂学杂志,2017,23(5):27-31.
[26]LI W,LING S,YANG Y,et al.Systematic hypothesis for post-stroke depression caused inflammation and neurotransmission and resultant on possible treatments[J].Neuro Endocrinol Lett,2014,35(2):104-109.
[27]吴全娥,高彦宇,李在斯,等.尖叶假龙胆与石菖蒲配伍抗抑郁的作用机理研究[J].中医药信息,2016,33(3):72-74.
[28]李梅,胡霖霖,张永华.加味酸枣仁汤联合佐匹克隆治疗焦虑性失眠及对5-羟色胺与多巴胺水平的影响[J].中国实验方剂学杂志,2015,21(17):161-164.
[2]WEI N,YONG W,LI X,et al.Post-stroke depression and lesion location:a systematic review[J].J Neurol,2015,262(1):81-90.
[3]Broomfield N M,Quinn T J,Abdul-Rahim A H,et al.Depression and anxiety symptoms post-stroke/TIA:prevalence and associations in cross-sectional data from a regional stroke registry[J].BMC Neurol,2014,14(1):198.
[4]魏海燕,成勇.卒中后抑郁的发病机制研究进展[J].神经损伤与功能重建,2014,9(4):335-336.
[5]孙觊,马涤辉.卒中后抑郁的发病机制[J].吉林医学,2009,30(1):83-85.
[6]郭怡菁,杨玲俐,隋毓秀,等.卒中后抑郁的发病机制[J].中国卒中杂志,2007,2(11):912-915.
[7]刘建兵,马芳菲,解燕昭,等.自拟中药复元方治疗卒中后抑郁疗效观察[J].现代中西医结合杂志,2016,25(06):620-622.
[8]王媛媛,李东.通窍解郁方治疗脑卒中后抑郁患者60例[J].光明中医,2014,29(3):513-514.
[9]邹义,李花,陈安,等.柴疏四君汤治疗肝郁脾虚型卒中后抑郁症疗效观察[J].西部中医药,2016,29(11):4-7.
[10]王新德.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[11]中华医学会精神科学会.中国精神疾病分类方案诊断标准[M].济南:山东科学技术出版社,2000:180-182.
[12]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,2012:33-34.
[13]陈东,高维滨,张倩.项针对脑卒中后假性球麻痹疗效及其血液流变学影响[J].上海针灸杂志,2011,30(4):223-224.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国中医药出版社,2002:88-89.
[15]Dwyer H K.Screening,diagnosis,and treatment of post-stroke depression.[J].J Neurosci Nurs,2014,46(3):135-141.
[16]YAN Y M,FAN W T,LIU L,et al.The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine[J].Neural Regen Res,2013,8(19):1765-1772.
[17]赵立波,徐露,车坷科,等.氟西汀对卒中后抑郁模型大鼠脑组织中5-HT、NE及NGF表达的影响[J].中国药房,2013,24(21):1939-1941.
[18]马玉峰,韩刚,邢佳,等.柴胡疏肝散对肝气郁结证大鼠前额叶及海马单胺类神经递质的影响[J].北京中医药,2016,35(12):1129-1133.
[19]陈贺华,刘勇,沈晓明.柴胡疏肝散加味治疗卒中后抑郁的临床观察与机制分析[J].辽宁中医杂志,2013,40(1):112-114.
[20]张喆,赵静洁,王永志,等.柴胡疏肝散药理作用及机制研究进展[J].中国中医药信息杂志,2017,24(9):128-131.
[21]陆小华,马骁,王建,等.赤芍的化学成分和药理作用研究进展[J].中草药,2015,46(4):595-602.
[22]江晋渝,马庆庆,宋芳,等.红花注射液对急性脑梗死患者神经功能及血清IL-6、IL-10水平的影响[J].中国中医基础医学杂志,2014,20(10):1350-1352,1366.
[23]张颖,陈宇霞,黄世敬.柴胡及柴胡类复方的抗抑郁研究现状[J].世界中西医结合杂志,2014,9(9):985-988.
[24]周天,李辉,凃中一,等.石菖蒲不同极性部位对抑郁模型小鼠抗抑郁效应及其机制[J].医药导报,2016,35(4):327-330.
[25]张小飞,詹娟娟,吴司琪,等.当归挥发油提取工艺优化及其乳化芳香水成分分析[J].中国实验方剂学杂志,2017,23(5):27-31.
[26]LI W,LING S,YANG Y,et al.Systematic hypothesis for post-stroke depression caused inflammation and neurotransmission and resultant on possible treatments[J].Neuro Endocrinol Lett,2014,35(2):104-109.
[27]吴全娥,高彦宇,李在斯,等.尖叶假龙胆与石菖蒲配伍抗抑郁的作用机理研究[J].中医药信息,2016,33(3):72-74.
[28]李梅,胡霖霖,张永华.加味酸枣仁汤联合佐匹克隆治疗焦虑性失眠及对5-羟色胺与多巴胺水平的影响[J].中国实验方剂学杂志,2015,21(17):161-164.