逍遥散对慢性心力衰竭合并抑郁患者心功能及近期预后的影响——附38例临床资料
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摘要
目的:观察逍遥散对慢性心力衰竭合并抑郁患者心功能及近期预后的影响。方法:选取慢性心力衰竭合并抑郁且中医辨证属肝郁脾虚患者共77例,随机分为治疗组38例和对照组39例。对照组予常规抗心衰治疗,治疗组在对照组基础上加用逍遥散口服,疗程为6个月。观察2组治疗前后汉密尔顿抑郁量表(HAMD)积分、心衰疗效(Lee氏心衰计分法)积分、N末端B型利钠肽原(NT-pro BNP)、左心室射血分数(LVEF)、明尼苏达心衰生活质量量表(MLHFQ)评分、血清IL-6水平及半年内心衰相关性死亡率和因心衰再入院率。结果:(1)治疗组Lee氏心衰疗效总有效率及抑郁症状疗效总有效率均明显高于对照组(P<0.05);(2)治疗组治疗后HAMD积分、NT-pro BNP及IL-6水平明显低于对照组(P<0.01,P<0.05),而LVEF显著高于对照组(P<0.01);(3)治疗组治疗后MLHFQ评分明显低于对照组(P<0.01);(4)治疗组半年内因心衰再入院率明显低于对照组(P<0.05)。结论:逍遥散能显著改善慢性心力衰竭合并抑郁患者的心功能及抑郁症状,提高生活质量,抑制炎症状态,降低再入院率。
引文
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[12]田俊生,左亚妹,孙海峰,等.GC-MS代谢组学分析逍遥散干预抑郁模型大鼠盲肠代谢物组的变化规律[J].中草药,2015,46(13):1931.
[13]陈建丽,孙海峰,秦雪梅,等.逍遥散对慢性温和不可预知应激诱导抑郁模型大鼠盲肠炎症应答相关基因表达的影响[J].中国药理学与毒理学杂志,2015,29(4):552.
[14]沈小丽,彭国茳,孙海峰,等.16S r RNA基因的PCR-DGGE技术分析逍遥散干预抑郁模型大鼠盲肠菌群的变化[J].山西医科大学学报,2015,46(3):240.
[15]李肖,宫文霞,周玉枝,等.逍遥散中抗抑郁有效成分及其作用机制研究进展[J].中草药,2015,46(20):3109.
[16]全淑林,张林,翟春涛,等.逍遥散加味治疗癫痫共病抑郁障碍的临床研究[J].世界中西医结合杂志,2018,13(3):384.
[17]邓岳红.中西药结合治疗产后抑郁症的临床观察[J].现代中西医结合杂志,2018,27(2):183.
[18]王文娟,蔡江涛,白梅.超声心动图评估老年心肌梗死后心力衰竭患者右心功能的临床价值[J].实用老年医学,2016,30(1):65.
[19]XIONG G L,PRYBOL K,BOYLE S H,et al.Inflammation markers and major depressive disorder in patients with chronic heart failure:results from the sertraline against depression and heart disease in chronic heart failure study[J].Psychosom Med,2015,77(7):808.
[20]FREY A,POPP S,POST A,et al.Experimental heart failure causes depression-like behavior together with differential regulation of inflammatory and structural genes in the brain[J].Front Behav Neurosci,2014,8(5):2974.1986
[2]温雪梅,卢仁泉,郭林,等.中国心力衰竭患者抑郁焦虑发病及干预效果的Meta分析[J].中华临床医师杂志(电子版),2014,8(4):702.
[3]YEAGER K R,BINKLEY P F,SAVEANU R V,et al.Screening and identification of depression among patients with coronary heart disease and congestive heart failure[J].Heart Fail Clin,2011,7(1):69.
[4]SOKORELI I,DEVRIES J J G,PAUWS S C,et al.Depression and anxiety as predictors of mortality among heart failure patients:systematic review and meta-analysis[J].Heart Fail Rev,2016,21(1):49.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):99.
[6]中华医学会精神科分会.CCMD-3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,2001:83.
[7]中华中医药学会.中医内科常见病诊疗指南·西医疾病部分[M].北京:中国中医药出版社,2008:301.
[8]BEKELMAN D B,ALLEN L A,MCBRYDE C F,et al.Effect of a collaborative care intervention vs usual care on health status of patients with chronic heart failure:the CASA randomized clinical trial[J].JAMA Intern Med,2018,178(4):511.
[9]ANGERMANN C E,GELBRICH G,ST?RK S,et al.Effect of escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression:the MOOD-HFrandomized clinical trial[J].JAMA,2016,315(24):2683.
[10]郭宁红,刘萧,李帅,等.抗抑郁药与心力衰竭患者死亡率关系的荟萃分析[J].临床心血管病杂志,2018,34(2):142.
[11]刘现彬,田秀青.抗抑郁治疗在慢性心力衰竭并抑郁病人中的应用[J].齐鲁医学杂志,2017,32(2):245.
[12]田俊生,左亚妹,孙海峰,等.GC-MS代谢组学分析逍遥散干预抑郁模型大鼠盲肠代谢物组的变化规律[J].中草药,2015,46(13):1931.
[13]陈建丽,孙海峰,秦雪梅,等.逍遥散对慢性温和不可预知应激诱导抑郁模型大鼠盲肠炎症应答相关基因表达的影响[J].中国药理学与毒理学杂志,2015,29(4):552.
[14]沈小丽,彭国茳,孙海峰,等.16S r RNA基因的PCR-DGGE技术分析逍遥散干预抑郁模型大鼠盲肠菌群的变化[J].山西医科大学学报,2015,46(3):240.
[15]李肖,宫文霞,周玉枝,等.逍遥散中抗抑郁有效成分及其作用机制研究进展[J].中草药,2015,46(20):3109.
[16]全淑林,张林,翟春涛,等.逍遥散加味治疗癫痫共病抑郁障碍的临床研究[J].世界中西医结合杂志,2018,13(3):384.
[17]邓岳红.中西药结合治疗产后抑郁症的临床观察[J].现代中西医结合杂志,2018,27(2):183.
[18]王文娟,蔡江涛,白梅.超声心动图评估老年心肌梗死后心力衰竭患者右心功能的临床价值[J].实用老年医学,2016,30(1):65.
[19]XIONG G L,PRYBOL K,BOYLE S H,et al.Inflammation markers and major depressive disorder in patients with chronic heart failure:results from the sertraline against depression and heart disease in chronic heart failure study[J].Psychosom Med,2015,77(7):808.
[20]FREY A,POPP S,POST A,et al.Experimental heart failure causes depression-like behavior together with differential regulation of inflammatory and structural genes in the brain[J].Front Behav Neurosci,2014,8(5):2974.1986