糖尿病伴发抑郁症的证候学研究及益肾解郁方干预的临床疗效评价
|
摘要
糖尿病伴发抑郁症是在糖尿病的基础上出现抑郁症状,临床表现主要为情绪低落、兴趣减退、内心痛苦、沮丧、忧伤、苦闷、悲观、失望和精神不振,乏力,睡眠障碍(入睡困难或早醒),还会出现认知功能障碍,严重者有自杀倾向。目前对于该病的治疗多应用西药抗抑郁剂进行治疗,因其副作用大,起效较慢,患者依从性较差。中医药辨证论治,副作用小,具有一定的优势。但是目前对该病的中医辨证分型尚无统一的标准；因此,开展该病的中医症候学研究,探索有效的方药,对于提高糖尿病伴发抑郁症的临床疗效具有重要的意义。
目的
通过证候学研究,探讨糖尿病伴发抑郁症的证型特点；采用随机对照的试验方法客观评价益肾解郁方治疗糖尿病伴发抑郁症肾虚肝郁证的临床疗效及部分机制探讨。
方法
1.以2008年中华中医药学会发布的《中医内科常见病诊疗指南·郁病》为基础制定糖尿病伴发抑郁症的中医证候学量表,根据患者的临床表现及临床资料,建立数据库,统计糖尿病伴发抑郁症患者中医辨证分型及证候规律。
2.采用随机、对照、盲法原则,共选取符合糖尿病伴发抑郁症及中医学肾虚肝郁证诊断标准的132例患者,随机分为治疗组和对照组。治疗组在基础治疗的同时给予口服益肾解郁方,每日1剂,分两次服。对照组在常规治疗的基础上予口服氟西汀胶囊,每日服用20mg。疗程3个月。
结果
一糖尿病伴发抑郁症的证候学研究
1在209例糖尿病伴发抑郁症的患者中中医辨证分型肾虚肝郁证最多,占28.23%,其次是肝郁脾虚证,占20.11%,肝气郁结证18.66%,血行郁滞证16.75%,肝胆湿热证占14.35%,忧郁伤神型最少,1.91%。
2.糖尿病伴发抑郁症患者肝郁脾虚证的焦虑／躯体化因子分高于肾虚肝郁证(p<0.05)；肝郁脾虚证的迟滞,绝望感和体重减轻因子分低于肾虚肝郁证,差异显著(p<0.05)。
二益肾解郁方治疗糖尿病伴发抑郁症的临床疗效
1两组HAMD量表评分比较
两组治疗后HAMD评分较治疗前均明显降低,差异显著(p<0.05)；治疗组总有效率85.24%,对照组总有效率为77.42%,两组疗效比较,差异显著(p<0.05)。表明治疗组在HAMD评分改善方面优于对照组。治疗组疗后的焦虑／躯体化因子分,迟滞因子分,睡眠障碍因子分均明显降低(p<0.05或p<0.01)。组间比较,治疗组的睡眠障碍因子得分低于对照组(p<0.05)。
2两组SDS量表评分比较
两组治疗后SDS量表得分均有所下降,与治疗前相比,差异显著(p<0.05)；治疗组起效时间为治疗2周,对照组起效时间为治疗4周。治疗组总有效率90.16%,对照组总有效率为79.03%,差异显著(p<0.05)。说明治疗组在治疗糖尿病伴发抑郁症方面,起效时间早于对照组,主观评价疗效优于对照组。
3两组中医证候疗效比较
中医疗效指数统计,治疗组的总有效率93.44%,对照组总有效率为82.26%,组间对照差异显著(p<0.05)。治疗组的中医症状情绪抑郁,兴趣索然,腰酸乏力,胸胁胀痛和睡眠状况均显著改善(p<0.05或p<0.01)。组间比较结果显示,治疗组的睡眠状况改善优于对照组(p<0.05)。
4两组糖尿病特异生存质量量表评分比较
疗后治疗组的生理维度,心理精神维度和总分低于治疗前,差异显著(p<0.05)。疗后对照组心理精神维度和总分低于治疗前,差异显著(p<0.05)。组间比较结果显示,疗后治疗组的在生理维度,心理精神维度和总分均低于对照组,差异显著(p<0.05)。说明治疗组患者的生存质量优于对照组。
5两组HPA轴功能指标比较
疗后治疗组和对照组8：00皮质醇数值和16：00皮质醇数值均有所下降,差异显著,(p<0.05)；疗后治疗组和对照组皮质醇节律消失患者比例均有所下降,与疗前相比,差异显著(p<0.05)。
6两组血清血糖,糖化血红蛋白,血脂,血压指标比较
疗后治疗组空腹血糖,餐后2h血糖,HBAIC均较治疗前下降,差异显著(p<0.01或p<0.05)；对照组仅空腹血糖较疗前下降(p<0.05),其余指标无显著改变。组间比较结果显示,治疗后治疗组空腹血糖和餐后2h血糖均低于对照组,差异显著(p<0.05)。
治疗组血脂,血压较治疗前无明显改变。
结论
12型糖尿病伴发抑郁症具有不同于单纯抑郁症的证候学特点,即肾虚肝郁证所占比例高于其他证型。
22型糖尿病伴发抑郁症的不同证型的抑郁表现的维度不同。
3益肾解郁方可以改善2型糖尿病伴发抑郁症肾虚肝郁证患者的抑郁症状,提高糖尿病患者的生存质量。
4益肾解郁方通过改善下丘脑-垂体-肾上腺轴的功能紊乱缓解2型糖尿病伴发抑郁症肾虚肝郁证患者的症状。
5益肾解郁方可以协助改善2型糖尿病伴发抑郁症肾虚肝郁证患者的血糖水平。
Type2diabetes with depression is a kind of depression combined with diabetes. The main clinical manifestation of Type2diabetes with depression is low in spirits, loss of interest and pleasure, sad, dejected, empty, hopeless, depressed, exhausted both in body and mind, sleep disorders,cognitive symptoms and suicide thoughts and behaviours. There is no standards of pattern identification of Traditional Chinese Medicine now. The treatment for Type2diabetes with depression is antidepressant, which has serious side effects and slow onset, thus the patients have poor compliance. Treatment based on pattern identification of traditional Chinese medicine has small side-effects and have certain advantages. It is important to study Type2diabetes with depression from the point of traditional Chinese medicine, and on this basis to improve the clinical curative effect of the disease.
Objective
To understand the characteristics of traditional Chinese medicine patterns of Type2diabetes with depression, and to study different patterns with the HAMD scale; observation on the Yishen Jieyu Decoction in treating Type2diabetes with depression of syndrome of kidney deficiency and liver qi stagnation and study on its mechanism.
Method
1. We developed survey questionnaires, collected information of209cases with survey method, identified the pattern of traditional Chinese medicine diagnosis according to the case information. Then we made a census of the data of the disease.
2According to the randomized, placebo-controlled and blinded principles,132patients of Type2diabetes with depression with TCM syndrome diagnostic of kidney deficiency and liver qi stagnation were selected and divided into the treatment and control group. The therapy group was given the Yishen Jieyu Decoction. The control group was given oral fluoxetine capsules,20mg a day. Each group were treated by oral medication for3months. After treatment both group were given the observation of curative effect.
Results
1. In209cases of Type2diabetes with depression,the highest rate of traditional Chinese medicine is the pattern of kidney deficiency and liver qi stagnation,28.23%, followed by liver qi stagnation and spleen deficiency syndrome,20.11%, pattern of liver qi stagnation syndrome18.66%, pattern of dampness-heat of liver and gallbladder14.35%, blood stasis pattern16.75%, pattern of melancholy and depression impairing the spirit is at least,1,91%.
2The anxiety/somatization score of patients with liver qi stagnation and spleen deficiency syndrome is higher than the score of patients with kidney deficiency and liver qi stagnation syndrome.The difference is significant (p<0.05).
The weight reduce score, retardation score and despair score of patients with kidney deficiency and liver qi stagnation syndrome is higher than the score of patients with liver qi stagnation and spleen deficiency syndrome. The difference is significant (p<0.01or p<0.05).
3The HAMD scores after treatment are significantly reduced than that before treatment. The difference is significant (p<0.05); The total effective rate of treatment group is85.24%, the total effective rate of the control group is77.42%. The difference is significant (p<0.05). The treatment group is better in improvement of HAMD score than controlled group.
4After treatment,anxiety/somatization score in the treatment group is significantly lower than that before the treatment (p<0.05); The retardation score in the treatment group is significantly lower than that before treatment (p<0.05), sleep disturbance score in the treatment group is significantly lower than before treatment (p<0.01). Comparison between the two groups showed that the sleep disturbance score in the treatment group is less than that of the control groups. The difference is significant (p<0.05).
5After treatment,SDS scale scores of the two groups declined, compared with that before treatment. The difference is significant (p<0.05). The onset time of the treatment group is2weeks after the treatment. The onset time of the control group is4weeks after the treatment. The total effective rate in the treatment group is90,16%, the total effective rate of the control group is79.03%. The difference is significant (p<0.05). The result proved that the subjective evaluation of the therapeutic effect in the treatment group is better than the control group and the onset time is earlier than the control group.
6Curative effect of traditional Chinese medicine index showed that the total effective rate of treatment group is93.44%, the total effective rate of control group is82.26%.Group comparison difference is significant(p<0.05).
7Diabetes-specific quality of life scale statistics showed that the physical dimension score, psycho-spiritual dimension score and total score in the treatment group after the treatment is lower than that before treatment. The difference is significant (p<0.05). Psycho-spiritual dimension score and total score in the control group after the treatment is lower than that before treatment. The difference is significant (p<0.05). Comparison between the two groups showed that, after treatment, physical dimension score, psycho-spiritual dimension score and total score in treatment group are lower than the control group. The difference is significant (p<0.05).This proved that the quality of life of treatment group is better than that of the control group.
8HPA-axis function index statistics showed that the cortisol level in8:00AM and16:00PM declined after the treatment. The difference is significant (p<0.05); The rate of cortisol rhythm disappears in treatment group decreased after treatment. The difference is significant (p<0.05).
9Serum glucose, HbAIC, serum lipids, blood pressure index statistics showed that fasting blood glucose,2H after a meal blood glucose, HbAIC declined after the treatment. The difference is significant (p<0.01, p<0.05); comparison of the two groups showed that fasting blood glucose and2H after a meal blood glucose are lower than the control group, The difference is significant (p<0.05). There is no obvious change in lipids and blood pressure.
Conclusion
1The syndrome differentiation typing in Type2diabetes with depression is different from a simple depression, high incidence of kidney deficiency and liver qi stagnation are its characteristics.
2The dimension on the performance of different patterns of Traditional Chinese Medicine in Type2diabetes with depression is different.
3The Yishen Jieyu Decoction can reduce the depression level of patients with Type2diabetes with depression, and improve the quality of life in patients with diabetes.
4TheYishen Jieyu decoction can improve dysfunction of the hypothalamus-pituitary-adrenal axis in patients of kidney deficiency and liver qi stagnation of Type2diabetes with depression.
5The Yishen Jieyu decoction can help to reduce the serum glucose level of patients of kidney deficiency and liver qi stagnation of Type2diabetes with depression.
目的
通过证候学研究,探讨糖尿病伴发抑郁症的证型特点；采用随机对照的试验方法客观评价益肾解郁方治疗糖尿病伴发抑郁症肾虚肝郁证的临床疗效及部分机制探讨。
方法
1.以2008年中华中医药学会发布的《中医内科常见病诊疗指南·郁病》为基础制定糖尿病伴发抑郁症的中医证候学量表,根据患者的临床表现及临床资料,建立数据库,统计糖尿病伴发抑郁症患者中医辨证分型及证候规律。
2.采用随机、对照、盲法原则,共选取符合糖尿病伴发抑郁症及中医学肾虚肝郁证诊断标准的132例患者,随机分为治疗组和对照组。治疗组在基础治疗的同时给予口服益肾解郁方,每日1剂,分两次服。对照组在常规治疗的基础上予口服氟西汀胶囊,每日服用20mg。疗程3个月。
结果
一糖尿病伴发抑郁症的证候学研究
1在209例糖尿病伴发抑郁症的患者中中医辨证分型肾虚肝郁证最多,占28.23%,其次是肝郁脾虚证,占20.11%,肝气郁结证18.66%,血行郁滞证16.75%,肝胆湿热证占14.35%,忧郁伤神型最少,1.91%。
2.糖尿病伴发抑郁症患者肝郁脾虚证的焦虑／躯体化因子分高于肾虚肝郁证(p<0.05)；肝郁脾虚证的迟滞,绝望感和体重减轻因子分低于肾虚肝郁证,差异显著(p<0.05)。
二益肾解郁方治疗糖尿病伴发抑郁症的临床疗效
1两组HAMD量表评分比较
两组治疗后HAMD评分较治疗前均明显降低,差异显著(p<0.05)；治疗组总有效率85.24%,对照组总有效率为77.42%,两组疗效比较,差异显著(p<0.05)。表明治疗组在HAMD评分改善方面优于对照组。治疗组疗后的焦虑／躯体化因子分,迟滞因子分,睡眠障碍因子分均明显降低(p<0.05或p<0.01)。组间比较,治疗组的睡眠障碍因子得分低于对照组(p<0.05)。
2两组SDS量表评分比较
两组治疗后SDS量表得分均有所下降,与治疗前相比,差异显著(p<0.05)；治疗组起效时间为治疗2周,对照组起效时间为治疗4周。治疗组总有效率90.16%,对照组总有效率为79.03%,差异显著(p<0.05)。说明治疗组在治疗糖尿病伴发抑郁症方面,起效时间早于对照组,主观评价疗效优于对照组。
3两组中医证候疗效比较
中医疗效指数统计,治疗组的总有效率93.44%,对照组总有效率为82.26%,组间对照差异显著(p<0.05)。治疗组的中医症状情绪抑郁,兴趣索然,腰酸乏力,胸胁胀痛和睡眠状况均显著改善(p<0.05或p<0.01)。组间比较结果显示,治疗组的睡眠状况改善优于对照组(p<0.05)。
4两组糖尿病特异生存质量量表评分比较
疗后治疗组的生理维度,心理精神维度和总分低于治疗前,差异显著(p<0.05)。疗后对照组心理精神维度和总分低于治疗前,差异显著(p<0.05)。组间比较结果显示,疗后治疗组的在生理维度,心理精神维度和总分均低于对照组,差异显著(p<0.05)。说明治疗组患者的生存质量优于对照组。
5两组HPA轴功能指标比较
疗后治疗组和对照组8：00皮质醇数值和16：00皮质醇数值均有所下降,差异显著,(p<0.05)；疗后治疗组和对照组皮质醇节律消失患者比例均有所下降,与疗前相比,差异显著(p<0.05)。
6两组血清血糖,糖化血红蛋白,血脂,血压指标比较
疗后治疗组空腹血糖,餐后2h血糖,HBAIC均较治疗前下降,差异显著(p<0.01或p<0.05)；对照组仅空腹血糖较疗前下降(p<0.05),其余指标无显著改变。组间比较结果显示,治疗后治疗组空腹血糖和餐后2h血糖均低于对照组,差异显著(p<0.05)。
治疗组血脂,血压较治疗前无明显改变。
结论
12型糖尿病伴发抑郁症具有不同于单纯抑郁症的证候学特点,即肾虚肝郁证所占比例高于其他证型。
22型糖尿病伴发抑郁症的不同证型的抑郁表现的维度不同。
3益肾解郁方可以改善2型糖尿病伴发抑郁症肾虚肝郁证患者的抑郁症状,提高糖尿病患者的生存质量。
4益肾解郁方通过改善下丘脑-垂体-肾上腺轴的功能紊乱缓解2型糖尿病伴发抑郁症肾虚肝郁证患者的症状。
5益肾解郁方可以协助改善2型糖尿病伴发抑郁症肾虚肝郁证患者的血糖水平。
Type2diabetes with depression is a kind of depression combined with diabetes. The main clinical manifestation of Type2diabetes with depression is low in spirits, loss of interest and pleasure, sad, dejected, empty, hopeless, depressed, exhausted both in body and mind, sleep disorders,cognitive symptoms and suicide thoughts and behaviours. There is no standards of pattern identification of Traditional Chinese Medicine now. The treatment for Type2diabetes with depression is antidepressant, which has serious side effects and slow onset, thus the patients have poor compliance. Treatment based on pattern identification of traditional Chinese medicine has small side-effects and have certain advantages. It is important to study Type2diabetes with depression from the point of traditional Chinese medicine, and on this basis to improve the clinical curative effect of the disease.
Objective
To understand the characteristics of traditional Chinese medicine patterns of Type2diabetes with depression, and to study different patterns with the HAMD scale; observation on the Yishen Jieyu Decoction in treating Type2diabetes with depression of syndrome of kidney deficiency and liver qi stagnation and study on its mechanism.
Method
1. We developed survey questionnaires, collected information of209cases with survey method, identified the pattern of traditional Chinese medicine diagnosis according to the case information. Then we made a census of the data of the disease.
2According to the randomized, placebo-controlled and blinded principles,132patients of Type2diabetes with depression with TCM syndrome diagnostic of kidney deficiency and liver qi stagnation were selected and divided into the treatment and control group. The therapy group was given the Yishen Jieyu Decoction. The control group was given oral fluoxetine capsules,20mg a day. Each group were treated by oral medication for3months. After treatment both group were given the observation of curative effect.
Results
1. In209cases of Type2diabetes with depression,the highest rate of traditional Chinese medicine is the pattern of kidney deficiency and liver qi stagnation,28.23%, followed by liver qi stagnation and spleen deficiency syndrome,20.11%, pattern of liver qi stagnation syndrome18.66%, pattern of dampness-heat of liver and gallbladder14.35%, blood stasis pattern16.75%, pattern of melancholy and depression impairing the spirit is at least,1,91%.
2The anxiety/somatization score of patients with liver qi stagnation and spleen deficiency syndrome is higher than the score of patients with kidney deficiency and liver qi stagnation syndrome.The difference is significant (p<0.05).
The weight reduce score, retardation score and despair score of patients with kidney deficiency and liver qi stagnation syndrome is higher than the score of patients with liver qi stagnation and spleen deficiency syndrome. The difference is significant (p<0.01or p<0.05).
3The HAMD scores after treatment are significantly reduced than that before treatment. The difference is significant (p<0.05); The total effective rate of treatment group is85.24%, the total effective rate of the control group is77.42%. The difference is significant (p<0.05). The treatment group is better in improvement of HAMD score than controlled group.
4After treatment,anxiety/somatization score in the treatment group is significantly lower than that before the treatment (p<0.05); The retardation score in the treatment group is significantly lower than that before treatment (p<0.05), sleep disturbance score in the treatment group is significantly lower than before treatment (p<0.01). Comparison between the two groups showed that the sleep disturbance score in the treatment group is less than that of the control groups. The difference is significant (p<0.05).
5After treatment,SDS scale scores of the two groups declined, compared with that before treatment. The difference is significant (p<0.05). The onset time of the treatment group is2weeks after the treatment. The onset time of the control group is4weeks after the treatment. The total effective rate in the treatment group is90,16%, the total effective rate of the control group is79.03%. The difference is significant (p<0.05). The result proved that the subjective evaluation of the therapeutic effect in the treatment group is better than the control group and the onset time is earlier than the control group.
6Curative effect of traditional Chinese medicine index showed that the total effective rate of treatment group is93.44%, the total effective rate of control group is82.26%.Group comparison difference is significant(p<0.05).
7Diabetes-specific quality of life scale statistics showed that the physical dimension score, psycho-spiritual dimension score and total score in the treatment group after the treatment is lower than that before treatment. The difference is significant (p<0.05). Psycho-spiritual dimension score and total score in the control group after the treatment is lower than that before treatment. The difference is significant (p<0.05). Comparison between the two groups showed that, after treatment, physical dimension score, psycho-spiritual dimension score and total score in treatment group are lower than the control group. The difference is significant (p<0.05).This proved that the quality of life of treatment group is better than that of the control group.
8HPA-axis function index statistics showed that the cortisol level in8:00AM and16:00PM declined after the treatment. The difference is significant (p<0.05); The rate of cortisol rhythm disappears in treatment group decreased after treatment. The difference is significant (p<0.05).
9Serum glucose, HbAIC, serum lipids, blood pressure index statistics showed that fasting blood glucose,2H after a meal blood glucose, HbAIC declined after the treatment. The difference is significant (p<0.01, p<0.05); comparison of the two groups showed that fasting blood glucose and2H after a meal blood glucose are lower than the control group, The difference is significant (p<0.05). There is no obvious change in lipids and blood pressure.
Conclusion
1The syndrome differentiation typing in Type2diabetes with depression is different from a simple depression, high incidence of kidney deficiency and liver qi stagnation are its characteristics.
2The dimension on the performance of different patterns of Traditional Chinese Medicine in Type2diabetes with depression is different.
3The Yishen Jieyu Decoction can reduce the depression level of patients with Type2diabetes with depression, and improve the quality of life in patients with diabetes.
4TheYishen Jieyu decoction can improve dysfunction of the hypothalamus-pituitary-adrenal axis in patients of kidney deficiency and liver qi stagnation of Type2diabetes with depression.
5The Yishen Jieyu decoction can help to reduce the serum glucose level of patients of kidney deficiency and liver qi stagnation of Type2diabetes with depression.
引文
[1]陆如春.五郁病机证治初探[J].陕西中医,1996,6(02)：78-80.
[2]朱伟.糖尿病伴发抑郁症的中医辨治规律探讨[J].中华中医杂志,2006,21(12)：755-756.
[3]唐启盛,裴清华,温清.消渴解郁方治疗糖尿病合并抑郁症的临床研究[J].中国中医基础医学杂志,2006,12(8)：605-607.
[4]赵成梅.一贯煎加味治疗糖尿病抑郁症30例[J].中国民康医学,2007,6(19)：89.
[5]李红.解郁方治疗2型糖尿病抑郁症的临床观察[J].福建医科大学学报,2006：,40(5)：488-489.
[6]中华中医药学会脑病专业委员会,国家中医药管理局全国脑病重点专科抑郁症协作组.抑郁症中医证候诊断标准及治疗方案[J].北京中医药大学学报,2011,34(12),810-811.
[7]路杰云.辨证分型治疗糖尿病抑郁症临床体会[J].光明中医.2008,23(10)：1584-1585.
[8]陆建华.糖尿病伴发抑郁症中医证治体会[J].中国社区医师,2003,19(16)：32.
[9]王玉霞,高彦彬,周晖.益气养阴解郁法治疗糖尿病伴发抑郁症的临床研究[J].世界中医药,2010,05(6)：397-399.
[10]唐启盛,裴清华,温清.消渴解郁方治疗糖尿病后抑郁症的临床研究[J].中国中医基础医学杂志,2006,12(8)：605—606.
[11]罗和春,钱瑞琴.丹栀逍遥散治疗抑郁症的临床疗效观察[J].中国中西医结合杂志,2006,26(3)：212—213.
[12]刘德庆,田宏薇.解郁安神对糖尿病合并抑郁患者血糖的影响[J].实用中医内科杂志,2007,21(1)：57.
[13]张萌,肖万泽.丹栀逍遥散加味治疗糖尿病伴抑郁症临床观察[J].辽宁中医药大学学报。2008,10(2)：108-109.
[14]李红,郑姜钦,吕绍光.解郁方治疗2型糖尿病抑郁症的临床观察[J].福建医科大学学报.2006,40(5)：488-489.
[15]李春桂,苗桂珍,朱学敏.糖尿病合并抑郁症的临床观察[J].北京中医药,2011,30(5)：378-379.
[16]白小林,杨建,杨国春.养阴清郁汤治疗糖尿病合并抑郁症[J].陕西中医,2007,28(8)：999-1000.
[17]周潮,李晓哲,周颖.中医分时辨治糖尿病合并抑郁症46例临床观察[J]. 河北中医,2011,33(5)：665-668.
[18]孙智霞.中西医结合治疗糖尿病伴抑郁症60例[J].光明中医,2009,24(10)：1951-1952.
[19]许金水,程立红.汉英对照针灸治疗抑郁症[J].2007,10(1)76.
[20]侯冬芬,夏李兵,张金喜等.中医治疗抑郁症的规范化研究[J].医学综述,2009,15(11),1705-1709.
[21]程坤,颜红,段可杰.针灸治疗抑郁症的临床与机理研究进展[J].中国针灸,2005,25(3)：221—223.
[22]张小兰,姜艳,殷凤凤.针刺治疗抑郁症35例[J].吉林中医药,2008,28(10)：753.
[1]强桂芬,崔景秋,孙津红.糖尿病与抑郁症[J].国外医学内分泌学分册,2001,21(3)：119-120
[2]Lusterman PJ, Anderson RJ, Freedland KE,etal. Depression and pogiycemic control:ameta analytic review of the literature.[J] Diabetes Care,2000,23:934-942
[3]Robertson MM, Katona CLE. Depression and Physical Illness.U.S.A. John Wiley& Sons Ltd,1997:257-260
[4]姚军,吴文源,李春波,等.2型糖尿病伴发抑郁症患者生命质量研究[J].中国行为医学科学,2006,15(4),323-325
[5]张明园,任福民,樊彬,等.正常人群中的抑郁症状的调查和CESD的应用[J].中华神经精神科杂志,1987,20(2)：67-71.
[6]周连华,周湘兰,施晓红,任风东.2型糖尿病合并抑郁症分析[J].中国临床医学2004,11(6)：7211-8211
[7]Garvard JA, Lustman PJ,Clouse RE. Prevalence of depression in adult with diabetes:An epidemiological evaluation. Diabetes Care,1993,16:116-117
[8]Thomas J,Jones G, Scarinci I, etal. A descriptive and comparative study of prevalence of depressive and anxiety disorders in low income adults with type 2 diabetes and other chronic illnesses. Diabetes Care,2003,26 (8):2311-2317
[9]赵湜,毛红,付阿丹,等.糖尿病人群伴发抑郁症的临床研究[J].中国糖尿病杂志,2002,10(5)：272-275
[10]许玲,王德全,任建民等.2型糖尿病患者抑郁的患病率及其危险因素[J].中国糖尿病杂志[J]2003,11(1)：46-50
[11]张娟, 毕艳, 沈山梅,等.2型糖尿病患者抑郁的患病率及相关危险因素分析[J].中华内分泌代谢杂志,2011,27(10)：796-799.
[12]Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. [J] Diabetes Care,1997,20:585-590
[13]杨成龙,蔡文治,黄海刚2型糖尿病共病抑郁症的危险因素分析[J].中国全科医学,2011,14(26),2956-2958
[14]中玮.糖尿病与抑郁症相关性及影响因素[J].中国误诊学杂志,2007,7(23)15486—5487.
[15]黄晓萍,姜维洁,陈同钧,李红.2型糖尿病合并抑郁障碍患者C反应蛋白和血脂检测的意义[J].中国微循环,2008,12(3)：173—174.
[16]Kaufman D, Banerji MA, Shorman I, et al. Early life stress and the development of obesity and insulin resistance in juvenile bonnet macaques. Diabetes,2007,56:1382-1386
[17]张炜,汤正义,黄防,等.诊断库欣综合征时多种检查方法的比较[J].中华内分泌代谢杂志,2005,21(5)：402-404.
[18]Fehm HL, Kern W, Peters A. The selfish brain. Competition for energy resources [J]. Prog Brain Res,2006,153:129-140
[19]张妍,徐桂芳,赵宝龙,等.2型糖尿病合并抑郁症患者胰岛素功能的变化研究[J].医学临床研究,2006,23(9)：1457
[20]周中华,马建东,郎艳.糖尿病教育对2型糖尿病患者情绪障碍及糖代谢的影响[J].临床研究,2003,12(1)：34-35
[21]梁志清,苏珂,唐灵.2型糖尿病伴发抑郁症患者下丘脑-垂体-肾上腺轴功能研究[J].华夏医学,2003,16(2)：145-146
[22]Brummett BH, Kuhn CM, Boyle SH, Babyak MA, Siegler IC, Williams RB. Cortisol responses to emotional stress in men:association with a functional polymorphism in the 5HTR2C gene. Biol Psychol.2012 Jan; 89(1):94-8.
[23]Arborelius L, Owens IJ, Plotsky PM. The role of corticotrophin releasing factor in depression and anxiety disorders[J]. J Endocrinol.1999,160(1):1-12.
[24]Kunugi H, Ida I, Owashi T. et al. Assement of the dexamethasone/CRH test at a state—dependent marker for hypothalamic pituitary adrenal(HPA)axis abnormalities in major depressive episode:a multi-center study [J]. Neuropsychopharmacology,2006,31(2):212-220
[25]Eaton WW, Armenian H, Gallo J etal. Depression and risk for onset of type 2 diabetes. A Prospective population based study.[J] Diabete Care.1996,19:1097-1102
[26]Pan A, Ye x, Franco O, et al. Insulin resistance and depressive symptoms in middle-aged and elderly Chinese findings from the Nutrition and Health of Aging Population in China Study. J Affect DiSOrd.2007,109:75-82.
[27]Lustman PJ, Clouse RE, Ciechanowski PS, et al. Depression related hyperglycemia in type 1 diabetes,a mediational approach. Psychosom Med, 2005,67:195-199
[28]周连华：周湘兰：施晓红.2型糖尿病合并抑郁症分析[J].中国临床医学,2004,11(6)：1127—1128.
[29]Williams JW, Katon W, Lin EHB, et al. The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients[J]. Annlntem Med,2004,140:1015-1024.
[30]姚静.糖尿病患者中的抑郁问题[J]. 国外医学精神病学分册,2001,28(4)：199-203
[31]Ferdinand E E, Does V D, Grootenhuis P A, et al. Symptoms and well-being in relation to glycemic control in type2 diabetes[J].Diabetes Care,1996,13:170-172.
[32]缪小萍,陈虹,姚正元.糖尿病教育对2型糖尿病患者抑郁症状的影响[J].中国心理卫生杂志,2000 01 10 14(1)：28-29
[33]Hooke GR, Pag AC. Predicting outcomes of group cognitive behavioral therapy for patients with affective and neurotic disorders. [J]. Behavioral Mordification,2002,26(5):78-82
[34]胡佩诚,申玉珍,李郁莉,等.糖尿病集体心理治疗的临床观察[J].中国临床心理学杂志,1996.4(4)：229-231.
[35]Lammers CA, Naciboff BD, Straotineyer AJ. The effect of progressive relaxtation on stress and diabetic control. [J] Behav Res Ther,1984,22:64-65
[36]石井均.糖尿病心理行动学的诸问题[J].糖尿病,2000,43,13-19
[37]Lustman PJ,Clouse RE.Depression in diabetic patients:the relationship between mood and glycemic control.[J]Diabetes Complications.2005,19(2):113-122
[38]梁志清,唐灵,曾爱源.氟西汀对2型糖尿病合并抑郁症患者下丘脑—垂体—肾上腺轴功能及临床疗效影响观察[J].中国实用内科杂志,2005,25(1)：67—68.
[39]刘惠惠.百忧解治疗2型糖尿病伴发抑郁障碍疗效观察[J].疑难病杂志,2005(4)6：355.
[40]Mahux P, Ducros F, Bourque J et al. Fluoxetine improves insulin sensitivity in obese patients with non-insulin-dent diabetes mellitus independently of weight loss.[J].Int J Obes Relat Metab Disord,1997,21(2):97-102
[41]Connolly VM, Gallagher A, Kesson CM. A Study of fluoxetion in obese elderly patients with type 2 diabetes. [J] Diabet Med.1995,12(5):416-418
[42]孙全新,段武钢,陈克全,等.帕罗西汀联合心理干预对2型糖尿病伴发抑郁症的疗效[J].中国全科医学,2006,9(10)： 805—806
[43]朱秋根,罗婷.米氮平治疗糖尿病合并抑郁症的临床研究[J].实用临床医学,2008,9(11)：16-18
[1]李惠林,黄皓月,邸振福等.2型糖尿病患者骨密度,性激素与肾虚关系研究.第八次全国中医药糖尿病学术大会论文集,2005.9：P268-272.
[2]《中药新药临床研究指导原则》[M].北京：中国医药科技出版社,2002.4.
[3]中华中医药学会发布.《中医内科常见病诊疗指南》[M].北京：中国中医药出版社,2008.7(1)
[4]赵燕,王天芳等.抑郁症中医证候及证候要素分布特点的文献研究[J].中医杂志,2006.9,47(9)：P691-692.
[5]胡随瑜,张宏耕,郑林等.1977例抑郁症患者中医不同证候构成比分析[J].中国医师杂志,2003.10,5(10)：P1312—1314.
[6]陈文恺,周玲,梅晓云等.571例抑郁症中医证候学临床流行病学调查[J].浙江中医杂志,2007.5,42(5)：P262—263.
[7]国家中医药管理局发布.《中医病证诊断疗效标准》[M].南京：南京大学出版社出版,1994.7(1)：20.
[8]中华中医药学会脑病专业委员会,国家中医药管理局全国脑病重点专科抑郁症协作组。抑郁症中医证候诊断标准及治疗方案[J].北京中医药大学学报,2011,34(12),810-811.
[9]唐启盛,裴清华,温琇清。消渴解郁方治疗糖尿病后抑郁症的临床研究[J].中国中医基础医学杂志,2006,12(8),605-607.
[10]张登本,武长春.内经辞典.北京：人民卫生出版社,1990.209.
[1]唐启盛,裴清华,温琇清。消渴解郁方治疗糖尿病后抑郁症的临床研究。中国中医基础医学杂志,2006,12(8),605-607
[2]曾艳,贾正平,张汝学,等.地黄寡糖在2型2型糖尿病大鼠模型上的降血糖作用及机制.中国药理学通报,2006,22(4)：411一415
[3]崔瑛,沈云辉,侯士良,等.熟地黄对记忆障碍模型小鼠记忆力影响的实验研究.[J].河南中医学院学报,2003,18(5)：32—34.
[4]王明艳,赵凤鸣,蔡宝昌.山茱萸及其活性成分的药效研究概述.[J].中华中医药学刊,2008,(26)7,1419-1421
[5]钮心懿。五味子有效成分“醇甲“对中枢神经系统作用[J].药学学报,1983,18(6)：416-421
[6]孙膑等柴胡皂甙对猫睡眠活动调节的实验研究,天津医科大学学报,2000,6(3)：274
[7]曹美群,胡随瑜,张春虎。白松片对慢性应激抑郁大鼠模型血浆CRH和ACTH浓度的影响。湖南中医学院学报,2004,(24)4：12-14
[8]李明亚,陈红梅。石菖蒲对行为绝望动物抑郁模型的抗抑郁作用.中药材,2001,24(1)：40
[9]杨晓燕,陈发奎,刘玉兰.石曹蒲抗抑郁药理作用的研究.海军军事医学,1999,20(2)：16
[10]雷载权,张廷模主编。中华临床中药学,人民卫生出版社,1998
[11]CooPer MS, Stewart PM. Beta-hydroxysteroid dehydrogenase type 1 and its role in the hyPothalamus — Pituitary — adrenalaxis, metabolie syndrome, and inflammation. [J] Clin Endoerinol Metab,2009,94 (12):4645-4654
[12]Chakravarty K, Cassuro H, Reshef L, Hanson RW. Factors that control the tissue — specific transcription of the gene for Phos Phoenol Pyruvate carboxykinase-C[J]. Crit. Rev. Biochem.2005,40(3):129-154.
[13]Gathereole, L. L. and Stewart, P.M. Targeting the prereceptor metabolism of cortisol as a novel therapy in obesity and diabetes [J] Steroid Bioehem.2010,122(1-3):129-135.
[14]Chiodini 1, DiLembo S, Morelli V, Epaminonda P, ColettiF, MasseriniB, SeillitaniA, ArosioM, AddaG. HyPothalamie — Pituitary — adrenal activity in type 2 diabetes mellitus:role of autonomic imbalanee [J]. Metabolism Clinical and ExPerimental,2006,55(8):1135-1140.
[15]夏凌,张春阳,刘志民.褪黑素抑制2型糖尿病大鼠下丘脑—垂体—肾上腺轴功能[J].第二军医大学学报,2007,28(11)：1184—1187.
[2]朱伟.糖尿病伴发抑郁症的中医辨治规律探讨[J].中华中医杂志,2006,21(12)：755-756.
[3]唐启盛,裴清华,温清.消渴解郁方治疗糖尿病合并抑郁症的临床研究[J].中国中医基础医学杂志,2006,12(8)：605-607.
[4]赵成梅.一贯煎加味治疗糖尿病抑郁症30例[J].中国民康医学,2007,6(19)：89.
[5]李红.解郁方治疗2型糖尿病抑郁症的临床观察[J].福建医科大学学报,2006：,40(5)：488-489.
[6]中华中医药学会脑病专业委员会,国家中医药管理局全国脑病重点专科抑郁症协作组.抑郁症中医证候诊断标准及治疗方案[J].北京中医药大学学报,2011,34(12),810-811.
[7]路杰云.辨证分型治疗糖尿病抑郁症临床体会[J].光明中医.2008,23(10)：1584-1585.
[8]陆建华.糖尿病伴发抑郁症中医证治体会[J].中国社区医师,2003,19(16)：32.
[9]王玉霞,高彦彬,周晖.益气养阴解郁法治疗糖尿病伴发抑郁症的临床研究[J].世界中医药,2010,05(6)：397-399.
[10]唐启盛,裴清华,温清.消渴解郁方治疗糖尿病后抑郁症的临床研究[J].中国中医基础医学杂志,2006,12(8)：605—606.
[11]罗和春,钱瑞琴.丹栀逍遥散治疗抑郁症的临床疗效观察[J].中国中西医结合杂志,2006,26(3)：212—213.
[12]刘德庆,田宏薇.解郁安神对糖尿病合并抑郁患者血糖的影响[J].实用中医内科杂志,2007,21(1)：57.
[13]张萌,肖万泽.丹栀逍遥散加味治疗糖尿病伴抑郁症临床观察[J].辽宁中医药大学学报。2008,10(2)：108-109.
[14]李红,郑姜钦,吕绍光.解郁方治疗2型糖尿病抑郁症的临床观察[J].福建医科大学学报.2006,40(5)：488-489.
[15]李春桂,苗桂珍,朱学敏.糖尿病合并抑郁症的临床观察[J].北京中医药,2011,30(5)：378-379.
[16]白小林,杨建,杨国春.养阴清郁汤治疗糖尿病合并抑郁症[J].陕西中医,2007,28(8)：999-1000.
[17]周潮,李晓哲,周颖.中医分时辨治糖尿病合并抑郁症46例临床观察[J]. 河北中医,2011,33(5)：665-668.
[18]孙智霞.中西医结合治疗糖尿病伴抑郁症60例[J].光明中医,2009,24(10)：1951-1952.
[19]许金水,程立红.汉英对照针灸治疗抑郁症[J].2007,10(1)76.
[20]侯冬芬,夏李兵,张金喜等.中医治疗抑郁症的规范化研究[J].医学综述,2009,15(11),1705-1709.
[21]程坤,颜红,段可杰.针灸治疗抑郁症的临床与机理研究进展[J].中国针灸,2005,25(3)：221—223.
[22]张小兰,姜艳,殷凤凤.针刺治疗抑郁症35例[J].吉林中医药,2008,28(10)：753.
[1]强桂芬,崔景秋,孙津红.糖尿病与抑郁症[J].国外医学内分泌学分册,2001,21(3)：119-120
[2]Lusterman PJ, Anderson RJ, Freedland KE,etal. Depression and pogiycemic control:ameta analytic review of the literature.[J] Diabetes Care,2000,23:934-942
[3]Robertson MM, Katona CLE. Depression and Physical Illness.U.S.A. John Wiley& Sons Ltd,1997:257-260
[4]姚军,吴文源,李春波,等.2型糖尿病伴发抑郁症患者生命质量研究[J].中国行为医学科学,2006,15(4),323-325
[5]张明园,任福民,樊彬,等.正常人群中的抑郁症状的调查和CESD的应用[J].中华神经精神科杂志,1987,20(2)：67-71.
[6]周连华,周湘兰,施晓红,任风东.2型糖尿病合并抑郁症分析[J].中国临床医学2004,11(6)：7211-8211
[7]Garvard JA, Lustman PJ,Clouse RE. Prevalence of depression in adult with diabetes:An epidemiological evaluation. Diabetes Care,1993,16:116-117
[8]Thomas J,Jones G, Scarinci I, etal. A descriptive and comparative study of prevalence of depressive and anxiety disorders in low income adults with type 2 diabetes and other chronic illnesses. Diabetes Care,2003,26 (8):2311-2317
[9]赵湜,毛红,付阿丹,等.糖尿病人群伴发抑郁症的临床研究[J].中国糖尿病杂志,2002,10(5)：272-275
[10]许玲,王德全,任建民等.2型糖尿病患者抑郁的患病率及其危险因素[J].中国糖尿病杂志[J]2003,11(1)：46-50
[11]张娟, 毕艳, 沈山梅,等.2型糖尿病患者抑郁的患病率及相关危险因素分析[J].中华内分泌代谢杂志,2011,27(10)：796-799.
[12]Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. [J] Diabetes Care,1997,20:585-590
[13]杨成龙,蔡文治,黄海刚2型糖尿病共病抑郁症的危险因素分析[J].中国全科医学,2011,14(26),2956-2958
[14]中玮.糖尿病与抑郁症相关性及影响因素[J].中国误诊学杂志,2007,7(23)15486—5487.
[15]黄晓萍,姜维洁,陈同钧,李红.2型糖尿病合并抑郁障碍患者C反应蛋白和血脂检测的意义[J].中国微循环,2008,12(3)：173—174.
[16]Kaufman D, Banerji MA, Shorman I, et al. Early life stress and the development of obesity and insulin resistance in juvenile bonnet macaques. Diabetes,2007,56:1382-1386
[17]张炜,汤正义,黄防,等.诊断库欣综合征时多种检查方法的比较[J].中华内分泌代谢杂志,2005,21(5)：402-404.
[18]Fehm HL, Kern W, Peters A. The selfish brain. Competition for energy resources [J]. Prog Brain Res,2006,153:129-140
[19]张妍,徐桂芳,赵宝龙,等.2型糖尿病合并抑郁症患者胰岛素功能的变化研究[J].医学临床研究,2006,23(9)：1457
[20]周中华,马建东,郎艳.糖尿病教育对2型糖尿病患者情绪障碍及糖代谢的影响[J].临床研究,2003,12(1)：34-35
[21]梁志清,苏珂,唐灵.2型糖尿病伴发抑郁症患者下丘脑-垂体-肾上腺轴功能研究[J].华夏医学,2003,16(2)：145-146
[22]Brummett BH, Kuhn CM, Boyle SH, Babyak MA, Siegler IC, Williams RB. Cortisol responses to emotional stress in men:association with a functional polymorphism in the 5HTR2C gene. Biol Psychol.2012 Jan; 89(1):94-8.
[23]Arborelius L, Owens IJ, Plotsky PM. The role of corticotrophin releasing factor in depression and anxiety disorders[J]. J Endocrinol.1999,160(1):1-12.
[24]Kunugi H, Ida I, Owashi T. et al. Assement of the dexamethasone/CRH test at a state—dependent marker for hypothalamic pituitary adrenal(HPA)axis abnormalities in major depressive episode:a multi-center study [J]. Neuropsychopharmacology,2006,31(2):212-220
[25]Eaton WW, Armenian H, Gallo J etal. Depression and risk for onset of type 2 diabetes. A Prospective population based study.[J] Diabete Care.1996,19:1097-1102
[26]Pan A, Ye x, Franco O, et al. Insulin resistance and depressive symptoms in middle-aged and elderly Chinese findings from the Nutrition and Health of Aging Population in China Study. J Affect DiSOrd.2007,109:75-82.
[27]Lustman PJ, Clouse RE, Ciechanowski PS, et al. Depression related hyperglycemia in type 1 diabetes,a mediational approach. Psychosom Med, 2005,67:195-199
[28]周连华：周湘兰：施晓红.2型糖尿病合并抑郁症分析[J].中国临床医学,2004,11(6)：1127—1128.
[29]Williams JW, Katon W, Lin EHB, et al. The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients[J]. Annlntem Med,2004,140:1015-1024.
[30]姚静.糖尿病患者中的抑郁问题[J]. 国外医学精神病学分册,2001,28(4)：199-203
[31]Ferdinand E E, Does V D, Grootenhuis P A, et al. Symptoms and well-being in relation to glycemic control in type2 diabetes[J].Diabetes Care,1996,13:170-172.
[32]缪小萍,陈虹,姚正元.糖尿病教育对2型糖尿病患者抑郁症状的影响[J].中国心理卫生杂志,2000 01 10 14(1)：28-29
[33]Hooke GR, Pag AC. Predicting outcomes of group cognitive behavioral therapy for patients with affective and neurotic disorders. [J]. Behavioral Mordification,2002,26(5):78-82
[34]胡佩诚,申玉珍,李郁莉,等.糖尿病集体心理治疗的临床观察[J].中国临床心理学杂志,1996.4(4)：229-231.
[35]Lammers CA, Naciboff BD, Straotineyer AJ. The effect of progressive relaxtation on stress and diabetic control. [J] Behav Res Ther,1984,22:64-65
[36]石井均.糖尿病心理行动学的诸问题[J].糖尿病,2000,43,13-19
[37]Lustman PJ,Clouse RE.Depression in diabetic patients:the relationship between mood and glycemic control.[J]Diabetes Complications.2005,19(2):113-122
[38]梁志清,唐灵,曾爱源.氟西汀对2型糖尿病合并抑郁症患者下丘脑—垂体—肾上腺轴功能及临床疗效影响观察[J].中国实用内科杂志,2005,25(1)：67—68.
[39]刘惠惠.百忧解治疗2型糖尿病伴发抑郁障碍疗效观察[J].疑难病杂志,2005(4)6：355.
[40]Mahux P, Ducros F, Bourque J et al. Fluoxetine improves insulin sensitivity in obese patients with non-insulin-dent diabetes mellitus independently of weight loss.[J].Int J Obes Relat Metab Disord,1997,21(2):97-102
[41]Connolly VM, Gallagher A, Kesson CM. A Study of fluoxetion in obese elderly patients with type 2 diabetes. [J] Diabet Med.1995,12(5):416-418
[42]孙全新,段武钢,陈克全,等.帕罗西汀联合心理干预对2型糖尿病伴发抑郁症的疗效[J].中国全科医学,2006,9(10)： 805—806
[43]朱秋根,罗婷.米氮平治疗糖尿病合并抑郁症的临床研究[J].实用临床医学,2008,9(11)：16-18
[1]李惠林,黄皓月,邸振福等.2型糖尿病患者骨密度,性激素与肾虚关系研究.第八次全国中医药糖尿病学术大会论文集,2005.9：P268-272.
[2]《中药新药临床研究指导原则》[M].北京：中国医药科技出版社,2002.4.
[3]中华中医药学会发布.《中医内科常见病诊疗指南》[M].北京：中国中医药出版社,2008.7(1)
[4]赵燕,王天芳等.抑郁症中医证候及证候要素分布特点的文献研究[J].中医杂志,2006.9,47(9)：P691-692.
[5]胡随瑜,张宏耕,郑林等.1977例抑郁症患者中医不同证候构成比分析[J].中国医师杂志,2003.10,5(10)：P1312—1314.
[6]陈文恺,周玲,梅晓云等.571例抑郁症中医证候学临床流行病学调查[J].浙江中医杂志,2007.5,42(5)：P262—263.
[7]国家中医药管理局发布.《中医病证诊断疗效标准》[M].南京：南京大学出版社出版,1994.7(1)：20.
[8]中华中医药学会脑病专业委员会,国家中医药管理局全国脑病重点专科抑郁症协作组。抑郁症中医证候诊断标准及治疗方案[J].北京中医药大学学报,2011,34(12),810-811.
[9]唐启盛,裴清华,温琇清。消渴解郁方治疗糖尿病后抑郁症的临床研究[J].中国中医基础医学杂志,2006,12(8),605-607.
[10]张登本,武长春.内经辞典.北京：人民卫生出版社,1990.209.
[1]唐启盛,裴清华,温琇清。消渴解郁方治疗糖尿病后抑郁症的临床研究。中国中医基础医学杂志,2006,12(8),605-607
[2]曾艳,贾正平,张汝学,等.地黄寡糖在2型2型糖尿病大鼠模型上的降血糖作用及机制.中国药理学通报,2006,22(4)：411一415
[3]崔瑛,沈云辉,侯士良,等.熟地黄对记忆障碍模型小鼠记忆力影响的实验研究.[J].河南中医学院学报,2003,18(5)：32—34.
[4]王明艳,赵凤鸣,蔡宝昌.山茱萸及其活性成分的药效研究概述.[J].中华中医药学刊,2008,(26)7,1419-1421
[5]钮心懿。五味子有效成分“醇甲“对中枢神经系统作用[J].药学学报,1983,18(6)：416-421
[6]孙膑等柴胡皂甙对猫睡眠活动调节的实验研究,天津医科大学学报,2000,6(3)：274
[7]曹美群,胡随瑜,张春虎。白松片对慢性应激抑郁大鼠模型血浆CRH和ACTH浓度的影响。湖南中医学院学报,2004,(24)4：12-14
[8]李明亚,陈红梅。石菖蒲对行为绝望动物抑郁模型的抗抑郁作用.中药材,2001,24(1)：40
[9]杨晓燕,陈发奎,刘玉兰.石曹蒲抗抑郁药理作用的研究.海军军事医学,1999,20(2)：16
[10]雷载权,张廷模主编。中华临床中药学,人民卫生出版社,1998
[11]CooPer MS, Stewart PM. Beta-hydroxysteroid dehydrogenase type 1 and its role in the hyPothalamus — Pituitary — adrenalaxis, metabolie syndrome, and inflammation. [J] Clin Endoerinol Metab,2009,94 (12):4645-4654
[12]Chakravarty K, Cassuro H, Reshef L, Hanson RW. Factors that control the tissue — specific transcription of the gene for Phos Phoenol Pyruvate carboxykinase-C[J]. Crit. Rev. Biochem.2005,40(3):129-154.
[13]Gathereole, L. L. and Stewart, P.M. Targeting the prereceptor metabolism of cortisol as a novel therapy in obesity and diabetes [J] Steroid Bioehem.2010,122(1-3):129-135.
[14]Chiodini 1, DiLembo S, Morelli V, Epaminonda P, ColettiF, MasseriniB, SeillitaniA, ArosioM, AddaG. HyPothalamie — Pituitary — adrenal activity in type 2 diabetes mellitus:role of autonomic imbalanee [J]. Metabolism Clinical and ExPerimental,2006,55(8):1135-1140.
[15]夏凌,张春阳,刘志民.褪黑素抑制2型糖尿病大鼠下丘脑—垂体—肾上腺轴功能[J].第二军医大学学报,2007,28(11)：1184—1187.