舒肝解郁胶囊联合重复经颅磁刺激治疗对围绝经期抑郁神经内分泌功能的影响
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摘要
目的:探讨舒肝解郁胶囊联合重复经颅磁刺激(r TMS)治疗对围绝经期抑郁的临床疗效及对神经内分泌功能的影响。方法:将符合要求的132例患者,按SAS软件生成的随机数字表法分为对照组和观察组。对照组65例,口服盐酸舍曲林片,50 mg/次,2次/d。观察组67例,口服舒肝解郁胶囊,2粒/次,分早、晚饭后服用; r TMS治疗,20 min/次,1次/d,连续治疗5 d为1个疗程,间隔2 d行下个疗程,共进行4个疗程。两组均连续治疗8周。采用汉密尔顿抑郁量表17项(HAMD-17)评价抑郁程度;进行治疗前后汉密尔顿焦虑量表(HAMA),匹兹堡睡眠质量指数(PSQI),Kupperman和肾虚肝郁证评分;检测治疗前后促卵泡刺激素(FSH),促黄体生成素(LH)和雌二醇(E2)等性激素水平;检测治疗前后5-羟色胺(5-HT),多巴胺(DA),去甲肾上腺素(NE)和5-羟吲哚乙酸(5-HIAA)水平;进行安全性评价。结果:经重复测量的方差分析,治疗后两组患者HAMD-17评分均明显下降(P <0. 01),观察组患者在治疗后第8周HAMD-17评分低于对照组(P <0. 01);观察组患者肾虚肝郁证,HAMA,PSQI和Kupperman评分均低于对照组(P <0. 01);观察组抑郁总有效率95. 52%高于对照组的81. 54%(X~2=6. 405,P <0. 05);观察组中医证候总有效率92. 54%,高于对照组的78. 46%(X~2=5. 304,P <0. 05);治疗后观察组患者FSH和LH水平均低于对照组,E2水平较高于对照组(P <0. 01);观察组患者血清5-HT,DA,NE和5-HIAA水平均高于对照组(P <0. 01)。结论:舒肝解郁胶囊联合r TMS治疗围绝经期抑郁肾虚肝郁型患者在改善抑郁、焦虑症状等方面疗效优于盐酸舍曲林片,并具有调节性激素和单胺类神经递质水平作用。
Objective: To discuss the clinical effect of Shugan Jieyu capsules combined with repetitivetranscranial magnetic stimulation(r TMS) on depression during perimenopause and neuroendocrine function. Method: One hundred and thirty-two patients were divided into control groupand observation groupby random number table. Patients(65 cases) in observation group got sertraline hydrochloride tablets,50 mg/time,2 times/days. Patients(67 cases) in control group got Shugan Jieyu capsules after breakfast and dinner,2 grains/time,and treatment of r TMS,20 minutes/time,1 time/day. And one course of treatment was 5 days,there were a2-day interval between two courses. And there were a total of 4 courses in the two groups. Both groups were continuously treated for8 weeks. Degree of depression was evaluated by Hamilton depression scale-17(HAMD-17). Before and after treatment,scores of Hamilton anxiety scale(HAMA),quality index of sleep in Pittsburgh(PSQI),Kupperman and syndrome of kidney deficiency and stagnation of liver were graded. Levels of follicle stimulating hormone(FSH),Luteinizing hormone(LH),estradiol(E2),5-serotonin(5-HT),dopamine(DA),norepinephrine(NE) and 5-hydroxyindolyl acetic acid(5-HIAA) were detected,and the safety was evaluated. Result: According to the variance analysis of repeated measurements, after treatment, score of HAMD-17 decreased(P < 0. 01). At the 8 thday after treatment,score of HAMD-17 of observation groupwas lower than that in control group(P < 0. 01). And scores of syndrome of kidney deficiency and stagnation of liver,HAMA,PSQI and Kupperman of observation group were lower than those in control group(P < 0. 01). And the total rate of depression in observation group was 95. 52%,which was higher than 81. 54% in control group(X~2=6. 405,P < 0. 05). And the total rate of traditional Chinese medicine(TCM) syndromes in observation group was92. 54%,which was higher than 78. 46% in control group(X~2= 5. 304,P < 0. 05). After treatment,levels of FSH and LH were lower than those in control group(P < 0. 01). Conclusion: Shugan Jieyu capsules combined with repetitivetranscranial magnetic stimulation can ameliorate symptoms of depression and anxiety, havea bettereffect than Sertraline hydrochloride tablets, and can regulate levels of sex hormone and monoamine neurotransmitter.
Objective: To discuss the clinical effect of Shugan Jieyu capsules combined with repetitivetranscranial magnetic stimulation(r TMS) on depression during perimenopause and neuroendocrine function. Method: One hundred and thirty-two patients were divided into control groupand observation groupby random number table. Patients(65 cases) in observation group got sertraline hydrochloride tablets,50 mg/time,2 times/days. Patients(67 cases) in control group got Shugan Jieyu capsules after breakfast and dinner,2 grains/time,and treatment of r TMS,20 minutes/time,1 time/day. And one course of treatment was 5 days,there were a2-day interval between two courses. And there were a total of 4 courses in the two groups. Both groups were continuously treated for8 weeks. Degree of depression was evaluated by Hamilton depression scale-17(HAMD-17). Before and after treatment,scores of Hamilton anxiety scale(HAMA),quality index of sleep in Pittsburgh(PSQI),Kupperman and syndrome of kidney deficiency and stagnation of liver were graded. Levels of follicle stimulating hormone(FSH),Luteinizing hormone(LH),estradiol(E2),5-serotonin(5-HT),dopamine(DA),norepinephrine(NE) and 5-hydroxyindolyl acetic acid(5-HIAA) were detected,and the safety was evaluated. Result: According to the variance analysis of repeated measurements, after treatment, score of HAMD-17 decreased(P < 0. 01). At the 8 thday after treatment,score of HAMD-17 of observation groupwas lower than that in control group(P < 0. 01). And scores of syndrome of kidney deficiency and stagnation of liver,HAMA,PSQI and Kupperman of observation group were lower than those in control group(P < 0. 01). And the total rate of depression in observation group was 95. 52%,which was higher than 81. 54% in control group(X~2=6. 405,P < 0. 05). And the total rate of traditional Chinese medicine(TCM) syndromes in observation group was92. 54%,which was higher than 78. 46% in control group(X~2= 5. 304,P < 0. 05). After treatment,levels of FSH and LH were lower than those in control group(P < 0. 01). Conclusion: Shugan Jieyu capsules combined with repetitivetranscranial magnetic stimulation can ameliorate symptoms of depression and anxiety, havea bettereffect than Sertraline hydrochloride tablets, and can regulate levels of sex hormone and monoamine neurotransmitter.
引文
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[2]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.
[3]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.
[4]马小娟,赵杰,冯振宇,等.加味甘麦大枣汤对更年期抑郁症患者神经内分泌系统的影响[J].中国中药杂志,2014,39(23):4680-4684.
[5]王含彦,郭冬梅,唐珍,等.舒肝解郁胶囊的抗抑郁作用及其机制[J].中成药,2018,40(1):187-190.
[6]石克威,徐卓,孙毅,等.舒肝解郁胶囊治疗围绝经期焦虑抑郁的疗效观察[J].解放军药学学报,2018,34(2):177-178.
[7]金毅琼.帕罗西汀联合重复经颅磁刺激治疗女性更年期抑郁症的对照研究[J].四川精神卫生,2015,28(6):515-518.
[8]吴萍,楼云霞,陈小鸣.围绝经期抑郁症与性激素水平关系的研究[J].中国性科学,2015,24(3):108-110.
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[11]李华芳.精神药物临床研究常用量表[M]. 2版.上海:上海科技教育出版社,2014:31-45.
[12]路桃影,李艳,夏萍,等.匹兹堡睡眠质量指数的信度及效度分析[J].重庆医学,2014,40(3):260-263.
[13]王新,王轶蓉.女性围绝经期综合征中医治疗[J].辽宁中医药大学学报,2016,18(11):107-109.
[14]马璇,蒋丽,杨燕芬,等.地贞颗粒对围绝经期综合征患者阴虚内热证神经-内分泌的影响[J].中国实验方剂学杂志,2018,24(12):182-187.
[15]许凤全,许琳洁,张莹. 98例女性更年期抑郁症患者中医证候分布规律临床研究[J].世界中西医结合杂志,2014,9(10):1056-1058.
[16]传娟娟,李燕.贯叶金丝桃(圣约翰草)的国内外研究概况[J].西北药学杂志,2016,31(3):330-332.
[17]杨歆科,赵瑞珍,李小黎,等.参芪解郁方对产后抑郁大鼠脑前额叶皮层,海马区5-HT,NE及其受体的干预机制[J].中国实验方剂学杂志,2017,23(24):112-120.
[18]潘菊华,李多娇,王彦云.刺五加抗抑郁作用探析[J].中医学报,2016,31(1):83-86.
[19]濮正平,夏江明,谢巍,等.基于文献的舒肝解郁胶囊临床应用文本挖掘研究[J].中国中药杂志,2017,42(17):3430-3433.
[20]李克建,郭娟,陈云.补肾解郁清心汤治疗更年期抑郁症疗效及对DA,NE,5-HIAA的影响[J].现代中西医结合杂志,2017,26(26):2864-2866.
[21]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.
[22]王睿,王琪,金明顺,等.白藜芦醇对围绝经期抑郁症模型小鼠行为学影响及机制分析[J].中国实验方剂学杂志,2017,23(4):132-139.
[2]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.
[3]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.
[4]马小娟,赵杰,冯振宇,等.加味甘麦大枣汤对更年期抑郁症患者神经内分泌系统的影响[J].中国中药杂志,2014,39(23):4680-4684.
[5]王含彦,郭冬梅,唐珍,等.舒肝解郁胶囊的抗抑郁作用及其机制[J].中成药,2018,40(1):187-190.
[6]石克威,徐卓,孙毅,等.舒肝解郁胶囊治疗围绝经期焦虑抑郁的疗效观察[J].解放军药学学报,2018,34(2):177-178.
[7]金毅琼.帕罗西汀联合重复经颅磁刺激治疗女性更年期抑郁症的对照研究[J].四川精神卫生,2015,28(6):515-518.
[8]吴萍,楼云霞,陈小鸣.围绝经期抑郁症与性激素水平关系的研究[J].中国性科学,2015,24(3):108-110.
[9]中华中医药学会.中医妇科常见病诊疗指南[M].北京:中国中医药出版社,2012:41-43.
[10]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.
[11]李华芳.精神药物临床研究常用量表[M]. 2版.上海:上海科技教育出版社,2014:31-45.
[12]路桃影,李艳,夏萍,等.匹兹堡睡眠质量指数的信度及效度分析[J].重庆医学,2014,40(3):260-263.
[13]王新,王轶蓉.女性围绝经期综合征中医治疗[J].辽宁中医药大学学报,2016,18(11):107-109.
[14]马璇,蒋丽,杨燕芬,等.地贞颗粒对围绝经期综合征患者阴虚内热证神经-内分泌的影响[J].中国实验方剂学杂志,2018,24(12):182-187.
[15]许凤全,许琳洁,张莹. 98例女性更年期抑郁症患者中医证候分布规律临床研究[J].世界中西医结合杂志,2014,9(10):1056-1058.
[16]传娟娟,李燕.贯叶金丝桃(圣约翰草)的国内外研究概况[J].西北药学杂志,2016,31(3):330-332.
[17]杨歆科,赵瑞珍,李小黎,等.参芪解郁方对产后抑郁大鼠脑前额叶皮层,海马区5-HT,NE及其受体的干预机制[J].中国实验方剂学杂志,2017,23(24):112-120.
[18]潘菊华,李多娇,王彦云.刺五加抗抑郁作用探析[J].中医学报,2016,31(1):83-86.
[19]濮正平,夏江明,谢巍,等.基于文献的舒肝解郁胶囊临床应用文本挖掘研究[J].中国中药杂志,2017,42(17):3430-3433.
[20]李克建,郭娟,陈云.补肾解郁清心汤治疗更年期抑郁症疗效及对DA,NE,5-HIAA的影响[J].现代中西医结合杂志,2017,26(26):2864-2866.
[21]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.
[22]王睿,王琪,金明顺,等.白藜芦醇对围绝经期抑郁症模型小鼠行为学影响及机制分析[J].中国实验方剂学杂志,2017,23(4):132-139.