解郁通络法对脑卒中后抑郁患者神经递质水平的影响  

Effect of Jieyu Tongluo Method in Regulating Levels of Neurotransmitter from Patients with Post-stroke Depression

作　　者：李庆丽[1] 王贵贤[1] 王艳捷 杨明[1] 薛中峰 LI Qing-li;WANG Gui-xian;WANG Yan-jie;YANG Ming;XUE Zhong-feng(The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China;Guangxi University of Traditional Chinese Medicine,Nanning 530001,China)

机构地区：[1]新乡医学院第二附属医院,河南新乡453002 [2]广西中医药大学,南宁530001

出　　处：《中国实验方剂学杂志》2019年第7期134-139,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省教育厅重点科学技术项目(16B320222)

摘　　要：目的:观察解郁通络法治疗卒中后抑郁(PSD)患者的临床疗效及对神经递质的调节作用。方法:共选择125例符合要求的PSD患者作为研究对象,采用SAS软件,按随机数字表法分为观察组63例和对照组62例。两组患者均口服盐酸舍曲林片,25～50 mg/次,2次/d。对照组口服舒肝解郁胶囊,2粒/次,2次/d;观察组内服解郁通络汤,1剂/d。两组疗程均为连续治疗6周。进行治疗前后汉密尔顿抑郁量表-17(HAMD-17),患者健康问卷-9项(PHQ-9),美国国立卫生研究院卒中量表(NHISS),中医证候评分和日常生活活动能力量表(ADL)评分,检测治疗前后5-羟色胺(5-HT),去甲肾上腺素(NE),多巴胺(DA)脑源性神经营养因子(BDNF),血清S100-β蛋白(S100-β)和神经元烯醇化酶(NSE)水平。结果:观察组临床疗效优于对照组(Z=2. 384,P <0. 01);观察组患者HAMD-17和PHQ-9评分均低于对照组(P <0. 01);观察组HAMD-17评分情况轻于对照组(Z=2. 266,P <0. 05),观察组PHQ-9评分情况轻于对照组(Z=2. 817,P <0. 01);观察组患者的NHISS,中医证候评分均低于对照组(P <0. 01),ADL评分高于对照组(P <0. 01);观察组血清5-HT,DA和NE水平均高于对照组(P <0. 01);观察组血清S100-β和NSE水平均低于对照组(P <0. 01),BDNF水平高于对照组(P <0. 01)。结论:在心理治疗和SSRI治疗的基础上,给予PSD患者服用解郁通络汤,可进一步的减轻患者抑郁程度,缓解抑郁症状,还能减轻神经功能缺损程度和提高日常生活活动能力,调节神经递质表达,促进了脑神经组织的修复,临床可取的一定疗效。Objective:To observe the clinical efficacy of Jieyu Tongluo decoction on post-stroke depression(PSD)and its regulatory effect on neurotransmitter.Method:One hundred and twenty-five patients with PSD were randomly divided into control group(62 cases)and observation group(63 cases)by random number table.Both groups got psychological support,health education,and sertraline hydrochloride tablets,25-50 mg/time,2 times/days.Patients in control group got Shugan Jieyu capsules,2 grains/time,2 times/days.Patients in observation group got Jieyu Tongluo decoction,1 dose/day.And a course of treatment was 6 weeks.Before and after treatment,hamilton depression scale(HAMD-17),patient health questionnaire-9(PHQ-9),national institutes of health stroke scale(NHISS),traditional Chinese medicine(TCM)syndrome and activity of daily living scale(ADL)were scored.And levels of 5-serotonin(5-HT),norepinephrine(NE),dopamine(DA),brain-derived neurotrophic factor(BDNF),serum S100-β and neuron enolase(NES)were detected.Result:By rank sum test,after treatment,the clinical efficacy of observation group was superior to that in control group(Z=2.384,P<0.01).Scores of HAMD-17 and PHQ-9 were lower than those in control group(P<0.01).Score of HAMD-17 was lower than that in control group(Z=2.266,P<0.05),and score of PHQ-9 was lower than that in control group(Z=2.817,P<0.05).And scores of NHISS,TCM syndromes,serum S100 βand neuron enolase(NES)were lower than those in control group(P<0.01),while levels of ADL,5-HT,DA,NE and BDNF were all higher than those in control group(P<0.01).Conclusion:In addition to psychotherapy and SSRI,Jieyu Tongluo decoction can relieve degree of depression,depressive symptoms and degree of neurologic impairment,increase activities of daily living,regulate neurotransmitter expression,and improve the reparation of cranial nerve tissue,with obvious clinical effects,and is worthy to be used in clinic.

关 键 词：卒中后抑郁 解郁通络汤 四逆散 桃红四物汤 神经递质 神经功能 生活活动能力 

分 类 号：R25[医药卫生—中医内科学] R255[医药卫生—中医学]