黄连温胆汤加味治疗卒中后抑郁症的效果及对脑神经代谢物表达水平的影响  

Effect of Modified Huanglian Wendan Decoction on post-stroke depression and its influence on the expression level of neurometabolites in brain

作　　者：王雅娟 刘玉洁 段红莉 张娟 WANG Yajuan;LIU Yujie;DUAN Hongli;ZHANG Juan(Department of Encephalopathy,Tangshan Hospital of Traditional Chinese Medicine,Hebei Province,Tangshan063000,China)

机构地区：[1]河北省唐山市中医医院脑病科

出　　处：《中国医药导报》2019年第32期75-78,94,共5页China Medical Herald

基　　金：河北省中医药管理局科研课题（2018320）

摘　　要：目的 探讨卒中后抑郁症(PSD)应用黄连温胆汤加味治疗的临床效果及对患者脑神经代谢物变化的影响。方法 选取2017年6月~2018年12月唐山市中医医院收治的96例PSD患者,采用随机数字表法将其分为观察组及对照组,每组48例。对照组口服盐酸舍曲林片治疗,观察组则在此基础上联合黄连温胆汤加味内服治疗,疗程8周。比较两组临床效果,治疗前后对两组抑郁症状[17项汉密尔顿抑郁量表(HAMD)、Zung抑郁自评量表(SDS)]、认知功能[简易精神状态检查(MMSE)]、睡眠质量[匹兹堡睡眠质量指数(PSQI)]、日常生活能力[改良Barthel指数(MBI)]状况各测评1次,同时测定脑神经代谢指标[去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)与5-羟吲哚乙酸(5-HIAA)比值(5-HT/5-HIAA比值)、3,4-二羟基苯乙酸(DOPAC)与高香草酸(HVA)比值(DOPAC/HVA比值)]水平。结果 观察组总有效率显著高于对照组(P <0.05)。两组治疗后HAMD、SDS和PSQI评分均显著降低,而MMSE、MBI评分均显著升高(均P <0.05),与对照组比较,观察组改善更明显(P <0.05)。两组治疗后血清NE、DA浓度及5-HT/5-HIAA、DOPAC/HVA比值均较治疗前显著增高(均P <0.05),与对照组比较,观察组改善更明显(P <0.05)。结论 黄连温胆汤加味辅助治疗PSD的整体效果切实,有助于缓解患者抑郁症状,改善认知功能及睡眠质量,这可能与该临床经验方显著正性调控相关脑神经代谢物表达水平有关。Objective To explore the clinical efficacy of Modified Huanglian Wendan Decoction in treating post-stroke depression(PSD)and its effect on the changes of brain neurometabolites in patients.Methods A total of 96 patients with PSD admitted to Tangshan Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were selected and randomly divided into the observation group and the control group according to random number table method,48 cases in each group.The control group was treated with Sertraline Hydrochloride Tablets orally,and the observation group was added with Modified Huanglian Wendan Decoction on the basis of the control group.All patients were treated for 8 weeks.The clinical efficacy of the two groups was compared.The depression symptoms[17 Hamilton depression scale(HAMD),Zung self-rating depression scale(SDS)],cognitive function[minimum mental state examination(MMSE)],the quality of sleep[Pittsburgh sleep quality index(PSQI)],daily living ability[improved Barthel index(MBI)]in the two groups were evaluated once before and after treatment.At the same time,the levels of brain neurometabolism indexs[norepinephrine(NE),dopamine(DA),the ratio of 5-hydroxytryptophan(5-HT)to 5-hydroxyindoleacetic acid(5-HIAA)(5-HT/5-HIAA ratio),and the ratio of 3,4-dihydroxyphenylacetic acid(DOPAC)to high vanillic acid(HVA)(DOPAC/HVA ratio)]were measured.Results The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).Compared with before treatment,the scores of HAMD,SDS and PSQI were significantly lower,while the scores of MMSE and MBI were significantly increased(all P<0.05).Compared with the control group,the improvement was more obvious in the observation group(P<0.05).The concentrations of serum NE,DA and the ratios of 5-HT/5-HIAA and DOPAC/HVA were significantly higher in the two groups after treatment (all P < 0.05). Compared with the control group, the improvement was more obvious in the observation group ( P < 0.05). Conclusion The overall efficacy

关 键 词：卒中后抑郁症 黄连温胆汤加味 认知功能 睡眠质量 

分 类 号：R743.3[医药卫生—神经病学与精神病学]