氟哌噻吨美利曲辛与帕罗西汀联合用药治疗脑卒中后重性抑郁障碍的临床研究  

Clinical study of haloperidazone-melitracen combined with paroxetine in the treatment of severe depressive disorder after stroke

作　　者：吴有林[1] 王永胜[2] WU Youlin;WANG Yongsheng(Central Laboratory of Gansu Provincial Institute of Traditional Chinese Medicine,Lanzhou Gansu 730050,China)

机构地区：[1]崇州市人民医院神经内科,611230 [2]甘肃省中医药研究院中心实验室,730050

出　　处：《中国神经免疫学和神经病学杂志》2019年第6期427-431,436,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：四川省卫生和计划生育委员会科研项目(18PJ338)。

摘　　要：目的观察氟哌噻吨美利曲辛与帕罗西汀联合治疗脑卒中后重性抑郁障碍的临床疗效及机制分析。方法使用随机分组法将100例脑卒中后重性抑郁障碍的患者随机分为对照组、观察组两组,每组50例。对照组给予盐酸帕罗西汀肠溶缓释片治疗(25 mg口服1次/d);观察组在对照组基础上给予氟哌噻吨美利曲辛片治疗〔20 mg(含氟哌噻吨0.5 mg、美利曲辛10 mg)口服,早上、中午各1次〕。比较两组患者的疗效、药物不良反应,两组患者治疗前后神经功能缺损程度〔以美国国立卫生研究院卒中量表(NIHSS)评分评定〕、汉密尔顿抑郁量表(HADM)评分、日常生活能力(ADL)评分、生活质量评定表(SS-QOL)分数以及白细胞介素-1β(IL-1β)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)及皮质醇(Cor)的水平。结果观察组临床治疗有效率高于对照组(90%比64%,P<0.05);治疗后观察组NIHSS、HADM、SS-QOL评分均明显低于对照组(P<0.05),ADL评分明显高于对照组(P<0.05);治疗后两组患者IL-1β、IL-2、IL-6、TNF-α、CRH、ACTH及Cor表达水平均明显低于治疗前(均P<0.05),且治疗后观察组上述各指标水平低于对照组(P<0.05);两组患者治疗过程中均无严重不良反应发生。结论氟哌噻吨美利曲辛与帕罗西汀联合用药治疗脑卒中后重性抑郁障碍较为安全有效,其主要机制可能为通过下调相关神经免疫炎性指标的表达水平抑制了患者丘脑-垂体-肾上腺轴功能亢进状态。Objective To observe the clinical efficacy and mechanism of haloperidazone-melitracen combined with paroxetine in the treatment of severe depressive disorder after stroke.Methods 100 patients with severe depressive disorder after stroke were randomly divided into a control group and an observation group with 50 cases in each group.The control group was treated with paroxetine hydrochloride enteric-coated sustained-release tablets(25 mg,once a day);the observation group was treated with flupenthixol and melitracen tablets(20 mg,0.5 mg and 10 mg respectively,once in the morning and once in the noon)on the basis of paroxetine therapy as the control group.The efficacy,adverse reactions,neurological impairment(NIHSS),Hamilton Depression Scale(HADM),ADL,SS-QOL,interleukin-1 beta(IL-1 beta),interleukin-2(IL-2),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-alpha),corticotropin releasing hormone(CRH),adrenocorticotropic hormone(ACTH)and cortisol(Cor)levels were compared between the two groups before and after treatment.Results The effective rate of clinical treatment in the observation group was higher than that in the control group(90%vs.64%,P<0.05);after treatment,the NIHSS,HADM,SS-QOL scores in the observation group were significantly lower than those in the control group(P<0.05),and the ADL score was significantly higher than those in the control group(P<0.05);after treatment,the expression levels of IL-1beta,IL-2,IL-6,TNF-alpha,CRH,ACTH and Cor in the two groups were significantly lower than baseline.The levels of the above indexes in the observation group were lower than those in the control group(P<0.05).There were no serious adverse reactions in the two groups during the treatment.Conclusions The combination of haloperidazone and paroxetine is safe and effective in the treatment of severe depressive disorder after stroke.The main mechanism may be that it inhibits the hyperfunction of thalamus-pituitary-adrenal axis by down-regulating the expression of related neuro-immune inflammatory markers.

关 键 词：氟哌噻吨美利曲辛 帕罗西汀 脑卒中 重性抑郁障碍 临床观察 作用机制 

分 类 号：R734.1[医药卫生—肿瘤]