高压氧联合舍曲林治疗卒中后抑郁的疗效分析及其对BDNF及mTOR的影响  

Analysis of the efficacy of hyperbaric oxygen combined with sertraline in the treatment of post-stroke depression and its effect on BDNF and mTOR

作　　者：杨驱云[1] 危智盛[1] 洪丽文[1] 李瑞莹[1] 皇甫丽 张美宋[1] YANG Quyun;WEI Zhisheng;HONG Liwen;LI Ruiying;HUANG Puli;ZHANG Meisong(The First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China)

机构地区：[1]广东药科大学附属第一医院,广东广州510080

出　　处：《广东药科大学学报》2020年第3期421-425,共5页Journal of Guangdong Pharmaceutical University

基　　金：广东省医学科学技术研究基金项目(A2018188)。

摘　　要：目的探讨高压氧(HBO)治疗是否能提高传统抗抑郁药物对卒中后抑郁(PSD)的疗效及缩短起效时间并探讨其可能机制。方法选取2017年1月至2019年6月在我院神经内科住院及门诊就诊的PSD患者60例,随机分成HBO治疗组和舍曲林治疗组。HBO治疗组28例,予以高压氧联合舍曲林治疗;高压氧治疗每日1次,每周5次,10次为1疗程,连续治疗2疗程,共观察4周;同时患者口服舍曲林(左洛复)50 mg/d,共观察4周。舍曲林治疗组32例,仅给予舍曲林50 mg/d,连续治疗观察4周。所有PSD患者在治疗前及治疗后第7、14、21、28天分别进行HAMD评分,同时采集静脉血,ELISA检测血清BDNF及mTOR表达。结果HBO治疗组在治疗第7天即能明显改善PSD患者HAMD评分,而舍曲林治疗组则无明显改善;在治疗第14、21、28天,HBO治疗组HAMD评分治疗前后改变差值均明显高于舍曲林治疗组。在治疗第7天,HBO治疗组与舍曲林治疗组治疗后血清BDNF的改变并无明显差异,而在第14天,HBO治疗组BDNF治疗前后改变差值明显高于舍曲林治疗组。HBO治疗组在治疗第7、14天,mTOR水平较治疗前明显升高,而舍曲林治疗组则无明显改善。结论HBO联合舍曲林能缩短舍曲林对PSD患者的起效时间,提高疗效;HBO联合舍曲林具有快速提高血清mTOR水平作用,可能是HBO介导快速协同抗抑郁作用的机制之一。Objective To explore whether hyperbaric oxygen(HBO)treatment can improve the effect of traditional antidepressants on post-stroke depression(PSD),shorten the onset time and explore its possible mechanism.Methods Sixty patients with PSD who were hospitalized and outpatient in neurology department of our hospital from January 2017 to June 2019 were randomly divided into HBO treatment group and sertraline treatment group.In HBO group,28 patients were treated with HBO and sertraline.HBO treatment was once a day,five times a week,10 times a course,two consecutive courses of treatment,a total of 4 weeks.At the same time,patients took sertraline(levofloxacin)50 mg/d,a total of 4 weeks.32 cases in sertraline group were treated with sertraline 50 mg/d for 4 weeks.All PSD patients were assessed with HAMD before and 7,14,21 and 28 days after treatment.Meanwhile,venous blood was collected and serum BDNF and mTOR were detected by ELISA.Results The HAMD score of PSD patients in HBO group was significantly improved on the 7th day,but not in the sertraline treatment group.On the 14th,21st and 28th day of treatment,the difference of HAMD score in HBO group before and after treatment was significantly higher than that in sertraline group.On the 7th day of treatment,there was no significant difference in serum BDNF between HBO group and sertraline group.On the 14th day,the difference of BDNF before and after treatment in HBO group was significantly higher than that in sertraline group.On the 7th and 14th day of treatment,mTOR level in HBO treatment group was significantly higher than that before treatment,but there was no significant improvement in sertraline treatment group.Conclusion HBO combined with sertraline can shorten the onset time of sertraline in PSD patients and improve the efficacy.HBO combined with sertraline can rapidly improve the level of mTOR in serum,which may be one of the mechanisms of HBO mediated rapid synergistic antidepressant effect.

关 键 词：高压氧 舍曲林 卒中后抑郁 脑源性神经营养因子 哺乳类雷帕霉素靶蛋白 HAMD量表 

分 类 号：R743[医药卫生—神经病学与精神病学]