加味四逆散与盐酸氟西汀治疗中风后抑郁症的系统评价  

Systematic Evaluation on Modified Sini Powder and Fluoxetine Hydrochloride in the Treatment of Post-stroke Depression

作　　者：盛守静 李轶璠 李德需[2] 赵永辰[2] SHENG Shoujing;LI Yifan;LI Dexu;ZHAO Yongchen(Graduate School,Hebei University,Hebei Province,Baoding 071000,China;Department of Integrated Medicine,Affiliated Hospital of Hebei University,Hebei Province,Baoding 071000,China)

机构地区：[1]河北大学,河北保定071000 [2]河北大学附属医院中西医结合科,河北保定071000

出　　处：《光明中医》2021年第5期667-674,共8页GUANGMING JOURNAL OF CHINESE MEDICINE

基　　金：河北省级中医药类重大科研课题资助项目(No.ZYZD2013016)。

摘　　要：目的评价中药加味四逆散与西药盐酸氟西汀治疗中风后抑郁症(PSD)的有效性和安全性。方法系统检索中文数据库CNKI、万方、CBM、VIP以及英文数据库PubMed、Embase中关于加味四逆散与盐酸氟西汀治疗PSD的文献,检索时限为各数据库建库起至2018年12月。结果纳入10篇临床随机对照研究文献,共851例患者,其中试验组434例,对照组417例。Meta分析结果:试验组的总有效率、汉密尔顿抑郁量表(HAMD)评分、神经功能缺损程度评分量表(SSS/NIHSS)评分、日常生活活动能力评分量表(ADL)评分、血浆皮质醇、血清去甲肾上腺素(血清NE)、5羟色胺(5-HT)水平及安全性均优于对照组,差异有统计学意义。结论中药加味四逆散单独治疗PSD以及联合西药盐酸氟西汀治疗PSD与单独使用西药盐酸氟西汀疗效相比,具有一定优势,主要表现为不良反应较少,安全性更高。但由于纳入的研究质量普遍较低,可能存在一定的偏倚风险,所以还需更多高质量临床随机对照试验来进一步证实。Objective To evaluate the efficacy and safety of traditional Chinese medicine Sini powder and western medicine fluoxetine hydrochloride in the treatment of post-stroke depression(PSD).Methods Six electronic databases(CNKI,WANFANG,CBM,VIP,Pubmed and Embase)were systematically searched for references on the treatment of PSD by modified Sini powder and fluoxetine hydrochloride.The retrieval time was from the establishment of each database to December 2018.Results A total of 10 randomized controlled clinical studies were included,including 851 patients,434 in the experimental group and 417 in the control group.Meta analysis results showed that the experimental group(modified Sini powder combined with fluoxetine hydrochloride),the total effective rate,Hamilton depression scale(HAMD),degree of nerve function defect score scale(SSS/NIHSS),daily life activities ability score scale(ADL),plasma cortisol levels measured results,serum norepinephrine(NE)in serum and 5 hydroxytryptamine(5-HT)and safety were better than those of the control group(fluoxetine hydrochloride),and the difference was statistically significant.At the same time,blood,urine,stool routine as well as liver and kidney function,electrocardiogram,myocardial enzyme were not abnormal.Conclusion Compared with fluoxetine hydrochloride alone,the treatment of PSD with traditional Chinese medicine supplemented with Sini powder and the combination of fluoxetine hydrochloride has certain advantages,mainly manifested as fewer adverse reactions and higher safety.However,due to the generally low quality of the included studies,there may be some risk of bias,so more high-quality clinical randomized controlled trials are needed for further confirmation.

关 键 词：中风后抑郁症 四逆散 盐酸氟西汀 系统评价 Meta分析 中西医结合疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]