酸枣仁汤联合氟西汀治疗肝郁血虚型抑郁症伴失眠的临床观察  

Clinical Observation of Suanzaoren Tang Combined with Fluoxetine in Treatment of Depression of Liver Stagnation and Blood Deficiency Accompanied by Insomnia

作　　者：尚立芝[1,2] 毛梦迪 李耀洋 季书 陈晓辉 王伟杰[3] 周春雨[1] 王伟 孙鸿昌[4] SHANG Li-zhi;MAO Meng-di;LI Yao-yang;JI Shu;CHEN Xiao-hui;WANG Wei-jie;ZHOU Chun-yu;WANG Wei;SUN Hong-chang(Henan University of Chinese Medicine,Zhengzhou 450046,China;Henan Key Laboratory of Modern Research of Zhang Zhongjing's Formulas and Prescriptions,Zhengzhou 450046,China;First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450006,China;Second Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450005,China)

机构地区：[1]河南中医药大学,郑州450046 [2]河南省仲景方药现代研究重点实验室,郑州450046 [3]河南中医药大学第一附属医院,郑州450006 [4]河南中医药大学第二附属医院,郑州450005

出　　处：《中国实验方剂学杂志》2021年第24期49-54,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省高等学校重点科研项目(20B360011,21A630020);河南省教育科学“十三五”规划一般课题([2019]-JKGHYB-0101,[2019]-JKGHYB-0114);河南省中医药科学研究专项课题(2019ZY3048)。

摘　　要：目的:观察酸枣仁汤联合氟西汀治疗肝郁血虚型抑郁症伴失眠患者的临床疗效。方法:将120例肝郁血虚型抑郁伴失眠患者随机平均分为观察组与对照组,每组60例,对照组口服盐酸氟西汀胶囊(百忧解),观察组用酸枣仁汤联合盐酸氟西汀,两组疗程均为8周。用汉密尔顿抑郁量表(HAMD),日常生活能力量表(ADL)和匹兹堡睡眠质量指数量表(PSQI)评估临床疗效;ELISA法测定血浆中5-羟色胺(5-HT),去甲肾上腺素(NE),脑源性神经营养因子(BDNF),胶质细胞源性神经营养因子(GDNF),神经元特异性烯醇化酶(NSE)和S100β水平。结果:治疗8周后,与同组治疗前比较,观察组的HAMD和PSQI评分均显著下降(P<0.01);ADL显著提高(P<0.01);血浆5-HT,NE,GDNF和BDNF均显著增高(P<0.01)。治疗后,与对照组比较,观察组总有效率显著升高(P<0.01),HAMD评分和PSQI均显著降低(P<0.01),ADL评分显著升高(P<0.01);血浆5-HT,NE,BDNF和GDNF水平均显著增高(P<0.01),而NSE和S100β水平均显著降低(P<0.01)。结论:酸枣仁汤联合氟西汀治疗肝郁血虚型抑郁症伴失眠的疗效优于单用氟西汀。其机制可能酸枣仁汤对氟西汀增加单胺类神经递质有协同作用,并与促进BDNF和GDNF的分泌,增加对神经细胞的保护有关。Objective:To observe the clinical therapeutic effect of Suanzaoren Tang combined with fluoxetine in the treatment of patients with depression of liver stagnation and blood deficiency accompanied by insomnia.Method:The patients with depression of liver stagnation and blood deficiency accompanied by insomnia(120 cases)were randomly divided into an observation group and a control group,with 60 cases in each group.The patients in the observation group received Suanzaoren Tang combined with fluoxetine,and those in the control group received fluoxetine.The course of treatment was eight weeks.The clinical efficacy was evaluated with Hamilton Depression Rating Scale(HAMD),Pittsburgh Sleep Quality Index(PSQI),and Activities of Daily Living(ADL)score.Enzyme-linked immunosorbent assay(ELISA)was used to determine the plasma levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),brain-derived neurotrophic factor(BDNF),glial cell-derived neurotrophic factor(GDNF),neuron-specific enolase(NSE),and S100β.Result:After eight weeks of treatment,the scores of HAMD and PSQI were reduced(P<0.01),while the scores of ADL were elevated(P<0.01),and the levels of 5-HT,NE,GDNF and BDNF were up-regulated(P<0.01)in the plasma of patients in the observation group as compared with those before treatment.After treatment,compared with the control group,the observation group showed increased total effective rate(P<0.01),decreased scores of HAMD and PSQI(P<0.01),elevated score of ADL(P<0.01),up-regulated levels of 5-HT,NE,GDNF and BDNF in plasma,and declining NSE and S100β(P<0.01).Conclusion:Suanzaoren Tang combined with fluoxetine is superior to fluoxetine alone in treating the depression of liver stagnation and blood deficiency accompanied by insomnia.Its therapeutic effect is achieved by increasing the release of monoamine neurotransmitters and promoting the secretion of BDNF and GDNF in the brain.

关 键 词：抑郁症 失眠 酸枣仁汤 去甲肾上腺素(NE) 5-羟色胺(5-HT) 脑源性神经营养因子(BDNF) 

分 类 号：R2-0[医药卫生—中医学] R22