加味柴胡桂枝汤联合草酸艾司西酞普兰对脑卒中后抑郁的干预作用及机制研究  

Intervention effect and mechanism of the Jiawei Chaihu Guizhi Decoction combined with escitalopram oxalate on post-stroke depression

作　　者：范穗强 孟春想 张凯娜[3] 张柏芳 金英花 王叶青[6] FAN Suiqiang;MENG Chunxiang;ZHANG Kaina;ZHANG Baifang;JIN Yinghua;WANG Yeqing(Department of Integrative Medicine and Metabolic Diseases,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China;Department of Rehabilitation Medicine,Guangdong Yanling Hospital,Guangzhou 510517,China;Department of Medical Record Statistics,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China;Department of Psychology,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China;Famous Chinese medicine studio,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China;Department of Traditional Chinese Medicine,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中西医结合代谢病科,广东广州510080 [2]广东燕岭医院康复医学科,广东广州510517 [3]广东药科大学附属第一医院病案统计科,广东广州510080 [4]广东药科大学附属第一医院心理科,广东广州510080 [5]广东药科大学附属第一医院名中医工作室,广东广州510080 [6]广东药科大学附属第一医院中医科,广东广州510080

出　　处：《中国现代医生》2022年第4期142-146,共5页China Modern Doctor

基　　金：广东省中医药局科研课题(20212113)。

摘　　要：目的研究加味柴胡桂枝汤联合草酸艾司西酞普兰对脑卒中后抑郁的干预作用,并探讨其治疗机制。方法选取2019年1月至2020年12月广东药科大学附属第一医院收治的脑卒中后抑郁(PSD)患者80例,按随机数字表法分为观察组和对照组,每组各40例。对照组单用草酸艾司西酞普兰治疗,观察组在对照组的基础上联合加味柴胡桂枝汤治疗。采用美国国立卫生研究院卒中量表(NIHSS)、汉密尔顿抑郁量表(HAMD)、日常生活能力表(BI)评分评估两组患者治疗前、治疗2、4、6周的神经功能、生活能力和抑郁改善情况;采集患者空腹血样,检测血清炎性因子白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)、血清神经递质5-羟色胺(5-HT)及脑功能损伤相关因子神经元特异性烯醇化酶(NSE)、神经肽Y(NPY)和脑源性神经营养因子(BDNF)的水平,探讨两组治疗方案对脑损伤调节的机制,记录不良反应,评估两组治疗方案的安全性。结果经治疗,两组的NIHSS、HAMD均降低,BI评分明显升高,且观察组NIHSS、HAMD评分情况低于对照组,BI评分高于对照组,差异有统计学意义(P<0.05)。观察组IL-6和TNF-α水平均低于对照组(P<0.001),5-HT水平高于对照组,NSE低于对照组,NPY和BDNF水平高于对照组。观察组不良反应总发生率为20.00%,低于对照组的37.50%(P>0.05)。结论相对于单独使用草酸艾司西酞普兰,加味柴胡桂枝汤联合草酸艾司西酞普兰对脑卒中后抑郁的治疗效果更显著,有效降低神经功能损伤,改善抑郁情况,提高患者的生活质量。Objective To study the intervention effect of Jiawei Chaihu Guizhi Decoction combined with escitalopram oxalate on post-stroke depression and explore its treatment mechanism.Methods A total of 80 patients with PSD admitted to the First Affiliated Hospital of Guangdong Pharmaceutical University from January 2019 to December 2020 were divided into observation group(n=40)and control group(n=40),according to the random number table method.The control group was treated with escitalopram oxalate alone,and the observation group was treated with Jiawei Chaihu Guizhi Decoction based on the control group.The National Institutes of Health Stroke Scale(NIHSS),Hamilton Depression Scale(HAMD),and Activities of Daily Living Scale Barthel Index(BI)were used to assess the improvement of neurological function,living ability,and depression before treatment and at 2,4,and 6 weeks of treatment in both groups.Fasting blood samples were collected from patients to detect the levels of serum inflammatory cytokines interleukin-6(IL-6)and tumor necrosis factorα(TNF-α),serum neurotransmitter serotonin(5-HT),and brain function injury-related factor neuron-specific enolase(NSE),neuropeptide Y(NPY),and brain-derived neurotrophic factor(BDNF).The mechanism of brain injury regulation by the two treatment regimens was investigated.The adverse reactions were recorded,and the safety of the two treatment regimens was assessed.Results After treatment,NIHSS and HAMD decreased,and BI score increased significantly in both groups.The NIHSS and HAMD scores in the observation group were lower than those in the control group,and the BI score was higher than that in the control group.The difference had statistical significance(P<0.05).IL-6 and TNF-αin the observation group were lower than those in the control group(P<0.001).The level of 5-HT in the observation group was higher than that in the control group,and the level of NSE was lower than that in the control group.The levels of NPY and BDNF in the observation group were higher than those in the contro

关 键 词：脑卒中后抑郁 加味柴胡桂枝汤 草酸艾司西酞普兰 干预作用 机制 

分 类 号：R741.05[医药卫生—神经病学与精神病学]