加减通窍活血汤联合富马酸喹硫平片治疗双相情感障碍躁狂发作痰火扰神兼气血瘀滞证的临床研究  

Clinical research of modified Tongqiao Huoxue Decoction combined with quetiapine fumarate tablets for bipolar disorder with manic episode of phlegm fire disturbing god and qi and blood stagnancy

作　　者：吴恩海[1] 丁莉莉 张丽卿 WU Enhai;DING Lili;ZHANG Liqing(Department of Psychiatry,East District of Handan First Hospital(Handan Psychiatric Hospital),Hebei,Handan 056001)

机构地区：[1]河北省邯郸市第一医院东区(邯郸市精神病医院)精神科,河北邯郸056001

出　　处：《河北中医》2022年第1期86-91,共6页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察加减通窍活血汤联合富马酸喹硫平片治疗双相情感障碍(BD)躁狂发作痰火扰神兼气血瘀滞证的临床疗效。方法将114例BD躁狂发作痰火扰神兼气血瘀滞证患者按照随机数字表法分为2组,对照组57例予富马酸喹硫平片治疗,治疗组57例在对照组基础上联合加减通窍活血汤治疗。2组均治疗8周统计疗效,比较2组治疗前及治疗3 d、2周、4周、8周倍克-拉范森躁狂量表(BRMS)评分和副反应量表(TESS)评分变化情况,比较2组治疗前及治疗8周阳性和阴性精神症状评定量表(PANSS)、汉密尔顿抑郁量表(HAMD)评分、认知功能指标[包括威斯康星卡片分类测验(WCST)、言语记忆测验(HVLT-R)、视听觉注意力持续操作测验(CPT)]及血清脑源性神经营养因子(BDNF)、白细胞介素-1β(IL-1β)、肿瘤坏死因子α(TNF-α)水平变化情况。结果治疗组总有效率94.74%(54/57),对照组总有效率77.19%(44/57),治疗组疗效优于对照组(P<0.05)。2组治疗3 d、2周、4周、8周BRMS评分与本组治疗前比较均降低(P<0.05),且治疗组治疗3 d、2周、4周、8周BRMS评分均低于对照组。2组治疗8周PANSS评分、HAMD评分与本组治疗前比较均降低(P<0.05),且治疗组治疗8周PANSS评分、HAMD评分均低于对照组(P<0.05)。2组治疗8周CPT评分与本组治疗前比较均增加(P<0.05),WCST评分、HVLT-R评分虽然也有增加趋势但比较差异无统计学意义(P>0.05),治疗组治疗8周CPT评分高于对照组(P<0.05)。2组治疗8周与本组治疗前比较BDNF水平增加(P<0.05),IL-1β、TNF-α水平降低(P<0.05),且治疗组治疗8周改善均优于对照组(P<0.05)。2组治疗3 d、2周、4周、8周TESS评分组间比较差异均无统计学意义(P>0.05),但2组治疗2、4、8周TESS评分较本组治疗3 d均升高(P<0.05)。结论加减通窍活血汤联合富马酸喹硫平片治疗BD躁狂发作痰火扰神兼气血瘀滞证疗效确切,可有效控制患者的躁狂症状,改善精神和抑郁症Objective To observe the effect of modified Tongqiao Huoxue Decoction combined with quetiapine fumarate tablets for bipolar disorder(BD)patients with manic episode(phlegm fire disturbing god and qi and blood stagnancy).Methods Totally 114 BD patients with manic episode(phlegm fire disturbing god and qi and blood stagnancy)were randomly assigned into the treatment group(n=57)and the control group(n=57).All patients were managed by quetiapine fumarate tablets,and those in the treatment group were additionally treated with modified Tongqiao Huoxue Decoction.Treated for 8 weeks,the aim was to compare Bech-Rafaelsen Mania Scale(BRMS)and Treatment Emergent Symptom Scale(TESS)on days 0 and 3 and on weeks 2,4 and 8;Positive and Negative Syndrome Scale(PANSS),Hamilton Depression Rating Scale(HAMD),cognitive function indicators(Wisconsin card sorting test[WCST],hopkin verbal learning test-revision[HVLT-R],visual and auditory continuous performance test[CPT]),serum brain-derived neurotrophic factor(BDNF),interleukin-1 bate(IL-1β),tumor necrosis factor-α(TNF-α)on weeks o and 8;the curative effect was assessed.Results The overall effective rate in the treatment group was better than that in the control group(94.74%[54/57]vs 77.19%[44/57],[P<0.05],respectively).Compared with before treatment,the BRMS scores in groups on day 3 and on weeks 2,4 and 8 were decreased(P<0.05),the treatment group was lower than the control group(P<0.05);the PANSS scores and HAMD scores in groups on week 8 were decreased(P<0.05),the treatment group was more common(P<0.05);the CPT scores in groups on week 8 were increased(P<0.05),the treatment group was more prevalent(P<0.05);the WCST scores and HVLT-R scores showed an increasing trend,but with no statistically significant difference(P>0.05);increased level of BDNF and decreased levels of IL-1βand TNF-αwere detected in groups on week 8,improvement of which in the treatment group were significantly better(P<0.05);the difference was not statistically significant in the TESS scores on day 3 and on w

关 键 词：双相情感障碍 抗躁狂药 躁狂发作 通窍活血汤 中西医结合疗法 

分 类 号：R277.7[医药卫生—中医学] R749.4