清心温胆汤联合丙戊酸镁治疗双相情感障碍躁狂发作的临床研究  

Clinical study on the treatment of QingxinWendan decoction in bipolar disorder manic episode patients

作　　者：李琪 杨萍[2] 李进 喻筠 肖慧琼[2] 张雪花[2] 刘学军[2] Li Qi;Yang Ping;Li Jin;Yu Jun;Xiao Huiqiong;Zhang Xuehua;Liu Xuejun(School of Clinical Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;Department of Psychiatry,Hunan Brain Hospital(the Second People's Hospital of Hunan Province),Changsha 410007,China)

机构地区：[1]湖南中医药大学临床医学院,长沙410208 [2]湖南省脑科医院(湖南省第二人民医院)精神科,长沙410007

出　　处：《中国医师杂志》2022年第5期707-711,共5页Journal of Chinese Physician

基　　金：湖南省创新平台与人才计划(2021SK4022);湖南省重点领域研发计划(2020SK2123);湖南省中医药科研计划重点课题(202032);湖南省发改委创新研发项目(25);2020年湖南省研究生教育创新工程和专业能力提升工程项目(CX20200754);2020年中医药古籍文献和特色技术传承专项(202012)。

摘　　要：目的研究清心温胆汤联合丙戊酸镁治疗双相情感障碍(BD)躁狂发作的临床效果。方法前瞻性选取2020年2月至12月湖南省脑科医院收治的60例BD躁狂发作患者,根据随机字母表法分别纳入对照组和观察组,每组30例。对照组用丙戊酸镁缓释片治疗,观察组用清心温胆汤联合丙戊酸镁缓释片治疗,连续治疗4周后评定疗效。采用贝克-拉范森躁狂量表(BRMS)评价治疗前、后的躁狂程度,采用韦氏成人智力量表(WAIS-RC)和韦氏记忆量表(WMS)评价治疗前、后的认知功能,同时用酶联免疫吸附(ELISA)法测定治疗前、后患者血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)和β淀粉样蛋白(Aβ)水平;采用Spearman相关性分析法分析两组患者血清NSE、Aβ水平与WAIS-RC、WMS评分的相关性。结果观察组疗效优于对照组,差异有统计学意义(P<0.05)。治疗后对照组和观察组的BRMS评分均降低(均P<0.05),且治疗后观察组BRMS评分低于对照组(P<0.05);治疗后对照组和观察组的WAIS-RC和WMS评分均升高(均P<0.05),且治疗后观察组的WAIS-RC和WMS评分高于对照组(均P<0.05)。治疗后两组患者血清IL-1β、TNF-α、NSE和Aβ水平均下降(均P<0.05),且观察组的IL-1β、TNF-α、NSE和Aβ水平低于对照组(均P<0.05)。NSE、Aβ水平与WMS评分,NSE水平与WAIS-RC评分均呈负相关(均P<0.05)。结论丙戊酸镁缓释片联合清心温胆汤治疗BD躁狂发作患者在降低躁狂评分,降低血清IL-1β、TNF-α、NSE和Aβ水平,以及提高患者的认知功能方面要优于单独使用丙戊酸镁缓释片。Objective To study the clinical effects of QingxinWendan decoction in the treatment of bipolar disorder(BD)manic episode.Methods 60 patients with BD manic episode treated in Hunan Brain Hospital from February 2020 to December 2020 were prospectively selected.They were included in the control group and the observation group according to the random alphabet method,with 30 cases in each group.The control group was treated with magnesium valproate sustained-release tablets,and the observation group was treated with Qingxin Wendan decoction combined with magnesium valproate sustained-release tablets.The curative effect was evaluated after 4 weeks of continuous treatment.The degree of mania before and after treatment was evaluated by Beck-Rafaelsen mania scale(BRMS);the cognitive function before and after treatment was evaluated by Wechsler Adult Intelligence Scale(WAIS-RC)and Wechsler Memory Scale(WMS);The levels of interleukin(IL)-1β,tumor necrosis factor-α(TNF-α),neuron specific enolase(NSE)and amyloid β protein(Aβ)levels were measured by enzyme linked immunosorbent assay(ELISA)before and after treatment.Spearman correlation analysis was used to analyze the correlation between serum NSE and Aβ levels and WAIS-RC and WMS scores in the two groups.Results The curative effect of the observation group was better than that of the control group,with statistically significant difference(P<0.05).After treatment,the BRMS scores of the control group and the observation group decreased(all P<0.05),and the BRMS scores of the observation group were lower than those of the control group(P<0.05);After treatment,the WAIS-RC and WMS scores of the control group and the observation group increased(all P<0.05),and the WAIS-RC and WMS scores of the observation group were higher than those of the control group(all P<0.05).After treatment,the serum levels of IL-1β,TNF-α,NSE and Aβin two groups were decreased(all P<0.05),and the levels of IL-1β,TNF-α,NSE and Aβ in the observation group were lower than those in the control group(

关 键 词：双相情感障碍 丙戊酸镁 清心温胆汤 神经元特异性烯醇化酶 β淀粉样蛋白 

分 类 号：R749.4[医药卫生—神经病学与精神病学]