心神宁片联合帕罗西汀肠溶片治疗脑卒中后重性抑郁障碍患者疗效及机制研究  

Efficacy and mechanism of Xinshenning tablets combined with paroxetine enteric coated tablets in the treatment of post-stroke major depressive disorder

作　　者：黄春海 土文珍 夏王斌 HUANG Chunhai;TU Wenzhen;XIA Wangbin(Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]温州市第七人民医院老年精神科

出　　处：《全科医学临床与教育》2023年第8期690-693,698,共5页Clinical Education of General Practice

基　　金：温州市科学技术局基础性医疗卫生科技项目(Y2020443)。

摘　　要：目的探讨心神宁片联合帕罗西汀肠溶片治疗脑卒中后重性抑郁障碍患者疗效及机制。方法选取96例脑卒中后重性抑郁障碍患者,随机分为观察组和对照组,各48例。观察组采用心神宁片联合帕罗西汀肠溶片治疗,对照组采用帕罗西汀肠溶片治疗,治疗3个月。比较两组患者临床疗效,治疗前后的汉密尔顿抑郁量表(HAMD)评分、神经功能缺损程度(NIHSS)评分、日常生活能力(ADL)评分、炎症因子、血浆P物质(SP)、神经肽Y(NPY)和促肾上腺皮质激素释放因子(CRF)水平及不良反应。结果观察组患者的临床总有效率(95.83%)明显高于对照组(79.17%),差异有统计学意义(χ^(2)=16.18,P<0.05);治疗后,观察组HAMD、NIHSS评分低于对照组,ADL评分高于对照组(t分别=-4.37、-3.98、5.82,P均<0.05);观察组血清白细胞介素-1β(IL-1β)、IL-2、IL-6、肿瘤坏死因子(TNF-α)、SP、CRF水平均低于对照组,NPY水平高于对照组(t分别=-3.51、-4.03、-5.11、-4.93、-4.68、-8.14、4.11,P均<0.05);两组治疗期间不良反应发生率比较,差异无统计学意义(χ^(2)=0.47,P>0.05)。结论心神宁片联合帕罗西汀肠溶片治疗脑卒中后重性抑郁障碍患者疗效显著,其主要机制可能与抑制神经免疫炎症因子的表达,激活中枢神经递质的传递相关。Objective To explore the effect and mechanism of Xinshenning tablet combined with paroxetine enteric coated tablets in the treatment of post-stroke major depressive disorder.Methods A total of 96 patients with post stroke major depressive disorder were randomly divided into the observation group and the control group,48 patients in each group.The observation group was treated with Xinshenning tablets and paroxetine enteric coated tablets,while the control group was treated with paroxetine enteric coated tablets for 3 months.The clinical efficacy,Hamilton depression scale(HAMD)score,NIHSS,ability of daily living(ADL)score,inflammatory factors,plasma substance P(SP),neuropeptide Y(NPY)and corticotropin releasing factor(CRF)levels and adverse reactions of the two groups were compared before and after treatment.Results The clinical efficacy rate of the observation group(95.83%)was significantly higher than that of the control group(79.17%),with a statistically significant difference(χ^(2)=16.18,P<0.05).After treatment,the score of HAMD and NIHSS in the observation group were lower than those in the control group,and the score of ADL in the observation group was higher than that in the control group(t=-4.37,-3.98,5.82,P<0.05).Serum IL-1β,IL-2,IL 6,TNF-α,SP and CRF levels in observation group were lower than those in the control group,while NPY level was higher than that in the control group(t=-3.51,-4.03,-5.11,-4.93,-4.68,-8.14,4.11,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(χ^(2)=0.47,P>0.05).Conclusion Xinshenning tablet combined with paroxetine enteric coated tablet has a significant effect on post-stroke major depressive disorder.Its main mechanism may be that it inhibits the expression of neuroimmune inflammatory factors and activates the transmission of central neurotransmitters.

关 键 词：心神宁片 帕罗西汀肠溶片 脑卒中 重性抑郁障碍 临床疗效 作用机制 

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]