舒心汤、温针灸结合盐酸舍曲林片调控HPA轴治疗老年双心病的作用机制  

Shuxin Decoction,warm acupuncture and moxibustion combined with sertraline hydrochloride tablets in the treatment of elderly with bicardiac disease via regulating the hypothalamic-pituitary-adrenal axis

作　　者：王戈 庄云山 王丹 WANG Ge;ZHUANG Yunshan;WANG Dan(Department of Geriatrics,Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China;不详)

机构地区：[1]北京中医药大学第三附属医院老年病科,北京市100029 [2]北京中医药大学第三附属医院脑病科,北京市100029 [3]内蒙古自治区赤峰松山中医蒙医医院心血管内科

出　　处：《河北医药》2024年第21期3217-3221,共5页Hebei Medical Journal

基　　金：国家自然科学基金资助项目(编号:81473658);国家中医药管理局唐启盛岐黄学者项目(编号:209-137);国家中医药管理局行业科研专项经费项目(编号:201507027)。

摘　　要：目的探讨舒心汤、温针灸结合盐酸舍曲林片调控下丘脑-垂体-肾上腺(HPA)轴治疗老年双心病(冠心病伴焦虑和抑郁状态)的作用机制,为双心病临床治疗提供有力依据。方法选取2021年4月至2023年1月收治的老年双心病(气滞血瘀证)患者126例,随机分为舒心汤组、温针灸组、联合组,每组42例。患者均给予基础治疗[冠心病二级预防(抗凝、扩冠、抗血小板、降脂治疗)和一般心理]与盐酸舍曲林片,在此基础上舒心汤组给予舒心汤,温针灸组给予温针灸,联合组给予舒心汤联合温针灸。比较3组心脏疾病主观症状疗效、中医证候积分、焦虑[焦虑自评量表(SAS)]、抑郁[抑郁自评量表(SDS)]、睡眠质量[匹兹堡睡眠质量指数量表(PSQI)]评分、HPA轴激素水平[肾上腺皮质激素(ACTH)、皮质醇(Cor)、促肾上腺皮质激素释放激素(CRH)]、炎性因子水平[C反应蛋白(CRP)、白介素-8(IL-8)、脂氧素A4(LXA4)、髓过氧化物酶(MPO)]及不良反应情况。结果联合组总有效率为95.24%高于舒心汤组78.57%、温针灸组76.19%(P<0.05);治疗4周、8周后联合组主症、次症积分均低于舒心汤组、温针灸组(P<0.05);治疗4周、8周后联合组PSQI、SAS、SDS评分均低于舒心汤组、温针灸组(P<0.05);治疗4周、8周后联合组血清ACTH、Cor、CRH水平均低于舒心汤组、温针灸组(P<0.05);治疗4周、8周后联合组血清CRP、IL-8、LXA4、MPO水平均低于舒心汤组、温针灸组(P<0.05);3组不良反应发生率比较差异无统计学意义(P>0.05)。结论舒心汤、温针灸结合盐酸舍曲林片治疗老年双心病的效果明显,可有效缓解焦虑抑郁、改善失眠,减轻炎性反应,其作用机制可能与HPA轴调控有关,有一定安全性。Objective To explore the mechanism of Shuxin Decoction,warm acupuncture and moxibustion combined with sertraline hydrochloride tablets in the treatment of bicardiac disease(coronary heart disease with anxiety and depression)by regulating the hypothalamic-pituitary-adrenal(HPA)axis,thus providing a strong basis for clinical treatment of bicardiac disease.Methods A total of 126 elderly patients with bicardiac disease(qi stagnation and blood stasis syndrome)admitted to our hospital from April 2021 to January 2023 were randomly assigned into Shuxin Decoction group(n=42),warm acupuncture and moxibustion group(n=42)and combined group(n=42).All patients were managed by basic treatment,including secondary prevention of coronary heart disease through anticoagulation,coronary enlargement,antiplatelet and lipid-lowering treatment,as well as general psychological treatment and medication of Sertraline hydrochloride tablets.Patients in Shuxin Decoction group and warm acupuncture and moxibustion group were given Shuxin Decoction,and warm acupuncture and moxibustion group,respectively.Those in the combined group were given Shuxin Decoction combined with warm acupuncture and moxibustion.The effect of subjective symptoms of cardiac disease,traditional Chinese medicine(TCM)syndrome score,anxiety(the Self-Rating Anxiety Scale[SAS]),(the Self-Rating Depression Scale[SDS]),sleep quality(the Pittsburgh Sleep Quality Index[PSQI]),HPA axis hormone levels(adrenocortical hormone[ACTH],cortisol[Cor]and corticotrophin releasing hormone[CRH]),inflammatory factor levels(C-reactive protein[CRP],interleukin-8[IL-8],lipoxygenin A4[LXA4],myeloperoxidase[MPO])and adverse events among the three groups were compared.Results The total effective rate of the combined group was significantly higher than that of Shuxin Decoction group and warm acupuncture and moxibustion group(95.24%vs 78.57%vs 76.19%,P<0.05).After 4 weeks and 8 weeks of treatment,the scores of main and secondary syndromes in the combined group were significantly lower than those of Shux

关 键 词：双心病 舒心汤 温针灸 盐酸舍曲林片 HPA轴 

分 类 号：R541[医药卫生—心血管疾病]