解郁醒神汤联合艾司西酞普兰治疗CYP2C19不同基因型脑梗死后抑郁的效果  

Effect of Jieyu Xingshen decoction combined with escitalopram on depression after cerebral infarction of different genotype of CYP2C19

作　　者：周准 谢风 许晓娜 张爱莲 ZHOU Zhun;XIE Feng;XU Xiaona;ZHANG Ailian(Department of Neurology,Shangrao People′s Hospital,Jiangxi Province,Shangrao 334000,China)

机构地区：[1]江西省上饶市人民医院神经内科,334000 [2]江西省上饶市人民医院中医风湿免疫科,334000 [3]江西省上饶市人民医院中医科,334000

出　　处：《临床合理用药》2025年第8期20-25,共6页Chinese Journal of Clinical Rational Drug Use

基　　金：江西省中医药管理局科技计划项目(2021B350)。

摘　　要：目的 观察解郁醒神汤联合艾司西酞普兰治疗细胞色素P450 2C19(CYP2C19)不同基因型脑梗死后抑郁的效果。方法 选取2022年1月—2023年12月于上饶市人民医院神经内科治疗的脑梗死后抑郁患者150例,采用DNA微芯片法检测CYP2C19基因多态性,根据CYP2C19基因型分为快代谢型(n=50)、中代谢型(n=50)、慢代谢型(n=50),各基因型患者采用随机数字表法分为试验组(n=25)和对照组(n=25),在常规治疗的基础上,试验组给予解郁醒神汤联合艾司西酞普兰治疗,对照组给予艾司西酞普兰治疗。比较各组临床疗效,治疗前、治疗4周、8周汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分,治疗前、治疗8周生活质量综合评定问卷(GQOLI-74)评分,不良反应。结果 各基因型的试验组总有效率均高于对照组(P<0.05)。治疗4周、8周,各基因型的2组HAMA、HAMD评分均低于治疗前,治疗8周HAMA、HAMD评分低于治疗4周,且试验组低于对照组(P<0.05或P<0.01)。治疗8周,各基因型的2组GQOLI-74各维度评分均高于治疗前,且试验组高于对照组(P<0.05或P<0.01)。各基因型的试验组与对照组不良反应总发生率比较差异无统计学意义(P>0.05)。结论 CYP2C19不同基因型脑梗死后抑郁患者应用解郁醒神汤联合艾司西酞普兰治疗均可改善患者的负性情绪和生活质量,较单独应用艾司西酞普兰的效果更好,且具有较高的安全性。Objective To observe the effect of Jieyu Xingshen decoction combined with escitalopram on depression after cerebral infarction of cytochrome P4502C19(CYP2C19)with different genotypes.Methods A total of 150 patients with depression after cerebral infarction treated in the Department of Neurology of Shangrao People′s Hospital from January 2022 to December 2023 were selected,and CYP2C19 gene polymorphism was detected by DNA microchip method.According to the type CYP2C19 genotype divided into fast metabolism type(n=50),middle metabolism type(n=50),slow metabolism type(n=50),each genotype patients by using random numbers table were divided into experimental group(n=25)and control group(n=25),on the basis of conventional treatment,experimental group was treated with Jieyu Xingshen decoction combined with escitalopram,control group was treated with escitalopram.The clinical efficacy of all groups was compared,the scores of HAMA and HAMD before treatment,4 weeks and 8 weeks of treatment were compared.The scores of GQOLI-74 before treatment and 8 weeks of treatment were compared.Results The total effective rate of experimental groups were higher than that of control group(P<0.05).After 4 and 8 weeks of treatment,HAMA and HAMD scores of the 2 groups of all genotypes were lower than before,HAMA and HAMD scores of the 8 weeks of treatment were lower than those of the 4 weeks of treatment,and the experimental group were lower than the control group(P<0.05 or P<0.01).After 8 weeks of treatment,GQOLI-74 scores of all genotypes in 2 groups were higher than before treatment,and the experimental group was higher than the control group(P<0.05 or P<0.01).There was no significant difference in the total incidence of adverse reactions between the experimental group and the control group(P>0.05).Conclusion Jieyu Xingshen decoction combined with escitalopram can improve the negative emotions and quality of life of patients with depression after cerebral infarction of different CYP2C19 genotypes,which is better than escitalopram alone,

关 键 词：脑梗死 抑郁 CYP2C19基因型 解郁醒神汤 艾司西酞普兰 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R743.33[医药卫生—临床医学]