益气解毒调和肝脾法治疗恶性血液病伴抑郁状态的临床研究

目的:观察益气解毒调和肝脾法治疗恶性血液病伴抑郁状态疗效及对T淋巴细胞亚群水平的影响。方法:采用随机数字表法,将60例门诊及住院辨证为正气虚弱、邪毒内蕴、肝郁脾虚型的恶性血液病伴抑郁状态患者随机分为2组。对照组30例口服帕罗西汀20 mg/d,1次/d,早餐时顿服,药片完整吞服。观察组30例在此治疗基础上给予参芪杀白汤合四逆散加减,水煎400 m L,早晚饭后口服。连续治疗6周。于治疗前及治疗2周、4周和6周后观察临床症状及HAMD评分,以及于治疗前后检测外周血T淋巴细胞亚群的水平。结果:治疗6周后,观察组有效8例,显效13例,痊愈6例,无效3例,总有效率90%;对照组有效10例,显效9例,痊愈2例,无效9例,总有效率70%。观察组临床疗效明显优于对照组(P0.05)。与治疗前比较,治疗2周、4周和6周后,2组HAMD评分均较治疗前低,差异有统计学意义(P均0.05)。而且从治疗2周后,观察组的HAMD评分改善程度优于对照组,差异有统计学意义(P均0.05)。治疗前2组CD3~+、CD4~+、CD4~+/CD8~+均显著降低,CD8~+显著升高,2组之间的差异均无统计学意义(P均0.05);治疗6周后,2组CD3~+、CD4~+、CD4~+/CD8~+均显著升高(P均0.05),CD8~+均显著降低(P均0.05),而且观察组改善程度显著优于对照组(P均0.05)。结论:益气解毒调和肝脾法治疗恶性血液病伴抑郁状态疗效显著,不良反应小,安全性高,并且可以显著提高本病患者的免疫功能,值得推广。

Clinical Study on the Treatment of Hematologic Malignancies with Depression by Replenishing Qi and Removing Toxicity and Harmonizing the Liver-Spleen Method

To observe antidepressant effect and changing levels of T lymphocyte subsets in patients suffered from hematologic malignancies and depression by replenishing qi and removing toxicity and harmonizing the liver-spleen method. Methods:A total of 60 cases from outpatients and hospitalized patients suffered from hematologic malignancies with depression and belong to syndrome of vital qi deficiency, internal accumulation of pathogenic factors and liver stagnation and spleen deficiency were randomly divided into two groups with a method of random number table. The control group (n=30) took paroxetine 20 mg/d once per day orally and swallowed pills completely at breakfast. The treatment group based on what the control group do (n=30) was given additional 400 mL modified Shenqi Shabai Decoction and Sini Powder, l after the breakfast and the dinner. One course lasted for 6 weeks. Before treatment and 2 weeks, 4 weeks and 6 weeks after treatment, HAMD scores and clinical symptoms were recorded as well as levels of peripheral blood T lymphocyte subsets. Results:After 6 weeks treatment, there were 8 effective cases, 13 markedly effective cases and 6 cases being cured and no effect in 3 cases in the treatment group and the total effective rate was 90%; while in the control group, there were 10 effective cases, 9 markedly effective cases and 2 cases being cured and no effect in 9 cases, and the total effective rate was 70%. Clinical efficacy of treatment group was obviously better than that of the control group (P<0.05). HAMD scores of the two groups lowered after 2 weeks, 4 weeks and 6 weeks of treatment than before the treatment, and there were statistically significant differences (all P<0.05). Since 2 weeks after treatment, improvement of HAMD scores in the treatment group was higher than that of the control group, and there were significant differences (all P<0.05). Levels of CD3+, CD4+ and ratio of CD4+/CD8+ were significantly reduced in the two groups before the treatment, but level of CD8+ increased significantly. There was no significant difference between the two groups (all P>0.05). But after 6 weeks, levels of CD3+, CD4+ and ratio of CD4+/CD8+ were significantly increased in the two groups (all P<0.05), and level of CD8+ was significantly descended (all P<0.05). The improvement degree of the treatment group was significantly higher than that of the control group (all P<0.05). Conclusion:Therapy of Shenqi Shabai Decoction and Sini Powder combined with paroxetine for patients suffered from hematologic malignancies with depression has a distinct curative effect with fewer side effects and high safety, which can significantly improve patient''s immune function and is worth to promote.