半夏泻心汤加减治疗围绝经期抑郁症的机制作用

目的:观察半夏泻心汤加减治疗围绝经期抑郁症的临床疗效及对5-羟色胺(5-HT)和促炎因子的影响。方法:将139例患者随机按数字表法分为对照组69例和观察组70例。对照组口服替勃龙片,2.5 mg/次,1次/d;口服盐酸帕罗西汀片,20 mg/次,1次/d。观察组西药治疗同对照组,并内服半夏泻心汤加减,1剂/d。两组疗程均为连续治疗8周。进行治疗前后汉密尔顿抑郁量表17项(HAMD-17),Zung氏抑郁自评量表(SDS),汉密尔顿焦虑量表(HAMA),改良Kupperman(KI),肝郁脾虚证和围绝经期综合征生活质量评定量表(MENQOL)评分;检测治疗前后5-HT,肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β)和脑源性神经营养因子(BDNF),进行不良反应量表(TESS)评价。结果:治疗后观察组HAMD-17和SDS评分均低于对照组(P<0.01);观察组抑郁症疗效优于对照组(Z=2.074,P<0.05);观察组抑郁程度轻于对照组(Z=2.157,P<0.05);观察组患者的HAMA,KI和肝郁脾虚证评分均低于对照组(P<0.01);观察组围绝经期综合征严重程度轻于对照组(Z=2.046,P<0.05);观察组MENQOL量表血管舒缩症状和心理症状2个维度评分和总分均低于对照组(P<0.05);治疗后观察组5-HT高于对照组,BDNF高于对照组(P<0.01),TNF-α,IL-1β水平均低于对照组(P<0.01);观察组TESS评分低于对照组(P<0.01)。结论:在常规西医治疗的基础上,加服半夏泻心汤加减能进一步改善抑郁、焦虑和围绝经期综合(PMS)症状,提高生活质量,并可抑制促炎因子,增强5-HT,BDNF表达,且无不良事件发生。

Effect and Mechanism of Modified Banxia Xiexintang on Depression During Perimenopause

Objective:To observe the effect of modified Banxia Xiexintang on depression during perimenopause,in order to study itseffecton 5-hydroxytryptamine(5-HT)and proinflammatory factors.Method:One hundred and thirty-nine patients were randomly divided into control group(69 cases)and observation group(70 cases)by random number table.Patients in control group got tibolone tablets,2.5 mg/time,1 time/day,and paroxetine hydrochloride tablets,20 mg/time,1 time/day.In addition to the therapy in control group,patients in observation group were added with modified Banxia Xiexintang,1 dose/day.The course of treatment was 8 weeks.And before and after treatment,Hamilton depression scale for-17 items(HAMD-17),Zung’s self-rating depression scale(SDS),hamilton anxiety scale(HAMA),improvement Kupperman(KI),liver depression and spleen deficiency syndrome,menopause-specific quality of life questionnaire(MENQOL)and treatment emergent symptom scale(TESS)were scored,and levels of 5-HT,rain-derived neurotrophic factor(BDNF),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were detected.Result:After treatment,scores of HAMD-17 and SDS in observation group were lower than those in control group(P<0.01).And the effect on trea depression in observation group was better than that in control group(Z=2.074,P<0.05).The degree of depression in observation group was ligher than that in control group(Z=2.157,P<0.05).And scores of HAMA,KI and liver depression and spleen deficiency syndrome were lower than those in control group(P<0.01).The severity of perimenopausal syndrome was ligher than that in control group(Z=2.046,P<0.05).And scores of vasomotor symptoms and psychological symptoms of MENQOL scale and the total scores were lower than those in control group(P<0.05).Levels of 5-HT and BDNF were higher than those in control group(P<0.01),while levels of IL-1β,TNF-αand TESS were lower than those in control group(P<0.01).Conclusion:In addition to theroutine western medicine,modified Banxia Xiexintang can alleviate the severity of depression,release the symptoms of depression,anxiety and perimenopausal syudrome(PMS),improve the quality of life,inhibit proinflammatory factors,and enhance the expressions of 5-HT and BDNF,with no adverse event.