柴胡温胆汤治疗卒中后抑郁的临床疗效及其机制探讨

目的:探究柴胡温胆汤加减辨治卒中后抑郁患者临床疗效及对患者血清5-羟色胺(5-HT)、炎性反应递质的影响,探讨柴胡温胆汤辨治卒中后抑郁的部分机制。方法:选取2016年1月至2018年1月唐山市中医医院收治的脑卒中后抑郁患者68例作为研究对象。按照入组顺序编号,单号设为对照组,双号设为观察组,每组34例。2组患者均予以常规抗凝、调脂、抗血小板治疗及康复训练。2组组患者均予以百忧解治疗,观察组再予以柴胡温胆汤加减辨治,2组患者均连续治疗3个月为1个疗程。比较2组患者治疗前、治疗后1个月、2个月、3个月血清5-羟色胺(5-HT)、多巴胺(DA)、及炎性反应递质白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]变化。治疗后根据患者治疗前后的中医症状积分、HAMD评分,对患者行中医临床疗效、抑郁临床疗效评定并行组间比较。比较2组患者观察期内药物不良反应率。比较2组患者治疗前后生命质量评分(QOL)。结果:治疗后1个月、2个月、3个月2组患者血清5-HT、DA水平均较治疗前明显升高,且不同时间段观察组高于对照组,差异有统计学意义(P<0.05);治疗后1个月、2个月、3个月2组血清IL-1、IL-6、TNF-α、hs-CRP水平较治疗前明显下降,且治疗后2个月、3个月观察组低于对照组,差异有统计学意义(P<0.05);治疗后2组患者HAMD评分较治疗前明显降低,且观察组低于对照组,观察组抑郁疗效率高于对照组,差异有统计学意义(P<0.05);治疗后观察组中医疗效率高于对照组,差异有统计学意义(P<0.05);2组患者观察期内药物不良反应率差异无统计学意义(P>0.05);2组患者治疗后,QOL评分均较治疗前上升,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:柴胡温胆汤加减辨治卒中后抑郁有效改善患者神经递质水平功能,降低患者炎性反应,改善患者不良情绪及临床症状,促进患者生命质量,且安全性高。

Clinical Efficacy of Chaihu Wendan Decoction in Treating Post-Stroke Depression and Its Effects

Objective:To explore the clinical efficacy of modified Chaihu Wendan Decoction in the treatment of post-stroke depression,and its influence on serum 5-hydroxytryptamine(5-HT)and inflammatory factors,and to explore the partial mechanism of Chaihu Wendan Decoction in the treatment of post-stroke depression.Methods:A total of 68 eligible patients with post-stroke depression in Tangshan Traditional Chinese Medicine Hospital from January 2016 to January 2018 were included as the study subjects.According to the order of enrollment,the odd number was set as the control group,and the even number was set as the observation group,with 34 cases in each group.Both groups were given routine anticoagulation,lipid regulation,antiplatelet therapy and rehabilitation training.Both groups were treated with Prozac,and the observation group was treated with modified Chaihu Wendan Decoction.Both groups were treated for 3 months for a course of treatment.The changes of serum 5-hydroxytryptamine(5-HT),dopamine(DA),inflammatory factor(IL-1),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-alpha)and hypersensitive C-reactive protein(hs-CRP)were compared between the 2 groups before treatment,1,2 and 3 months after treatment.After treatment,according to the symptoms of TCM and HAMD scores before and after treatment,the clinical efficacy of TCM and depression were evaluated and compared between groups.The rates of adverse drug reactions(ADRs)and toxic side effects(ADRs)were compared between the 2 groups during trail period.Quality of life score(QOL)was compared between the 2 groups before and after treatment.Results:1)The serum levels of 5-HT and DA in the 2 groups were significantly increased than those before treatment,and the observation group was better than those in the control group in different time periods(P<0.05).2)The serum levels of IL-1,IL-6,TNF-αand hs-CRP in the 2 groups were significantly decreased than those before treatment,and the observation group was lower than the control group in the 2 and 3 months after treatment(P<0.05).3)HAMD score of the 2 groups after treatment was significantly decreased than that before treatment,and the observation group was lower than that of the control group.The curative effect of depression in the observation group was higher than that of the control group(P<0.05).4)The curative effect of traditional Chinese medicine in the observation group was higher than that of the control group(P<0.05).5)There was no significant difference in the adverse drug reaction rate between the 2 groups during the observation period(P>0.05).6)After treatment,QOL scores of both groups were increased than those before treatment,and the observation group was higher than the control group(P<0.05).Conclusion:Modified Chaihu Wendan Decoction can effectively improve the neurotransmitter level,reduce the degree of inflammation,improve the patients′bad mood and clinical symptoms,and promote the quality of life of patients with post-stroke depression.It is safe and has high clinical value.