柴胡疏肝汤加减治疗肝气郁结型卒中后抑郁疗效及对患者血清神经递质、神经功能恢复的影响

目的:探讨肝气郁结型卒中后抑郁(PSD)应用柴胡疏肝汤加减治疗的临床效果及对患者血清神经递质、神经功能恢复的影响。方法:选取2016年4月至2017年4月在天津中医药大学第一附属医院收治的86例肝气郁结型PSD患者,采用随机数字表法均分为两组。对照组(43例)予以氟西汀治疗,观察组(43例)采取柴胡疏肝汤加减治疗。记录比较两组临床疗效,治疗前后血清单胺类和氨基酸类神经递质水平及神经功能指标变化,不良反应发生情况。结果:观察组治疗6周后总有效率为95.4%(41/43),较对照组81.4%(35/43)明显升高(P0.05)。与本组治疗前相比,两组治疗后血清多巴胺(DA),5-羟色胺(5-HT),去甲肾上腺素(NE)及甘氨酸(Gly)水平均显著升高(P0.01),天冬氨酸(Asp),谷氨酸(Glu)水平均显著降低(P0.01);并以观察组改善更显著(P0.01)。与本组治疗前比较,两组治疗后血清神经元烯醇化酶(NSE)水平,美国国立卫生研究院卒中量表(NIHSS)评分均显著降低(P0.01),血清脑源性神经营养因子(BDNF)水平均显著升高(P0.01);且以观察组改善更显著(P0.01)。两组均未见明显不良反应/事件。结论:肝气郁结型PSD应用柴胡疏肝汤加减治疗更能有效改善患者症状,调节机体神经递质表达,促进神经功能恢复,疗效显著且安全可靠。

Effect of Modified Chaihu Shugan Tang in Treatment of Liver-Qi Stagnation Type of Post-stroke Depression and on Serum Nerve Transmitters and Nerve Function Recovery

Objective: To investigate the clinical effect of Chaihu Shugan Tang in treating the liver-Qi stagnation type of post-stroke depression (PSD) and on serum nerve transmitters and nerve function recovery. Method: Totally 86 cases of the liver-Qi stagnation type of the liver-Qi PSD treated in our hospital from April 2016 to April 2017 were selected and divided into two groups with the random number table. The control group (43 cases) was treated with modified fluoxetine, and the observation group (43 cases) was treated with modified Chaihu Shugan Tang. The clinical efficacy, the levels of serum monoamine and amino acid neurotransmitters, the changes of neurological function and the incidence of adverse reactions were recorded and compared between the two groups. Result: The total effective rate in the observation group was 95.4% (41/43) after 6 weeks of treatment, which was significantly higher than 81.4% (35/43) in the control group (P<0.05). Compared with those before the treatment, serum dopamine (DA), 5-hydroxytryptamine (5-HT), norepinephrine (NE) and glycine (Gly) levels all increased significantly in the two groups after the treatment (P<0.01), and the levels of aspartic acid (Asp) and glutamic acid (Glu) decreased significantly (P<0.01); the improvement of the observation group was more significant (P<0.01). Compared with before the treatment, the levels of serum neuron enolase (NSE) and National Institutes of Health Stroke Scale (NIHSS) significantly decreased after the treatment in two groups (P<0.01). The level of serum brain derived neurotrophic factor (BDNF) increased significantly (P<0.01); the improvement of observation group was more significant (P<0.01). There was no obvious adverse reaction in the two groups. Conclusion: The application modified Chaihu Shugan Tang can effectively alleviate symptoms of cases of the liver-Qi stagnation type of the liver-Qi PSD, regulate neurotransmitter expression, and promote the recovery of neurological function, with a significant efficacy and safety.