米氮平联合乌灵胶囊及单一米氮平治疗抑郁和焦虑障碍共病的疗效对照

目的:比较米氮平联合乌灵胶囊及单一米氮平抗抑郁和焦虑障碍共病的作用和不良反应。方法:67例同时符合抑郁症与焦虑障碍诊断标准的门诊患者,分别随机给予口服米氮平联合乌灵胶囊(简称A组)和单一口服米氮平(简称B组)。研究全程为期6周,禁止应用任何抗精神病药物及安定类药物。入组前、治疗后的第1、2、4、6周进行HAMD、HAMA、TESS评定。第6周末复查血尿常规、肝肾功能、心电图。结果:治疗第1周A组HAMD得分下降比B组明显,有显著差异(P<0.05);而HAMA得分下降更为明显,差异非常显著(P<0.01)。从治疗的第2周开始A组HAMD、HAMA得分下降均比B组来的显著,差异非常显著(P<0.01)。经过6周的治疗,A组临床治愈19例,临床有效29例;B组临床治愈16例,临床有效28例。2组患者的临床治愈率、临床有效率均无显著性差异(P>0.05)。2组患者不良反应发生率无显著性差异(P>0.05)。结论:米氮平联合乌灵胶囊能迅速缓解焦虑障碍及抑郁症状,对抑郁和焦虑障碍共病的患者,乌灵胶囊可以作为一种安全有效增效剂来使用。     

调督解郁法针刺治疗肿瘤相关性抑郁:随机对照研究

目的:观察调督解郁法针刺联合盐酸舍曲林片与单纯盐酸舍曲林片对肿瘤相关性抑郁患者的影响,探讨其作用机制。方法:将120例肿瘤相关性抑郁患者随机分为观察组和对照组,各60例。在肿瘤内科常规治疗基础上,对照组予盐酸舍曲林片口服,每次50 mg,每日1次;观察组在对照组治疗基础上加用调督解郁法针刺治疗,穴取中脘、百会、神庭、心俞、肝俞、脾俞、神门、太冲、太溪,治疗20~40 min,每日1次,每周5次,均治疗6周。观察治疗前,治疗2、4、6周后两组患者抑郁自评量表(SDS)和汉密尔顿抑郁量表(HAMD)评分及治疗前后外周血血清白细胞介素(IL)-2、IL-4、IL-10、γ干扰素(IFN-γ)、转化生长因子β(TGF-β)水平。结果:治疗2、4、6周后,两组患者SDS、HAMD评分均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后,两组患者外周血血清IL-4、IL-10、TGF-β水平均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);外周血血清IL-2、IFN-γ水平均较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。结论:调督解郁法针刺联合盐酸舍曲林片可有效缓解肿瘤相关性抑郁患者的抑郁状态,疗效优于单纯盐酸舍曲林片,其作用机制可能与调节机体免疫相关细胞因子表达有关。     

Increased Tidal Volume Variability in Children is a Better Marker of Opioid-Induced Respiratory Depression than Decreased Respiratory Rate

OBJECTIVE: During opioid administration, decreasing respiratory rate is typically used as a predictor of respiratory depression. Prior to opioid-induced apnea, progressively irregular breathing patterns have been noticed. We hypothesize that opioid administration to children will increase tidal volume variability (TV(var)) and that this will be a better predictor of respiratory depression than a decrease in respiratory rate. METHODS: We recruited 32 children aged 2-8 years scheduled to undergo surgery. During spontaneous ventilation, flow rates and respiratory rates were continuously recorded, while remifentanil was infused at stepwise increasing doses each lasting 10 min. The infusion was continued until the patient showed signs of respiratory depression. Flow data from each dose was used to calculate tidal volumes, from which TV(var) was calculated. The respiratory rate and TV(var) during the last (D(last)), second to last (D-2), and third to last (D-3), administered doses were compared to those during baseline (fourth to last dose). We chose a threshold of TV(var) increase and compared it to a decrease in respiratory rate below 10 breaths per min as predictors of respiratory depression. RESULTS: Compared to baseline, the TV(var) increased by 336% and 668% during D(-2) and D(last), respectively, whereas respiratory rate decreased by 14.3%, 31.7%, and 55.5% during D(-3), D(-2), and D(last), respectively. A threshold increase in TV(var) of 150% over baseline correctly predicted respiratory depression in 41% of patients, compared to a drop in respiratory rate correctly predicting 22% of patients. CONCLUSIONS: TV(var) increases as children approach opioid-induced respiratory depression. This is a more useful predictor of respiratory depression than a fall in respiratory rate because the TV(var) increase is 10 times the drop in respiratory rate. A TV(var) increase also correctly predicts respiratory depression twice as often as decreased respiratory rate and is independent of age-related alterations in physiologic respiratory rates.     

Carnosic acid ameliorates depressive‐like symptoms along with the modulation of FGF9 in the hippocampus of middle carotid artery occlusion‐induced Sprague Dawley rats

The increased survival rate of stroke patients has led to the higher incidences of post‐stroke depression. Carnosic acid has the ability to cross blood brain barrier with good neuro‐modulatory actions. Recently, inclined level of fibroblast growth factor 9 (FGF9) in the postmortem brain of the depressed patients was noted. Therefore, in the present study, the effect of carnosic acid on post‐stroke depression‐like behavior, and the expression of FGF9 were evaluated. After 3 weeks of middle carotid artery occlusion in Sprague Dawley rats, carnosic acid (20 and 40 mg/kg) was administered for 2 weeks. Sucrose preference test, forced swimming test, and open field test were performed and hippocampi were analyzed for FGF9 and FGFR‐3. In comparison to post‐stroke depressed rats, carnosic acid increased the sucrose preference, and reduced the immobility time of the rats by ~2×. The speed and distance‐covered were also increased. At 40 mg/kg, FGF9 was reduced by ~3× while FGFR‐3/Actin was increased by ~1.5×. Altogether results suggest anti‐depressant‐like activity of carnosic acid in post‐stroke depressed rats with decreased expression of hippocampal FGF9.     

慢性淋巴细胞性甲状腺炎亚临床期病机探析

慢性淋巴细胞性甲状腺炎(CLT)是临床常见的自身免疫性甲状腺疾病,以无疼痛、弥漫性甲状腺肿大,伴有甲状腺自身抗体滴度升高为特征。慢性淋巴细胞性甲状腺炎分为三期,CLT亚临床期治疗是逆转疾病进程关键阶段,该期患者呈现相对可逆性,如早期进行干预,能够逆转其向甲状腺功能异常期进展,中医对CLT亚临床期的辨证治疗具有独特优势。本文从CLT亚临床期的中医病机特点,结合CLT亚临床期的临床表现及病理特点,阐述CLT亚临床期发病的中医病机核心是肝郁脾虚,以及其与西医免疫功能紊乱、甲状腺细胞凋亡的相关性为切入点探析CLT亚临床期发病机制,为慢性淋巴细胞性甲状腺炎亚临床期的治疗提供坚实理论依据。     

柴胡加龙骨牡蛎汤加减联合太极拳运动治疗抑郁症40例临床观察

目的:观察柴胡加龙骨牡蛎汤加减联合太极拳运动治疗肝气阻滞兼痰热型抑郁症的临床疗效。方法:将80例肝气阻滞兼痰热型抑郁症患者随机分为治疗组和对照组,每组各40例。治疗组给予柴胡加龙骨牡蛎汤加减联合太极拳运动治疗,对照组给予盐酸帕罗西汀治疗。2组疗程均为6周。观察患者的综合疗效及抑郁自评量表(SDS)评分、汉密尔顿抑郁量表(HAMD)评分、中医证候评分、不良反应量表(TESS)评分。结果:治疗组脱落1例,对照组脱落2例。综合疗效总有效率治疗组为94.87%(37/39),对照组为81.58%(31/38),2组比较,差异有统计学意义(P<0.05);2组治疗2、4、6周后SDS、HAMD及中医证候评分均低于治疗前(P<0.01),且治疗组治疗后各时间节点的SDS、HAMD、TESS及中医证候评分均低于对照组(P<0.05或P<0.01)。结论:柴胡加龙骨牡蛎汤加减联合太极拳运动治疗肝气阻滞兼痰热型抑郁症疗效确切,且无明显不良反应,值得临床推广应用。     

An interpersonal analysis of social anxiety and depression

Depressed and socially anxious individuals were compared in terms of their social self-perceptions using the interpersonal problem circle, a conceptualization of the domain of interpersonal problems derived from Horowitz' Inventory of Interpersonal Problems. Subjects who were socially anxious, whether depressed or not, differed significantly from a control group of nondepressed, nonanxious subjects on both dimensions of problematic social behavior. These subjects characterized themselves as nonassertive and socially avoidant. Individuals who were depressed but not socially anxious were no different than control subjects in their social self-perceptions. These results suggest that beliefs and self-perceptions concerning characteristic patterns of interpersonal behavior may distinguish individuals with various types of affective complaints.This research was supported by a grant to Lynn Alden from the Social Sciences and Humanities Research Council of Canada.     

脑肠轴理论针灸法治疗抑郁症的临床研究

目的比较基于脑肠轴理论针灸取穴联合米氮平与单纯服用米氮平治疗抑郁症的近远期疗效差异。方法将77例抑郁症伴随肠道功能紊乱的患者随机分为A组(39例)和B组(38例)。2组患者均给予口服米氮平治疗,A组增加针灸取穴。观察2组患者临床效果以及症状体征改善情况。结果A组总有效率为92.3%(36/39),B组为89.4%(34/38),2组总有效率相当(P>0.05);A组愈显率为84.6%(33/39),优于B组的73.7%(28/39),P<0.05);A组复发率为7.7%(3/39),B组为23.6%(9/38),2组比较差异有统计学意义(P<0.05)。结论基于脑肠轴理论取穴治疗抑郁症在显效率方面优于单纯服用米氮平,并可显著减少抑郁症的复发。     

基于藏象理论探讨化疗药的药物毒性

恶性肿瘤是威胁人类健康的重要疾病,虽然近年来靶向和免疫疗法逐步在恶性肿瘤的治疗中应用,能在一定程度上缓解患者的痛苦,但亦存在不良反应大、易耐药等问题。目前,化疗仍是恶性肿瘤治疗的主要手段,化疗在杀伤肿瘤细胞的同时,对正常细胞也有损害,常导致骨髓抑制、消化道不良反应、肝肾功能损害、口腔黏膜反应等药物毒性。虽然现代医学治疗化疗药药物毒性有一定疗效,仍存在局限性。中医药治疗恶性肿瘤历史悠久,认为化疗为药物毒邪侵袭机体,加重机体"虚""毒""瘀",致使气血脏腑损伤,以脾胃、肝肾最为明显,导致骨髓抑制、肝肾功能损伤等不良反应,研究证实运用中医药治疗具有较好临床疗效。因此,需要从中医学基础理论出发,探寻新的治疗方法。藏象理论作为中医学理论体系的核心部分,与中医学的望、闻、问、切相联系,不断发展完善,对疾病的诊治具有重要的指导意义。本研究以中医藏象理论为指导,以中医病因病机为基础,从骨髓抑制、消化道不良反应、肝肾功能损伤、口腔黏膜反应等化疗药常见药物毒性的临床表现着手,即化疗药药物毒性的外在征象,将脏腑的病理表现与生理功能相联系,由象及藏,系统归纳了各类常见化疗药的药物毒性的脏腑特点,为临床运用中医药治疗化疗药物毒性提供新的治疗思路和方法,促进中医藏象理论在诊治疾病中的应用。     

方剂反证在构建病证结合动物模型中的作用以逍遥散反证抑郁症肝郁脾虚证为例

目的 通过方剂反证寻找病证结合动物模型的证候稳定时间窗,并验证证候的稳定可靠性。方法 采用慢性不可预知温和应激（CUMS）法并通过体质量测量、糖水消耗实验、行为学实验、脑组织5-羟色胺（5-HT）检测建立大鼠抑郁症模型,通过人类临床症状等效转化为大鼠宏观表征等方法来进行大鼠的肝郁脾虚证的证候判别,基于宏观表征动态采集量表用逍遥散反证抑郁症肝郁脾虚证病证结合动物模型的稳定可靠性。结果 大鼠16周龄时,CUMS组（应激8周）大鼠糖水消耗量、旷场实验穿格次数和活动总距离均明显低于正常组（P<0.05）;免疫组化结果显示,CUMS组大鼠脑组织海马CA2区5-HT含量也明显低于正常组（P<0.05）,说明抑郁症疾病的模型制作成功。CUMS组大鼠肝郁脾虚证出现于14周龄（应激后6周）,16周龄（应激后8周）时数量达到最大值占比约70%,往后数量逐渐下降。方剂反证CUMS组14,16,18,20,22周龄大鼠证候积分分别减少66.6%,70.7%,54.8%,50.4%,44.8%,证候疗效分别为有效、显效、有效、有效、有效。结论 CUMS组大鼠14~16周龄即CUMS 6~8周是抑郁症肝郁脾虚证稳定可靠的时间窗。