调冲解郁汤治疗围绝经期抑郁症60例临床观察

目的:探讨调冲解郁汤治疗围绝经期抑郁症的疗效及对雌二醇(E2),促卵泡刺激素(FSH),促黄体生成素(LH)水平和5-羟色胺(5-HT)水平的影响。方法:将120例患者随机按数字表法分为观察组和对照组各60例。两组均口服替勃龙片,2.5 mg/次,1次/d。对照组口服氟哌噻吨美利曲辛片,2片/d,早晨及中午各1片;观察组采用调冲解郁汤治疗。两组疗程均为8周。于治疗前、治疗后4,8周进行汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA),匹兹堡失眠质量指数(PSQI)和Kupperman评分;检测治疗前后E2,FSH,LH,和5-HT水平;记录两组治疗期间不良反应。结果:观察组抑郁疗效总有效率为90%,对照组为86.67%,两组比较差异无统计学意义;观察组围绝经期综合征疗效总有效率为91.67%,优于对照组的76.67%(P0.05);治疗后两组间HAMD评分差异无统计学意义;治疗后8周观察组HAMA评分低于对照组,治疗后4,8周观察组PSQI和Kupperman量表评分均低于对照组(P0.01);观察组HAMA,PSQI和Kupperman量表评分下降幅度均多于对照组(P0.01);观察组治疗后FSH和LH水平低于对照组(P0.01),治疗后观察组E2和5-HT水平高于对照组(P0.01);对照组不良反应发生率为18.3%,观察组未见明显不良反应发生。结论:在雌激素替代疗法的基础上,调冲解郁汤改善围绝经期抑郁症的疗效与氟哌噻吨美利曲辛片相当,且副作用少,并对睡眠及绝经期综合征症状有明显改善作用,其作用机制可能是通过调节神经内分泌激素水平来实现的。

Clinical Observation of Tiaochong Jieyu Decoction in Treating 60 Patients with Depression of Perimenopausal

Objective: To discuss the clinical effect of Tiaochong Jieyu decoction in treating depression of perimenopausal, and to investigate its influence on levels of estrogen (E₂), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and 5-hydroxytryptamine (5-HT). Method: One hundred and twenty patients were randomly divided into the control group (60 cases) and the observation group (60 cases) by a random number table. All patients in both groups received 2.5 mg tibolone tablets once daily. Patients in the control group added 2 flupentixol and melitracen tablets in the morning and noon. Patients in the observation added Tiaochong Jieyu decoction. All patients in two groups received 8 weeks of treatment. Before and at the fourth and the eighth week after treatment, sores of Hamilton depression scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh sleep quality index (PSQI) and Kupperman were graded. Levels of E₂, FSH, LH and 5-HT were detected, and adverse reactions were monitored. Result: The total clinical efficiency of depression in the observation group was 90%, which was 86.67% in the control group. There was no statistical significance difference between the two groups. Total clinical efficient of syndrome of perimenopausal in the observation group was 91.67%, which was superior to that of 76.67% in the control group (P<0.05). There was no statistical significance difference for HAMD scores between the two groups. HAMA scores were lower at the eighth week after treatment, sores of PSQI and Kupperman were lower at the fourth and eighth week after treatment in the observation group than those in the control group (P<0.01). Besides, the results of HAMA, PSQI and Kupperman were more obvious in the observation group (P<0.01). After treatment, levels of FSH and LH were lower (P<0.01), and levels of E₂and 5-HT were higher (P<0.01) in the observation group than those in the control group. The rate of adverse reaction was 18.3% in the control group, and there was no adverse reaction in the observation group. Conclusion: Based on the treatment of estrogen replacement therapy, the curative effect of Tiaochong Jieyu decoction was the same as flupentixol and melitracen tablets, while there was rare side effect. Moreover, there was obvious amelioration on sleep and syndrome in menopause, its mechanism of action may be related to regulating levels of neuroendocrine hormone.