舍曲林对缺血性脑卒中后抑郁症患者下丘脑-垂体-肾上腺素轴及认知功能的影响

目的探讨舍曲林对缺血性脑卒中后抑郁症(PISD)患者下丘脑-垂体-肾上腺素轴及认知功能的影响。方法选择2015年1月～2016年2月就诊的PISD患者92例,随机分为观察组和对照组。两组均予以缺血性脑卒中常规对症治疗,观察组在此基础上加用舍曲林,对照组在此基础上加用阿米替林片,两组疗程均为8周。评估两组治疗前后HPA轴功能血清促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)及皮质醇(Cor)]水平的变化,并比较其神经、抑郁症状及认知功能的变化。结果治疗8周后,两组血清CRH、ACTH及Cor水平均较前下降(P0.05或P0.01),且观察组下降幅度更明显(P0.05);同时两组CSS及HAMD评分较前明显下降,而MMSE评分较前明显上升(P0.05或P0.01),且观察组变化更明显(P0.05)。结论舍曲林治疗PISD患者的疗效肯定,安全性较佳,能更明显促进神经功能的恢复,改善抑郁症状,并能改善其认知功能,其作用机制与其能降低血清CRH、ACTH及Cor水平,纠正HPA轴功能紊乱密切相关。

Effects of sertraline on the hypothalamus-pituitary-adrenergic axis and cognitive function in the patients with post-ischemic stroke depression

Objective To investigate the effects of sertraline on hypothalamic-pituitary-adrenergic axis and cognitive function in the patients with post-ischemic stroke depression(PISD).Methods A total of 92 patients with PISD who were admitted from January 2015 to February 2016 were selected and randomly divided into observation group and control group.Both groups were given routine symptomatic treatment of ischemic stroke.The observation group was further given sertraline on this basis,and the control group was further given amitriptyline tablets on this basis.The duration of treatment in both groups was 8 weeks.The changes of the levels of HPA axis functionsserum corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH)and cortisol(Cor)]before and after treatment were evaluated,the changes in nerves,depressive symptoms,and cognitive function were compared in both groups.Results After 8 weeks of treatment,the serum levels of CRH,ACTH and Cor were decreased in both groups(P<0.05 or P<0.01),and the observation group decreased more significantly(P<0.05);at the same time,CSS and HAMD scores in the two groups were significantly lower than before treatment.The MMSE score was significantly higher than before treatment(P<0.05 or P<0.01),and the observation group had more significant changes(P<0.05).Conclusion Sertraline is effective and safe in the treatment of PISD patients,which can significantly promote the recovery of neurological function,improve depressive symptoms,and improve their cognitive function.Its mechanism of action is closely related to its ability to reduce serum CRH,ACTH and Cor levels,and to correct the HPA axis dysfunction.