益肾温胆汤联合舍曲林对肝郁痰阻型老年抑郁障碍患者血清甲状腺激素水平的影响

The effect of tonifying kidney and clearing gallbladder-heat decoction combined sertraline on serum thyroid hormone level in senile depression patients with liver depression and phlegm obstruction

目的探讨肝郁痰阻型老年抑郁障碍患者使用益肾温胆汤干预后血清甲状腺激素水平的变化,分析其与疗效相关性。方法 57例患者随机分为中药组(益肾温胆汤联合舍曲林) 29例、对照组(舍曲林) 28例,分别于基线及治疗后第2、4、6、8周末检测血清甲状腺激素(血清甲状腺素T4、三碘甲状腺原氨酸T3、游离甲状腺素FT4、游离三碘甲状腺原氨酸FT3、促甲状腺激素TSH)水平变化情况,记录汉密尔顿抑郁量表(HAMD-24)评分及抑郁自评量表(SDS)评分。结果中药组在第8周T4值与基线比较、与对照组同期比较差异有统计学意义(P <0. 05);中药组T3在第2、4、6、8周与基线相比差异有显著性意义(P <0. 01),与对照组同期比较差异有统计学意义(P <0. 05);中药组FT4在第4、6、8周与基线比较差异有统计学意义(P <0. 05),但与同期对照组比较差异无统计学意义(P <0. 05); 2组TSH均从第2周开始至第8周呈缓慢下降趋势,中药组早于对照组。结论益肾温胆汤联合舍曲林对调节肝郁痰阻型老年抑郁障碍患者甲状腺激素T3、T4、FT4、TSH水平有积极作用,对患者抑郁状态有一定改善作用,效果优于单纯应用舍曲林。

Objective To discuss serum thyroid hormone changes in senile depression patients with liver depression and phlegm obstruction after the treatment of tonifying kidney and clearing gallbladder-heat decoction,as well as the correlation with the effect. Methods Fifty-seven patients were randomly divided into two groups: traditional Chinese medicine( TCM) group( 29 cases with tonifying kidney and clearing gallbladder-heat decoction combined with sertraline) and control group( 28 cases with sertraline).Serum thyroid hormone T4,triiodothyronine T3,free thyroxine FT4,free triiodothyronine FT3,Thyroid Stimulating Hormone( TSH) were separately measured at baseline and the end of the 2 nd,4 th,6 th and8 th week after treatment. Recorded Hamilton Depression scale( HAMD-24) score and self-rating depression scale( SDS) score. Results The result of T4 had statistic difference between the end of the 8 th week and the baseline in TCM group,and between the two groups at the same times( P < 0. 05). The result of T3 had significant differences at the 2 nd,4 th,6 th and 8 th week compared with the baseline inTCM group( P < 0. 01),and the differences was statistically significant compared with control group at the same time( P < 0. 05). FT4 in the TCM group was significantly different at the 4 th,6 th and 8 th week compared to the baseline( P < 0. 05),while there was no significant difference between the two groups( P > 0. 05). Both groups decreased slowly from the 2 nd week to the 8 th week,TCM group was better than control group. Conclusions Tonifying kidney and clearing gallbladder-heat decoction combined with sertraline has positive effects to regulate thyroid hormone levels of T3、T4、FT4 and TSH in senile depression patients with liver depression and phlegm obstruction. It could help improving the depression state of the patients. The effect is superior to sertraline alone.