中西医治疗抑郁症疗效及对HPA、HPT及HPG轴影响研究

Effects of Traditional and Western Medicine Therapy on the HPA,HPT and HPG Axis in Depression Patients

目的明确逍遥散治疗抑郁症的临床疗效,比较中西医结合治疗的优势,探讨逍遥散抗抑郁作用的相关机制。方法将90例抑郁症患者随机分为中药组(逍遥散治疗组)、西药组(西酞普兰治疗组)和中西药结合组(逍遥散加味方合并西酞普兰治疗组)。三组均治疗6周,每组在治疗前后分别做地塞米松抑制试验(DST)并检测血浆皮质醇和促肾上腺皮质激素(ACTH)的浓度;同时检测T3、T4、促甲状腺激素(TSH)、睾酮(T)、雌二醇(E2)的浓度。结果逍遥散治疗抑郁症愈显率约73.3%,且不良反应小;三组血浆皮质醇和ACTH浓度在治疗前后差异均有显著性意义(P<0.05),三组女性患者的雌二醇(E2)浓度在治疗前后差异均有显著性意义(P<0.05),而且其含量随临床症状的缓解趋于正常。中西药结合组HAMD评分治疗结束时下降更明显,与其他两组评分比较有显著性意义(P<0.05)。结论逍遥散对抑郁症患者下丘脑-垂体-肾上腺(HPA)轴及下丘脑-垂体-性腺轴(HPG轴)的影响是状态依赖性的,即随着抗抑郁疗效的出现,患者的HPA轴及HPG轴功能也逐步恢复正常。逍遥散对抑郁症疗效与5-HT再摄取抑制剂相当,而两者结合治疗疗效更佳。

Objective To observe the clinical effect of Xiaoyao Powder in treatment of depression patients,find the superiority of Traditional and Western Medicine Therapy,and explore the neuroendocrine mechanism of Xiaoyao Powder in anti-depression.Methods 90 cases of depression patients were randomly divided into traditional Chinese medicine group（treatment by oral Xiaoyao Powder）,western medicine group（treatment by oral citalopram） and group conbined traditional Chinese medicine with western medicine（conbined treatment of Xiaoyao Powder and citalopram）.They were all treated for 6 weeks.Dexamethasone suppression test（DST） before and after treatment were made and then the plasma cortisone,adrenocorticotropic hormone（ACTH）,T3,T4,TSH,testosterone and estradiol were determined.Results The markedly effective rate was 73.3% in traditional Chinese medicine group with a less reverse effect;there were significant differences before and after treatment in the plasma cortisone and ACTH levels in the three groups（all P 0.05）,there were also significant differences before and after treatment in the plasma estradiol levels of female patients in the three groups（all P 0.05）,and their levels tended to normal with alleviation of clinical symptoms.After 6 weeks of treatmenf,the score of HAMD decreased remarkably in the group conbined traditional Chinese medicine with western medicine than that in the other two groups（P 0.05）.Conclusions Xiaoyao Powder has the same therapeutic effect on depression as SSRI and a better therapeutic effect with conbined treatment of Xiaoyao Powder and citalopram.Xiaoyao Powder can markedly decrease plasma cortical,ACTH and estradiol levels in depression patients.