肝肾阳虚型抑郁症与血ACTH、CORT关系及助阳舒心方干预作用的研究

Research on Relationship between Depression of Liver-Kidney Yang Deficiency and ACTH CORT and Intervention of Zhuyang Shuxin

目的:观察肝肾阳虚型抑郁症与外周血ACTH、CORT关系及助阳舒心方的干预作用。方法:将100例肝肾阳虚型抑郁症患者随机分为治疗组和对照组,其中治疗组用助阳舒心方治疗,对照组用氟西汀治疗,疗程均为6周,比较外周血ACTH、CORT在治疗前后的变化,分析治疗前HAMD总分、中医证候积分与ACTH、CORT的相关性,分析治疗前后HAMD总分、中医证候积分减分率与ACTH、CORT减分率的相关性。结果:肝肾阳虚型抑郁症治疗前外周血ACTH和CORT含量升高,并与HAMD总分、证候积分呈正相关关系;两组治疗后ACTH和CORT含量均恢复正常,与治疗前比较均有显著的统计学差异(P<0.01);两组治疗后ACTH比较有显著的统计学差异(P<0.01);HAMD总分减分率与CORT减分率呈正相关关系。结论:肝肾阳虚型抑郁症存在HPA轴功能的亢进,外周血异常的ACTH和CORT含量与病情严重程度有关,CORT减分率可用于临床疗效评估的参考;调控异常的HPA轴功能是助阳舒心方治疗抑郁症的机制之一。

Objective：To observe the relationship between depression of liver - kidney yang deficiency and ACTH, CORT and intervention of Zhuyang Shuxin to it. Methods ： 100 cases were randomly divided into treatment group treated with Zhuyang Shuxin and control group treated with fluoxetine for six weeks. ACTH and CORT were observed before and after treatment. The correlation of HAMD total score,TCM syndrome score and ACTH and CORT before treatment was explored, the correlation of HAMD total score, TCM syndrome score reducing rate and ACTH and CORT score reducing rate before and after treatment was also observed. Results ： ACTH and CORT were higher in depression of liver - kidney yang deficiency type than that in normal person. HAMD total score and TCM syndrome score had a positive correlation with ACTH and CORT. ACTH and CORT reduced to normal after treatment. There were significant statistical differences in ACTH between two groups after treatment（P 〈 0.01 ）. HAMD score reducing rate had a positive correlation with CORT score reducing rate. Conclusion ： Depression of liver - kidney yang deficiency type is related to hyperfunction of hypothalamic -pituitary -adrenal（HPA） axis. The levels of ACTH and CORT were related to the severity of depression. CORT score reducing could be a reference for valuation of clinical effect. The regulation effect on HPA axis function may be one of the mechanisms of Zhuyang Shuxin treating depression.