丁苯酞对卒中后抑郁的疗效观察及作用机制研究

Study on the curative effect of butylphthalide on post-stroke depression and its mechanism

目的 探讨丁苯酞用于卒中后抑郁（post-stroke depression,PSD）治疗的有效性、可行性。方法 以2015年3月-2016年2月我院收治的171例PSD患者为研究对象,本次临床分组采用双盲法将患者分为常规、观察、治疗三组,每组57例。其中常规组采用艾司西酞普兰治疗,观察组以丁苯酞治疗,治疗组以两种药物联合治疗,对用药前后患者抑郁、脑卒中恢复情况进行评估,并比较NIHSS、HAMD、m RS评分。检查用药前后患者超敏C反应蛋白（hypersensitive C-reactive protein hs-CRP）、去甲肾上腺素（Noradrenaline,NE）情况,统计治疗期间用药所致不良反应。结果 治疗前患者美国国立卫生研究所脑卒中量表（National Institute of Health stroke scale,NIHSS）评分、汉密顿抑郁量表（Hamilton Depression Scale,HAMD）、改良Rankin量表（Modified Rankin Scale,m RS）评分比较差异无统计学意义（P〉0.05）,用药后各组患者NIHSS、HAMD、m RS评分均有改善,治疗组、观察组评分低于常规组,且治疗组患者卒中、抑郁恢复情况优于观察组（P〈0.05）;治疗前患者NE、hs-CRP差异无统计学意义（P〉0.05）,服药后治疗组指标恢复优于常规组、观察组,且治疗组恢复情况较观察组好（P〈0.05）。结论 临床对卒中后抑郁患者使用艾司西酞普兰、丁苯酞联合治疗效果好。

Objective To investigate the efficacy and feasibility of butyphthalide in the treatment of post-stroke depression （PSD）. Methods A total of 171 patients with PSD who were admitted to our hospital from March 2015 to February 2016 were selected as the research subjects. Double blind method was applied in the clinical gTouping. The patients were divided into three groups： conventional group, observation group and treatment group, with 57 patients in each group. The conventional group was treated with escitalopram, and the observation group was treated with butylph- thalide. The treatment group was treated with the two drugs in combination. The recovery of patients＇ depression and cerebral stroke before and after medication and the NIHSS, HAMD, mRS scores were evaluated. The levels of hypersensitive C-reactive protein（hs-CRP） and noradrenaline （NE） were measured before and after medication. Adverse reactions caused by medication during the course of treatment were statistically analzed. Results Before treatment, there were no significant differences in the National Institute of Health stroke scale（NIHSS） score, Hamilton Depression Scale （HAMD）, Modified Rankin Scale（mRS） score before the treatment in the patients（P〉0.05）. NIHSS, HAMD and mRS scores were improved in all groups after treatment. The scores in the treatment group and the observation group were lower than those in the conventional group, and the recovery of stroke and depression in the treatment group was better than that in the observation group（P〈0.05）; before treatment, thedifferences of NE and hs-CRP were not significant（P〉 0.05）. After treatment, the recovery of indices in the treatment group was better than that in the conventional group and the observation group, and the recovery in the treatment group was better than that in the observation group（P〈0.05）. Conclusion The clinical efficacy of combined treatment of escitalopram and butylphthalide for the patients with stroke and depression is favorable.