珍珠养心安神汤对创伤后应激障碍患者HAMD和PTSD-SS评分及细胞因子和相关代谢产物的影响

Effect of pearl Yangxin Anshen Decoction on HAMD and PTSD-SS scores and changes of cytokines and related metabolites in patients with posttraumatic stress disorder

目的观察珍珠养心安神汤对创伤后应激障碍(PTSD)患者的汉密尔顿抑郁量表(HAMD)和创伤后应激障碍自评量表(PTSD-SS)评分及细胞因子和相关代谢产物的影响。方法选取2015年6至2016年5月在海南省两家医院中医门诊就诊且年龄在30~60岁的55例PTSD患者,采用完全随机分组方法分为观察组28例和对照组27例,两组患者均给予口服盐酸帕罗西汀片及心理疗法等综合治疗3个月,观察组再加服自拟中药珍珠养心安神汤。比较两组患者治疗前后的HAMD和PTSS评分及不同时间点细胞因子和相关代谢产物的变化情况。结果治疗前对照组和观察组两组患者PTSD-SS评分为(63.24±6.16)分、(65.64±7.02)分,HAMD得分为(30.24±2.05)分、(29.28±1.97)分,治疗前两组患者PTSD-SS评分和HAMD得分比较差异均无统计学意义(P>0.05);治疗后对照组和观察组两组患者PTSD-SS评分为(31.40±4.29)分、(28.32±4.18)分,HAMD得分为(13.08±2.30)分、(11.72±2.13)分,治疗后两组患者PTSD-SS评分和HAMD得分比较差异均有统计学意义(P<0.05)。两组患者随着治疗时间的延长血浆白介素2(IL-2)、白介素6(IL-6)、白介素8(IL-8)、血清丙二醛(MDA)、去甲肾上腺素(NE)、一氧化氮(NO)、人血管活性肠肽(VIP)含量均呈逐渐降低的趋势(P<0.05),且观察组患者降低水平均高于对照组。两组患者促肾上腺皮质激素(ACTH)和超氧化物歧化酶(SOD)含量随着治疗时间的延长呈逐渐升高的趋势(P<0.05)。结论珍珠养心安神汤可改善创伤后应激障碍的患者PTSD症状,对PTSD患者的细胞因子及相关代谢产物变化有一定的影响。

Objective To observe the effect of pearl Yangxin Anshen Decoction on Hamilton Rating Scale for Depression（HAMD） and posttraumatic stress disorder self-rating scale（PTSD-SS） scores and changes of cytokines and related metabolites in patients with posttraumatic stress disorder（PTSD）. Methods A total of 55 patients with PTSD aged 30-60, who admitted to outpatient clinic of two hospitals of Traditional Chinese Medicine from June 2015 to May2016, were selected and divided into the treatment group（n=28） and the control group（n=27） according to random-number table. The two groups were given oral administration of paroxetine hydrochloride tablets and psychological therapy and other comprehensive treatment for 3 months, and the treatment group was additionally treated with self-induced Chinese medicine pearl Yangxin Anshen Decoction. The HAMD and PTSS scores of the two groups before and after the treatment and the changes of cytokines and related metabolites at different time points were compared. Results Before the treatment, the scores of PTSD-SS in the control group and the observation group were respectively（63.24 ± 6.16） and（65.64±7.02）, and the HAMD scores were（30.24±2.05） and（29.28±1.97）, respectively, with no significant difference in PTSD-SS score and HAMD score between the two groups（P〈0.05）. After the treatment, the scores of PTSD-SS in the control group and the observation group were（31.40 ± 4.29）,（28.32 ± 4.18）, the scores of HAMD were（13.08 ± 2.30）,（11.72±2.13）, with significant differences in PTSD-SS score and HAMD score between the two groups（P〈0.05）. With the prolongation of treatment time, the levels of plasma interleukin-2（IL-2）, interleukin-6（IL-6）, interleukin-8（IL-8）,serum malondialdehyde（MDA）, norepinephrine（NE）, nitric oxide（NO）, vasoactive intestinal peptide（VIP） in the two groups showed a decreasing trend（P〈0.05）, and The level of reduction in the observation group was significantly higher than that in the control group（P〈0.05）. The levels of adrenocorticotropic hormone（ACTH） and superoxide dismutase（SOD） in the two groups were gradually increased with the prolongation of treatment time（P〈0.05）. Conclusion Pearl Yangxin Anshen Decoction can improve the symptoms of patients with PTSD, and has significant effect on the changes in cytokines and associated metabolites in patients with PTSD.