养血清脑颗粒治疗卒中后抑郁的疗效及对脑白质结构改变的影响

Effect of Yangxue Qingnao Granule on Treating Depression after Stroke and Its Effect on Structure Change of White Matter of Brain

目的:探讨养血清脑颗粒治疗卒中后抑郁的疗效及对脑白质结构改变的影响。方法:选择从2013年2月—2016年10月于医院神经内科收治的125名脑卒中后的抑郁(Post-Stroke Depression,以下简称PSD)患者,所有入组PSD患者给予养血清脑颗粒,在治疗后汉密尔顿抑郁量表评分≤8分,则判定为治愈,如果汉密尔顿抑郁量表评分≥9分,则判定为难治,比较两组的FA值变化情况。结果:在治疗期间一共有5例病例失访,剩下的120例患者完了汉密尔顿抑郁量表评分,在完成治疗后,汉密尔顿抑郁量表评分≤8分的患者共有56例,即治愈组56例,汉密尔顿抑郁量表评分>9分的患者共有74例,即难治组74例。在治愈组中和难治组中,分别有20例和25例完成治疗前后的DTI数据采集,在使用养血清脑颗粒治疗之前和之后的治愈组患者,在不同解剖部位的FA值比较,结果显示只有左侧额叶的FA值的差异具有统计学意义(P<0.05),而且为治疗之后高于治疗之前,其他部位的数据差异均没有统计学意义(P>0.05),将治愈组和难治组在进行治疗之前不同位置的FA值数据进行比较,结果显示左侧额叶和右侧海马的FA值的差异具有统计学意义(P<0.05),其他部位的数据差异均没有统计学意义(P>0.05)。结论:PSD的主要发病原因可能是前额叶神经纤维通路的损伤,而且海马区域的易损性则可能使PSD病情迁延反复的主要原因,两者可能构成PSD的病理基础,提示医师应该提高对PSD的警示意识,尽早进行预防和正确的干预。

Objective：To investigate the therapeutic effect of Yangxue Qingnao Granule on post -stroke depression and its effect on the changes of white matter structure. Methods ：A total of 125 post - stroke depression （PSD） patients were selected from Feb. 2013 to Oct. 2016. All the PSD patients were treated with Yangxue Qingnao Granule. Hamilton de- pression score after treatment was less than or equal to 8 points, the patients would be judged to be cured. If the Hamilton Depression Rating Scale was greater than or equal to 9 points, and then the patients would be judged to be refractory. We compared the two groups＂ FA value changes. Result ： A total of 5 cases were lost during the treatment, and the remaining 120 patients completed the Hamilton Depression Rating Scale. After completion of the treatment, the Hamilton Depres- sion Rating Scale score was less than or equal to 8 patients in 56 cases,indicating 56 cases in cured group. The Hamilton depression scale score more than 9 were in 74 cases, indicating 74 cases in refractory group. In the cured group and the refractory group, 20 cases and 25 eases were completed DTI data collection before and after treatment. Before and after Yangxue Qingnao Granules treatment for patients in the cured group, FA values in different anatomic sites showed there was no statistically significant difference （ P 〉 0. 05 ） in the difference of FA values between the left frontal lobe and the frontal lobe before treatment. The difference of FA values between the left frontal lobe and the right hippocampus was sta- tistically significant （ P 〈 0.05 ）. There was no statistically significant difference in the FA values of other parts of the re- fractory group before treatment（P 〉0.05）. Conclusion：The main cause of PSD may be the damage of the prefrontal nerve fiber pathway, and the vulnerability of the hippoeampal region may be the main reason for the protracted recurrence of PSD, which may constitute the pathological basis of PSD, suggesting that physicians should improve the PSD warning awareness, early prevention and correct intervention.