逐瘀开郁化痰汤治疗PSD的疗效及对神经功能和单胺类神经递质的影响

Clinical effect of Zhuyu Kaiyu Huatan decoction in treatment of post-stroke depression and its effect on neurological function and monoamine neurotransmitters

目的:观察逐瘀开郁化痰汤治疗脑卒中后抑郁(PSD)的临床疗效及对神经功能和血清单胺类神经递质的影响。方法:将PSD患者160例,按随机区划设计分为2组,每组各80例。治疗组采用逐瘀开郁化痰汤治疗,对照组采用舍曲林治疗。治疗4周后评定2组患者综合疗效与中医证候疗效,并比较2组患者治疗前后的汉密尔顿抑郁量表(HAMD-24)评分、焦虑自评量表(SAS)评分、神经功能缺损(CSS)评分及血清单胺类神经递质多巴胺(DA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)水平的变化。结果:综合疗效、中医证候疗效总有效率治疗组分别为98. 75%、97. 50%,对照组均为88. 75%,组间比较,差异均有统计学意义(均P <0. 05); 2组HAMD-24、SAS、CSS评分及血清神经递质(DA、NE、5-HT)含量治疗前后组内比较及治疗后组间比较,差异均有统计学意义(均P <0. 05)。结论:逐瘀开郁化痰汤能显著改善PSD患者的神经功能和抑郁焦虑状态,提高血清单胺类神经递质(DA、NE、5-HT)水平,且不良反应少。

Objective: To investigate the clinical effect of Zhuyu Kaiyu Huatan decoction in the treatment of post-stroke depression( PSD) and its effect on neurological function and serum monoamine neurotransmitters. Methods: A total of 160 PSD patients were randomly divided into treatment group and control group,with 80 patients in each group. The patients in the treatment group were given Zhuyu Kaiyu Huatan decoction,and those in the control group were given sertraline. Overall response and response of traditional Chinese medicine( TCM) syndrome were evaluated after 4 weeks of treatment,and the two groups were compared in terms of the changes in 24-item Hamilton Depression Scale( HAMD-24) score,Self-Rating Anxiety Scale( SAS) score,clinical severity score( CSS) of neurological deficit,and serum levels of the monoamine neurotransmitters dopamine( DA),norepinephrine( NE),and 5-hydroxytryptamine( 5-HT)after treatment. Results: After treatment,there were significant differences between the treatment group and the control group in overall response rate( 98. 75% vs 88. 75%,P < 0. 05) and overall response rate for TCM syndrome( 97. 50% vs88. 75%,P < 0. 05). Both groups had significant changes in HAMD-24 score,SAS score,CSS score,and serum levels of DA,NE,and 5-HT after treatment,and there were significant differences in these indices between the two groups after treatment( all P < 0. 05). Conclusion: In patients with PSD,Zhuyu Kaiyu Huatan decoction can significantly improve their neurological function and depression/anxiety state and increase the serum levels of the monoamine neurotransmitters DA,NE,and 5-HT,with few adverse effects.