疏肝解郁胶囊治疗卒中后抑郁患者的临床疗效及其对去甲肾上腺素和5-羟色胺水平的影响

Clinical Efficacy of Shugan Jieyu Capsules in Post-stroke Depression and Its Effects on NE and 5-HT Levels

目的:探究疏肝解郁胶囊对卒中后抑郁患者的临床疗效及对去甲肾上腺素(NE)、5-羟色胺(5-HT)水平的影响。方法:选取2017年1月至2018年1月北京中医医院顺义医院收治的卒中后抑郁患者118例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组59例。对照组予以常规西医治疗,观察组加用疏肝解郁胶囊,2组均连续治疗4周。观察2组治疗前、治疗后血清脑源性神经营养因子(BDNF)、神经生长因子(NGF)、多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)水平并比较;观察2组治疗前、治疗后在肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、同型半胱氨酸(Hcy)水平并比较;观察治疗前、治疗后在HAMD、抑郁自评量表(SDS)、日常生活能力量表(ADL)、神经功能缺损评分(NFDS)变化并比较;治疗过程中进行不良反应监测,包括胃肠道反应、食欲减退、大便干结、震颤等。结果:2组患者治疗前Hcy、TNF-α、IL-1β比较,差异无统计学意义(P>0.05),治疗后2组以上指标较治疗前均显著下降,差异有统计学意义(P<0.05),治疗后观察组患者以上指标显著低于对照组,差异有统计学意义(P<0.05)。2组患者治疗前BDNF、NGF、DA、5-HT、NE比较,差异无统计学意义(P>0.05),治疗后2组以上指标较治疗前均显著升高,差异有统计学意义(P<0.05),治疗后观察组患者以上指标高于对照组,差异有统计学意义(P<0.05)。2组患者治疗前HAMD、SDS、ADL、NFDS比较,差异无统计学意义(P>0.05),治疗后2组HAMD、SDS、NFDS较治疗前均显著下降,ADL较治疗前均显著升高,差异有统计学意义(P<0.05),治疗后观察组患者以上指标显著优于对照组,差异有统计学意义(P<0.05)。对照组不良反应发生率8.47%,观察组不良反应发生率6.78%,差异无统计学意义(P>0.05)。结论:疏肝解郁胶囊能降低卒中后抑郁程度,提高NE、5-HT水平,抑制炎性反应,从而提高疗效。

Objective:To explore the clinical efficacy of Shugan Jieyu Capsules in post-stroke depression and its effects on the levels of norepinephrine(NE)and 5-hydroxytryptamine(5-HT),so as to enrich the treatment methods,improve the efficacy and reduce the influence of depression. Methods:A total of 118 patients with post-stroke depression treated in Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine from January 2017 to January 2018 were selected as research objects,and according to their numbers,they were randomly divided into control group(59 cases)and observation group(59 cases).The control group was treated with conventional western medicine,while the observation group was treated with conventional western medicine and Shugan Jieyu Capsules.The 2 groups were treated for 4 weeks.The levels of brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),dopamine(DA),5-hydroxytryptamine(5-HT)and norepinephrine(NE)in serum of the 2 groups before and after the treatment were observed and compared.The levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and homocysteine(HCY)of the 2 groups before and after the treatment were observed and compared.The changes of Hamilton Depression Scale(HAMD),Self-rating Depression Scale(SDS),Activity of Daily Living Scale(ADL)and Neurological Functional Deficit Scale(NFDS)were observed and compared before and after the treatment,and the adverse reactions including gastrointestinal reaction,loss of appetite,dry stool,tremor,etc were monitored. Results:There was no significant difference in HCY,TNF-α and IL-1β between the 2 groups before the treatment( P >0.05).After the treatment,the above indexes of the 2 groups were significantly lower than those before the treatment( P <0.05).After the treatment,the above indexes of the observation group were significantly lower than those of the control group( P <0.05).(2)There was no significant difference in BDNF,NGF,DA,5-HT and NE between the 2 groups before the treatment( P >0.05).After the treatment,the above indexes in the 2 groups were significantly higher than those before the treatment( P <0.05).After the treatment,the above indexes in the observation group were significantly higher than those in the control group( P <0.05).(3)There was no significant difference in the scores of HAMD,SDS,ADL and NFDS between the 2 groups before the treatment( P >0.05).After the treatment,the scores of HAMD,SDS and NFDS in the 2 groups were decreased significantly and the score of ADL was increased significantly,compared with those before the treatment( P <0.05).After the treatment,the above indexes in the observation group were significantly better than those in the control group( P <0.05).The incidence of adverse reactions was 8.47% in the control group and 6.78% in the observation group.There was no significant difference between the 2 groups( P >0.05). Conclusion:Shugan Jieyu Capsules can reduce the degree of post-stroke depression,increase the levels of NE and 5-HT,inhibit inflammation,and improve the efficacy.