加味通窍活血汤联合丙戊酸盐治疗双相情感障碍躁狂发作

Jiawei Tongqiao Huoxue Decoction Combined with Valproate in the Treatment of Bipolar Affective Disorder Manic Episode

目的探讨加味通窍活血汤联合丙戊酸盐治疗双相情感障碍躁狂发作的临床疗效。方法选取2017年2月-2018年8月我院收治的双相情感障碍躁狂发作患者病例97例为研究对象,按数字表法随机分为对照组和研究组。对照组48例,给予丙戊酸镁缓释片治疗;研究组49例,在对照组基础上给予加味通窍活血汤治疗。2组患者均治疗2个月。比较2组患者的临床疗效;比较治疗前后躁狂(BRMS)、抑郁(HAMD)量表变化及血清白细胞介素-4(IL-4),白细胞介素-1β(IL-1β),肿瘤坏死因子-α(TNF-α)指标水平变化及生活质量;比较治疗期间2组患者出现的不良反应。结果研究组的临床总有效率为93.88%,高于对照组的68.75%;研究组的证候分型为火盛伤阴型、肝胆郁热型及痰浊内壅型,总有效率均高于对照组同证候(P<0.05);治疗后2组BRMS、HAMD评分均低于治疗前,且研究组低于对照组(P<0.05);治疗后2组IL-4、IL-1β及TNF-α低于治疗前,且研究组低于对照组(P<0.05);治疗后2组的生活质量各维度物质生活、生理功能、心理功能、社会功能评分均高于治疗前,且研究组高于对照组(P<0.05)。结论加味通窍活血汤联合丙戊酸盐治疗双相情感障碍躁狂发作临床疗效确切,可改善患者的免疫功能,同时减轻患者躁狂、抑郁精神症状,提高生活质量,不良反应少,安全性高。

Objective To explore the clinical efficacy of Jiawei Tongqiao Huoxue Decoction combined with valproate in the treatment of bipolar affective disorder manic episode. Methods 97 patients with bipolar affective disorder manic episode admitted to our hospital from February 2017 to August 2018 were selected as the study subjects. They were randomly divided into control group (48 cases) and study group (49 cases) according to the number table method. The control group was treated with sustained-release magnesium valproate tablet, and the study group was treated with Jiawei Tongqiao Huoxue Decoction on the basis of the control group. Both groups were treated for 2 months. The clinical efficacy of the two groups was compared. The change of Bech-Rafaelsen Mania Rating Scale (BRMS), Hamilton Depression Scale (HAMD), serum interleukin-4 (IL-4), interleukin-1beta (IL-1β), tumor necrosis factor-a (TNF-α) and quality of life was compared before and after treatment. The adverse reaction of the two groups during the treatment was compared. Results The total clinical effective rate in study group was 93.88%, which was higher than 68.75% in control group. The total effective rate of syndrome types in study group, including excessive fire damaging yim type, liver-gallbladder stagnant-heat type and phlegm turbid retention type, was higher than that in control group (P<0.05). After treatment, BRMS and HAMD scores in both groups were lower than those before treatment, and those in study group were lower than those in control group (P<0.05). After treatment, the level of IL-4, IL-1β and TNF-α in two groups was lower than that before treatment, and that in study group was lower than that in control group (P<0.05). After treatment, the score of quality of life including physical life, physiological function, psychological function and social function in the two groups was higher than that before treatment, and the score in study group was higher than that in control group (P<0.05). Conclusion Jiawei Tongqiao Huoxue Decoction combined with valproate in the treatment of bipolar affective disorder manic episode has a definite clinical effect. It can improve the immune function of patients, alleviate manic and depressive psychiatric symptoms, improve the quality of life, with fewer adverse reactions and high safety.