疏肝养心汤治疗冠心病合并抑郁症30例临床观察

Clinical effect of Shugan Yangxin decoction in treatment of patients with coronary heart disease and depression:An analysis of 30 cases

目的:观察疏肝养心汤治疗冠心病合并抑郁症患者的临床疗效,初步探讨其疗效机制。方法:将确诊为冠心病合并抑郁症的患者60例随机分为治疗组与对照组,每组各30例。2组患者均采用标准冠心病二级预防用药治疗,在此基础上治疗组加用疏肝养心汤颗粒剂治疗,对照组加用舍曲林胶囊治疗。治疗8周后比较2组抑郁症疗效、中医证候疗效及实验室指标改善情况。结果:抑郁症改善总有效率治疗组为83.33%、对照组为66.67%,中医证候疗效总有效率治疗组为83.33%、对照组为70.00%,2组比较,差异均有统计学意义(P<0.05);2组治疗后TG、LDL-C水平均较治疗前下降,且治疗组LDL-C改善情况优于对照组,差异有统计学意义(P<0.05);治疗组治疗后肾素水平升高,醛固酮及hs-CRP水平降低,与治疗前比较,差异均有统计学意义(P<0.05);且治疗组hs-CRP降低幅度明显大于对照组,差异有统计学意义(P<0.05)。结论:疏肝养心汤能够明显改善冠心病合并抑郁症患者的抑郁及心绞痛等临床症状,其作用机制可能与其降低炎性因子、对抗RAAS系统过度激活、改善血管内皮损伤、降低交感神经兴奋性等有关。

Objective:To investigate the clinical effect and therapeutic mechanism of Shugan Yangxin decoction in the treatment of patients with coronary heart disease and depression.Methods:A total of 60 patients who were diagnosed with coronary heart disease and depression were randomly divided into treatment group and control group,with 30 patients in each group.In addition to the standard secondary preventive medication for coronary heart disease,the patients in the treatment group were given Shugan Yangxin granules,and those in the control group were given sertraline capsules.After 8 weeks of treatment,the two groups were compared in terms of the outcome of depression,the outcome of traditional Chinese medicine(TCM)syndrome,and the improvement in laboratory markers.Results:There were significant differences between the treatment group and the control group in the overall rate of improvement in depression(83.33%vs 66.67%,P<0.05)and the overall response rate of TCM syndrome(83.33%vs 70.00%,P<0.05).Both groups had significant reductions in triglyceride and low-density lipoprotein cholesterol(LDL-C)after treatment,and the treatment group had a significantly greater improvement in LDL-C than the control group(P<0.05).After treatment,the treatment group had a significant increase in renin and significant reductions in aldosterone and high-sensitivity C-reactive protein(hs-CRP)(P<0.05),and the treatment group had a significantly greater reduction in hs-CRP than the control group(P<0.05).Conclusion:In patients with coronary heart disease and depression,Shugan Yangxin decoction can significantly improve the clinical symptoms of depression and angina pectoris,possibly by reducing inflammatory factors,overactivating the anti-RAAS system,improving vascular endothelial injury,and reducing the excitability of sympathetic nerve.