疏肝解郁汤治疗肝气郁结型老年抑郁症临床研究

Clinical Study on Shugan Jieyu Tang for Senile Patients with Depression of Liver Qi Depression Type

目的:观察疏肝解郁汤治疗肝气郁结型老年抑郁症的临床效果。方法:选取70例肝气郁结型老年抑郁症患者,按随机数字表法分为对照组和观察组各35例。对照组给予盐酸文拉法辛缓释胶囊治疗,观察组在对照组基础上给予疏肝解郁汤治疗。比较2组治疗前后汉密尔顿抑郁量表17项(HAMD-17)评分与中医证候评分,并检测血清中皮质醇(CORT)、去甲肾上腺素(NA)、5-羟色胺(5-HT)和脑源性神经营养因子(BDNF)水平,观察不良反应,评价临床疗效。结果:对照组总有效率为80.00%,观察组为94.29%,2组总有效率比较,差异无统计学意义(P>0.05)。治疗前,2组HAMD-17评分及中医证候评分比较,差异无统计学意义(P>0.05)。治疗后,2组HAMD-17评分及中医证候评分较治疗前降低(P<0.05),且观察组HAMD-17评分及中医证候评分低于对照组(P<0.05)。治疗前,2组血清CORT、NA、5-HT、BDNF水平比较,差异无统计学意义(P>0.05)。治疗后,2组血清CORT低于治疗前,血清NA、5-HT、BDNF水平高于治疗前(P<0.05);且观察组血清CORT低于对照组,血清NA、5-HT、BDNF水平高于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:疏肝解郁汤治疗肝气郁结型老年抑郁症,不良反应少,能改善患者抑郁症状,作用机制可能与调节CORT、NA、5-HT、BDNF的表达有关。

Objective:To observe the clinical effect of Shugan Jieyu tang for senile patients with depression of liver qi depression type,and explore its mechanism and safety. Methods:A total of 70 cases of senile patients with depression of liver qi depression type were selected and divided into the control group and the observation group according to the random number table method, 35 cases in each group. The control group was treated with venlafaxine hydrochloride sustainedrelease capsules,and the observation group was additionally treated with Shugan Jieyu tang based on the treatment of the control group. The scores of 17-item Hamilton Depression Scale(HAMD-17) and Chinese medicine syndromes in the two groups were compared before and after treatment;the levels of cortisol(CORT),noradrenaline(NA),5-hydroxytryptamine(5-HT) and brain-derived neurotrophic factor(BDNF) in serum were detected;adverse reactions were observed;the clinical effect was evaluated. Results: The total effective rate was 80.00% in the control group and 94.29% in the observation group,there being no significance in the difference(P>0.05). Before treatment,there was no significant difference being found in the comparison of the scores of HAMD-17 and Chinese medicine syndromes between the two groups(P>0.05).After treatment, the scores of HAMD-17 and Chinese medicine syndromes in the two groups were decreased when compared with those before treatment(P<0.05),and the above scores in the observation group were lower than those in the control group(P<0.05). Before treatment,there was no significant difference being found in the comparison of the levels of CORT,NA,5-HT and BDNF in serum between the two groups(P>0.05). After treatment,the levels of CORT in serum in the two groups were lower than those before treatment,and the levels of NA,5-HT and BDNF in serum were higher(P<0.05);the level of CORT in serum in the observation group was lower than that in the control group,and the levels of NA,5-HT and BDNF in serum were higher(P<0.05). There was no significant difference being found in the comparison of the incidences of adverse reactions between the two groups(P>0.05). Conclusion:The application of Shugan Jieyu tang for senile patients with depression of liver qi depression type can improve their depression with few adverse reactions. The mechanism may be related to the regulation of the expressions of CORT,NA,5-HT and BDNF.