基于脑-肠轴理论观察解郁1号方联合大黄膏敷脐治疗脑卒中后抑郁的临床效果

Clinical effect of Jieyu No.1 Recipe combined with umbilicus-applying Rheum Officinale Ointment in the treatment of post-stroke depression based on the theory of brain-gut axis

目的基于脑-肠轴理论探讨解郁1号方联合大黄膏敷脐治疗脑卒中后抑郁(PSD)的临床效果及作用机制。方法选取2016年12月至2017年12月我院神经内科住院患者100例随机单盲法分成两组,每组各50例。两组患者均进行常规西药及解郁1号方内服治疗,试验组加用大黄膏敷脐治疗。分别采用汉密尔顿抑郁量表(HAMD)、中国卒中量表(CSS)对两组PSD患者抑郁情况及神经功能情况进行评价,两组患者治疗前、治疗后2周、4周和第8周分别评价1次;治疗前、治疗后4周检测两组患者血清中5-HT、NE水平。结果试验组患者治疗的总有效率为91.11%,对照组为78.26%,组间比较差异有统计学意义(P<0.05)。治疗后4周和第8周随访,试验组HAMD、CSS评分均低于对照组,差异均有统计学意义(P<0.05)。治疗后4周两组5-HT和NE水平均较治疗前明显提高,差异均有统计学意义(P<0.05),且试验组治疗后4周5-HT和NE水平均高于对照组,差异均有统计学意义(P<0.05)。结论解郁1号方联合大黄膏敷脐治疗PSD的临床疗效显著,其机制可能与上调5-HT、NE的表达有关。

Objective To explore the clinical effect and mechanism of Jieyu No.1 Recipe combined with umbilicus-applying Rheum Officinale Ointment in the treatment of post-stroke depression(PSD)based on the theory of brain-gut axis.Methods From December 2016 to December 2017,100 inpatients in the department of neurology were randomly divided into two groups based on the single-blinded method,with 50 patients in each group.Both groups of patients were orally given conventional western medicine and Jieyu No.1 Recipe.The experimental group was further given umbilicus-applying Rheum Officinale Ointment for treatment.The Hamilton Depression Scale(HAMD)and the Chinese Stroke Scale(CSS)were used to evaluate the depression and neurological impairment of PSD patients;two groups of patients were evaluated once before treatment,and at 2,4 and 8 weeks after treatment;the levels of serum 5-hydroxytryptamine(5-HT)and norepinephrine(NE)in the patients were measured before treatment and 4 weeks after treatment.Results The total effective rate of treatment in the experimental group was 91.11%,and that in the control group was 78.26%.The difference was statistically significant(P<0.05).According to the follow-up visits at 4 weeks and 8 weeks after treatment,the HAMD and CSS scores in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the expression levels of 5-HT and NE were significantly higher than those before treatment,and the differences were statistically significant(P<0.05).The levels of 5-HT and NE in the experimental group after 4 weeks of treatment were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Jieyu No.1 Recipe combined with umbilicus-applying Rheum Officinale Ointment has a significant clinical effect on PSD,and its mechanism may be related to the up-regulation of 5-HT and NE expression.