中医治疗糖尿病抑郁症共病的研究进展

Treatment of Diabetic Depression with Traditional Chinese Medicine:A Review

糖尿病和抑郁症均为难治愈慢性疾病,二者相生相伴,临床上称之为糖尿病抑郁症共病。大量的流行病学和临床研究已证实,糖尿病与抑郁症交互,导致糖尿病抑郁症共病病情复杂,治疗难度大,预后差。现有临床治疗糖尿病抑郁症共病的方法大多将糖尿病与抑郁症作为两个独立的疾病进行治疗,存在显效率低不良反应强等诸多缺陷。中医治疗糖尿病抑郁症共病具有多靶点、多途径、整体协调的特点,能够调动机体多个系统之间的协同作用,在糖尿病抑郁症共病的治疗中显现出诸多优势。但是中医治疗糖尿病抑郁症共病的疗效评价大多只局限于临床症状的改善、血糖水平的控制及抑郁量表评分,缺少作用机制的深入研究,因此,许多研究者致力于探索中医药治疗糖尿病合并抑郁症的潜在作用机制。明确糖尿病抑郁症的共病机制是治疗糖尿病抑郁症共病的关键枢纽,在此,笔者回顾了中医治疗糖尿病抑郁症共病的相关文献,根据其作用机制进行介绍,并概括整理了糖尿病抑郁症的共病机制,主要包括胰岛素抵抗机制、氧化应激和炎症机制、神经系统紊乱机制。各个机制之间相互作用,进一步加重了糖尿病抑郁症共病的复杂性,笔者绘制了糖尿病与抑郁症共病的机制通路图,以期为临床诊疗提供新思路。

Diabetes and depression are both incurable chronic diseases,which are complementary and integrated.They are clinically called diabetic depression.A large number of epidemiological and clinical studies have confirmed that diabetes interacts with depression,leading to complex conditions of diabetic depression,difficult treatment,and poor prognosis.Diabetes and depression are considered two independent diseases in the majority of the existing clinical methods for the treatment of diabetic depression,with many defects such as low efficiency and severe side effects.Traditional Chinese medicine(TCM)treatment of diabetic depression,characterized by multiple targets,multiple pathways,and overall coordination,can adjust the synergy between multiple systems of the body and is advantageous in the treatment of diabetic depression.However,the evaluation of the efficacy of TCM in the treatment of diabetic depression is mostly limited to the improvement of clinical symptoms,the control of blood sugar level,and the score of depression scale,and there is a lack of indepth research on the mechanism of action.Therefore,many researchers are devoted to exploring the underlying mechanism of TCM in the treatment of diabetes combined with depression.Clarifying the comorbidity mechanism is the key in treating diabetic depression.In this study,we made an introduction according to the mechanism based on the relevant research reports on the treatment of diabetic depression with TCM and summarized its specific mechanisms,including insulin resistance,oxidative stress and inflammation,and nervous system disorder.The interaction between the various mechanisms has further aggravated the complexity of diabetic depression.We have drawn a diagram of the mechanism pathways of diabetic depression in order to provide new ideas for clinical diagnosis and treatment.