郁金治疗卒中后抑郁的药理机制研究进展

Pharmacological Mechanism of Curcumae Radix in Treatment of Post-stroke Depression:A Review

卒中后抑郁是中风后最常见的精神并发症,严重危害患者的生活质量,甚至生命安全,是临床治疗的一大难点。其发病机制复杂多样,目前较为认可的机制包括炎症机制、神经递质机制、内分泌机制等。中医认为患者卒中后,气滞、血瘀、痰浊上蒙清窍则发为情志病,而郁金作为临床常用的传统中药,功可活血止痛,行气解郁。通过总结邓铁涛、张学文等多位国医大师及其他医师的用药规律,发现郁金是临床上治疗郁证、卒中、卒中后抑郁用药频率最高的单味中药之一,现代药理研究也发现郁金含有β-谷甾醇、莪术二酮、姜黄素等多种药用成分。该文首次对郁金有效成分的药理作用及其治疗卒中后抑郁的药理机制进行综述,并创新性地对各种基源郁金的炮制方法进行归纳梳理,以明确郁金对卒中后抑郁的重要作用及郁金治疗卒中后抑郁的最佳药用选择。结果发现郁金所具有的调节神经递质、抑制神经炎症、保护神经元、调节神经内分泌、抗血栓等作用可通过多成分、多靶点、多途径对卒中后抑郁起到防治作用,其中以黄丝郁金酒制品效果最佳。

Post-stroke depression,a common mental complication after stroke,seriously affects the quality of life and even endangers the life safety of patients.It is difficult to be cured due to the complex and diverse pathogenesis.At present,the widely accepted pathogenesis mechanisms include inflammatory mechanism,neurotransmitter mechanism,and endocrine mechanism.According to the theory of Chinese medicine,Qi stagnation,blood stasis,and phlegm turbidity lead to the occurrence of mental diseases after stroke.Curcumae Radix,as a commonly used Chinese herbal medicine,can activate blood circulation for relieving pain,regulate Qi,and relieve depression.The summary of the medication rules of DENG Tie-tao,ZHANG Xue-wen and other Chinese medical physicians showcases that Curcumae Radix is frequently used in the clinical treatment of depression,stroke,and post-stroke depression.Modern pharmacological studies have demonstrated that Curcumae Radix containsβ-sitosterol,curdione,curcumin and other medicinal ingredients.This study reviewed the pharmacological effects of effective components in Curcumae Radix and the pharmacological mechanism in the treatment of post-stroke depression and summarized the processing methods of Curcumae Radix,aiming to clarify the important role and determine the optimal processing method of Curcumae Radix in the treatment of post-stroke depression.The results indicate that Curcumae Radix has the effects of regulating neurotransmitters,inhibiting neuroinflammation,protecting neurons,regulating neuroendocrine and antithrombosis,which can prevent and treat post-stroke depression through multiple components,targets,and pathways.The wine-processed Curcuma longa has the best effect.