针刺联合中药复方治疗卒中后抑郁的疗效观察及对患者血清5-HT、NE和BDNF水平的影响

Efficacy Observation of Acupuncture Combined with Compound Chinese Medication for Post-stroke Depression and Its Effects on the Serum Levels of 5-HT,NE,and BDNF

目的观察针刺联合中药复方大柴胡汤合桂枝茯苓丸治疗卒中后抑郁的临床疗效及其对患者血清5-羟色胺(5-HT)、去甲肾上腺素(NE)和脑源性神经营养因子(BDNF)水平的影响。方法纳入50例卒中后抑郁患者,采用随机数字表法分为研究组(25例)及对照组(25例)。对照组予口服大柴胡汤合桂枝茯苓丸治疗,研究组在对照组的治疗基础上联合针刺治疗。比较两组的临床疗效,比较两组治疗前后汉密尔顿抑郁量表(HAMD)评分、神经功能缺损程度(SSS)评分、日常生活能力(ADL)评分以及血清5-HT、NE、BDNF水平的变化,观察两组不良反应发生情况。结果对照组与研究组总有效率分别为76.0%和96.0%,研究组明显高于对照组(P<0.05)。治疗后,两组患者HAMD及SSS评分均较同组治疗前明显降低(P<0.05),且研究组明显低于对照组(P<0.05);两组ADL评分及血清5-HT、NE、BDNF水平均较同组治疗前明显升高(P<0.05),且研究组均明显高于对照组(P<0.05)。研究组与对照组不良反应发生率分别为8.0%和12.0%,差异无统计学意义(P>0.05)。HAMD评分、SSS评分、ADL评分均与血清5-HT、NE和BDNF水平呈负相关(P<0.05)。结论针刺联合中药复方治疗卒中后抑郁能升高血清5-HT、NE和BDNF水平,改善患者临床症状,疗效优于单纯中药复方治疗。

Objective To observe the clinical efficacy of acupuncture plus compound Chinese medication consisting of Da Chai Hu decoction and Gui Zhi Fu Ling pills in treating post-stroke depression and its effects on the serum levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),and brain-derived neurotrophic factor(BDNF).Method Fifty post-stroke depression patients were divided into a research group(25 cases)and a control group(25 cases)using the random number table method.The control group was given oral administration of Da Chai Hu decoction and Gui Zhi Fu Ling pills,and the research group received additional acupuncture treatment.The clinical efficacy was compared between the two groups.Before and after the treatment,the Hamilton depression scale(HAMD)score,Scandinavian stroke scale(SSS)score,activities of daily living(ADL)score,and serum levels of 5-HT,NE,and BDNF were compared.The adverse reactions in the two groups were also observed.Result The total effective rate was 76.0%in the control group versus 96.0%in the research group,and the research group was markedly higher than the control group(P<0.05).After the treatment,the HAMD and SSS scores declined significantly in both groups(P<0.05)and were notably lower in the research group than in the control group(P<0.05);the ADL score and the serum levels of 5-HT,NE,and BDNF increased significantly in both groups(P<0.05)and were markedly higher in the research group than in the control group(P<0.05).The adverse reaction rate was 8.0%in the research group versus 12.0%in the control group,and the between-group difference was statistically insignificant(P>0.05).The HAMD,SSS,and ADL scores were negatively correlated with the serum levels of 5-HT,NE,and BDNF(P<0.05).Conclusion Acupuncture plus compound Chinese medication can up-regulate the serum levels of 5-HT,NE,and BDNF and improve the clinical symptoms in treating post-stroke depression,producing more significant efficacy than using the compound Chinese medication alone.