调肝解郁方对血虚肝郁型围绝经期情绪障碍患者的临床疗效

Clinical effect of Tiaogan Jieyu Decoction in treating patients of perimenopausal emotional disorder with syndrome of blood deficiency and liver depression

目的:观察调肝解郁方干预围绝经期情绪障碍患者的临床疗效,并基于神经肽的调节作用初步探讨其疗效机制。方法:选择肝郁血虚型围绝经期情绪障碍患者101例,随机分为治疗组51例和对照组50例。两组患者均给予基础心理疏导治疗;同时,治疗组患者给予调肝解郁方口服,对照组患者给予更年宁口服,治疗周期均为8周。比较两组患者治疗前后的中医症状总积分及主要症状积分,评价并比较两组患者的Greene更年期量表及焦虑自评量表(SAS)、抑郁自评量表(SDS)评分;检测并比较所有患者的雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)、孕酮(P)、催乳素(PRL)及β-内啡肽(β-EP)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)水平。结果:①治疗后,两组患者的中医症状总积分较治疗前均显著降低(P<0.01),且治疗组患者的积分明显低于对照组(P<0.01)。②治疗后,两组患者的主要症状(如潮热汗出、抑郁等)积分较治疗前均降低(P<0.05,P<0.01),且治疗组患者的主要症状(如潮热汗出、抑郁、焦虑等)积分低于对照组(P<0.05,P<0.01)。③治疗后,两组患者的Greene更年期量表评分较治疗前均显著降低(P<0.01),且治疗组患者的评分明显低于对照组(P<0.01)。④治疗后,两组患者的SAS、SDS评分较治疗前均显著降低(P<0.01),且治疗组患者的评分均低于对照组(P<0.05)。⑤治疗后,两组患者的E2、P水平均升高(P<0.05,P<0.01),FSH水平均降低(P<0.01),治疗组患者的LH水平亦降低(P<0.05),且治疗组患者的E2、P水平高于对照组(P<0.05),FSH水平低于对照组(P<0.05)。⑥治疗后,两组患者的β-EP水平较治疗前均降低(P<0.05,P<0.01)、5-HT水平均升高(P<0.05),且治疗组患者的β-EP水平低于对照组(P<0.05)。结论:调肝解郁方可有效改善肝郁血虚型围绝经期情绪障碍患者的临床症状及焦虑、抑郁状态,其机制可能与调节神经内分泌激素及β-EP、5-HT等神经肽水平相关。

Objective:To observe the clinical efficacy of Tiaogan Jieyu Decoction in the treatment of perimenopausal emotional disorder,and preliminarily explore its mechanism based on neuropeptide regulation.Methods:A total of 101 patients of perimenopausal emotional disorder with liver stagnation and blood deficiency type were selected and randomly divided into the treatment group(51 cases)and control group(50 cases).The patients in both groups were treated with basic psychological counseling.Meanwhile,the patients in the treatment group were orally treated with Tiaogan Jieyu Decoction and the patients in the control group were orally treated with Gengnianning.The treatment course of both groups was 8 weeks.Before and after treatment,the total scores of Chinese medical symptoms and main symptom scores between the two groups were compared,and the scores of Greene menopause scale,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)of the two groups were evaluated and compared.Before and after treatment,the levels of estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),progesterone(P),prolactin(PRL)andβ-endorphins(β-EP),serotonin(5-HT),norepinephrine(NE)and dopamine(DA)were detected and compared.Results:①After treatment,the total scores of Chinese medical symptoms in the two groups were significantly decreased compared with those before treatment(P<0.01),and the score in the treatment group was significantly lower than that in the control group(P<0.01).②After treatment,the scores of main symptoms(such as tidal fever and sweatiness,depression,etc)in the two groups were decreased compared with those before treatment(P<0.05,P<0.01),and the scores of main symptoms(such as tidal fever and sweatiness,depression,anxiety,etc)in the treatment group were lower than those in the control group(P<0.05,P<0.01).③After treatment,the scores of Greene menopause scale in the two groups were significantly decreased compared with those before treatment(P<0.01),and the score of the treatment group was significantly lower than that of the control group(P<0.01).④After treatment,the scores of SAS and SDS in the two groups were significantly decreased compared with those before treatment(P<0.01),and the scores of the treatment group were lower than those of the control group(P<0.05).⑤After treatment,the levels of E2and P in the two groups were increased(P<0.05,P<0.01),the level of FSH was decreased(P<0.01),the level of LH in the treatment group was also decreased(P<0.05),and the levels of E2and P in the treatment group were higher than those in the control group(P<0.05),the level of FSH was lower than that in the control group(P<0.05).⑥After treatment,the level ofβ-EP in the two groups was decreased compared with that before treatment(P<0.05,P<0.01),the level of 5-HT was increased(P<0.05),and the level ofβ-EP in the treatment group was lower than that in the control group(P<0.05).Conclusion:Tiaogan Jieyu Decoction can effectively improve the clinical symptoms,anxiety and depression status in patients of perimenopausal emotional disorder with liver depression and blood deficiency type,and its mechanisms may be related to the regulation of neuropeptide levels such as neuroendocrine hormones,β-EP and 5-HT.