柴胡加龙骨牡蛎汤加减结合西医常规疗法治疗卒中后抑郁临床研究

The therapeutic effect of Chaihu Longgu Muli Decoction combined with western medicine in the treatment of post-stroke depression

目的评价柴胡加龙骨牡蛎汤加减结合西医常规疗法治疗卒中后抑郁的临床疗效。方法将符合入选标准的2019年4月-2020年12月本院卒中后抑郁患者130例采用随机数字表法分为2组,每组65例。对照组在常规治疗基础上给予氟哌噻吨美利曲辛片治疗,观察组在常规治疗基础上给予柴胡加龙骨牡蛎汤加减治疗。2组均连续治疗4周。分别于治疗前后进行中医证候评分;采用ELISA法检测血清Hcy、hs-CRP水平及血浆5-羟色胺(5-HT)、脑源性神经营养因子(brain derived neurotrophic factor,BDNF)水平;采用全自动血细胞分析仪行血常规检测,计算中性粒细胞和淋巴细胞比值(NLR),评价临床疗效。结果观察组总有效率为92.3%(60/65)、对照组为75.4%(49/65),2组比较差异有统计学意义(χ^(2)=6.87,P=0.009)。治疗后,观察组血清Hcy[(11.87±1.56)μmol/L比(16.69±1.77)μmol/L,t=16.47]、hs-CRP[(7.81±1.66)mg/L比(16.45±4.87)mg/L,t=13.54]水平低于对照组(P<0.01);血浆5-HT[(150.41±17.54)μg/L比(123.24±16.02)μg/L,t=9.22]、BDNF[(19.45±2.48)μg/L比(12.56±2.23)μg/L,t=16.66]水平高于对照组(P<0.01)。观察组治疗后外周血NLR与中医证候评分均低于对照组(t值分别为6.03、7.15,P值均<0.01)。结论柴胡加龙骨牡蛎汤加减结合西医常规疗法可快速纠正卒中后抑郁患者外周血HCy、hs-CRP、5-HT、BDNF、NLR水平,缓解患者的抑郁及焦虑状态,提高临床疗效。

Objective To evaluate the clinical efficacy of Chaihu Longgu Muli Decoction in the treatment of post-stroke depression.Methods A total of 130 patients with post-stroke depression who met the inclusion criteria from April 2019 to December 2020 were enrolled in the study.The patients were randomly divided into two groups with 65 cases in each group.The control group was treated with Flupentixol and melitracen tablets on the basis of routine treatment,and the observation group was treated with Chaihu Longgu Muli Decoction on the basis of routine treatment.Both groups were treated for 4 weeks.TCM syndrome scores were performed before and after treatment.The levels of serum Hcy and hs CRP,Plasma 5-HT and brain-derived neurotrophic factor(BDNF)were detected by ELISA,and the ratio of neutrophils to lymphoblasts(NLR)was recorded.Results The response rate was 92.3%(60/65)in the observation group and 75.4%(49/65)in the control group.There was significant difference between the two groups(χ^(2)=6.87,P=0.009).After treatment,the serum Hcy[(11.87±1.56)μmol/L vs.(16.69±1.77)μmol/L,t=16.47]and hs-CRP[(7.81±1.66)mg/L vs.(16.45±4.87)mg/L,t=13.54]in the observation group were significantly lower than those in the control group(P<0.01),and Plasma 5-HT[(150.41±17.54)μg/L vs.(123.24±16.02)μg/L,t=9.22],BDNF[(19.45±2.48)μg/L vs.(12.56±2.23)μg/L,t=16.66]were significantly higher than those in the control group(P<0.01).After treatment,the NLR and TCM syndrome scores in the observation group were significantly lower than those in the control group(t values were 6.03 and 7.15,respectively,all Ps<0.01).Conclusion The Chaihu Longgu Muli Decoction combined with western medicine treatment can correct the levels of Hcy,hs-CRP,5-HT,BDNF and NLR in peripheral blood,alleviate the state of depression and anxiety of patients with post-stroke depression.