基于TCD探讨逍遥散联合帕罗西汀片治疗肝郁血虚型偏头痛与抑郁共病的临床疗效

Clinical Efficacy of Xiaoyaosan Combined with Paroxetine Tablets in Treatment of Migraine with Liver Depression and Blood Deficiency Syndrome and Depression Based on Transcranial Doppler

目的:基于经颅多普勒超声(TCD)的血流动力指标,分析视觉模拟评分(VAS)、24项汉密尔顿抑郁量表(HAMD-24)评分与大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)的平均血流速度(Vm)的相关性,以及头痛VAS评分与抑郁HAMD-24评分的相关性,同时探讨逍遥散联合帕罗西汀治疗肝郁血虚型偏头痛与抑郁共病的临床疗效。方法:纳入62例2019年1月至2020年6月在安徽中医药大学第一附属医院脑病科门诊治疗的符合诊断标准的患者,随机分成观察组(32例)和对照组(30例),对照组给盐酸帕罗西汀片,观察组在其基础上加逍遥散汤剂服用,比较两组患者在治疗前后的相关指标变化。分析逍遥散对TCD指标(Vm_(ACA)、Vm_(MCA)、Vm_(PCA))和偏头痛、抑郁评分[包括VAS、头痛影响测验-6(HIT-6)、HAMD-24]及中医证候的影响。结果:VAS评分、HAMD-24评分均与Vm_(ACA)、Vm_(MCA)、Vm_(PCA)呈正相关(P<0.01);VAS评分与HAMD-24评分呈正相关。与本组疗前比较,两组患者疗后的TCD指标Vm_(ACA)、Vm_(MCA)、Vm_(PCA)水平均显著下降(P<0.01),两组患者HIT-6、VAS、HAMD-24评分均显著改善(P<0.01)。与对照组治疗后比较,观察组患者TCD指标(Vm_(ACA)、Vm_(MCA)、Vm_(PCA))水平显著降低(P<0.01),HIT-6、VAS、HAMD-24评分改善均优于对照组(P<0.01)。观察组患者有效率为90.6%(29/32),对照组患者有效率为63.3%(19/30),观察组患者有效率高于对照组,差异具有统计学意义(χ^(2)=5.13,P<0.05)。两组患者不良反应发生情况差异无统计学意义。结论:TCD血流动力学指标可有效地反映偏头痛与抑郁共病患者的脑部血流状态,且偏头痛与抑郁的发病及病情严重程度有一定的相关性。综合分析,逍遥散合帕罗西汀片治疗肝郁血虚型偏头痛与抑郁共病的疗效比单用帕罗西汀片更好,显著改善了患者脑部血流状态及偏头痛和抑郁障碍的症状和程度,可供临床参考。

Objective:Based on the hemodynamic indicators of transcranial Doppler(TCD),this study aimed to analyze the correlations of visual analogue scale(VAS)and Hamilton depression rating scale 24-item(HAMD-24)scores with mean blood velocity(Vm)of the anterior cerebral artery(ACA),the middle cerebral artery(MCA),and the posterior cerebral artery(PCA),and the correlation between VAS score of headache and HAMD-24 score,and explore the clinical efficacy of Xiaoyaosan combined with paroxetine tablets in the treatment of migraine with liver depression and blood deficiency syndrome and depression.Method:Sixty-two outpatients treated in the encephalopathy department,the First Afffiliated Hospital of Anhui University of Chinese Medicine between January 2019 to June 2020 who were in line with the diagnostic criteria were enrolled and divided into a treatment group(32 cases)and a control group(30 cases).All patients were treated with paroxetine tablets,while those in the treatment group received additional Xiaoyaosan.The changes in relevant indicators in the two groups before and after treatment were observed.The effects of Xiaoyaosan on the TCD indicators(Vm_(ACA),Vm_(MCA),and Vm_(PCA)),scores of migraine and depression[including VAS score,Headache Impact Test-6(HIT-6)score,and HAMD-24 score],and the traditional Chinese medicine(TCM)syndrome score were analyzed.Result:VAS and HAMD-24 scores were positively correlated with Vm_(ACA),Vm_(MCA),and Vm_(PCA)(P<0.01).VAS scores were positively correlated with HAMD-24 scores.Compared with the conditions before treatment,the levels of TCD indicators(Vm_(ACA),Vm_(MCA),and Vm_(PCA))in the two groups decreased after treatment(P<0.01),and the scores of HIT-6,VAS,and HAMD-24 in the two groups were significantly improved(P<0.01).Compared with the control group after treatment,the treatment group showed decreased levels of TCD indicators(Vm_(ACA),Vm_(MCA),and Vm_(PCA))(P<0.01)and superior improvement of HIT-6,VAS,and HAMD-24 scores(P<0.01).The effective rate in the treatment group was 90.6%(29/32),higher than 63.3%(19/30)in the control group(χ^(2)=5.13,P<0.05).There was no significant difference in adverse reactions between the two groups.Conclusion:TCD indicators can effectively reflect the cerebral blood flow of patients with migraine and depression co-morbidity,and migraine is correlated with the onset and severity of depression.The comprehensive analysis showed that the efficacy of Xiaoyaosan combine paroxetine tablets was better than that of paroxetine tablets alone in the treatment of migraine with liver depression and blood deficiency syndrome and depression.This therapeutic protocol can significantly improve cerebral blood flow and the symptoms and degree of migraine and depression and can provide references for clinical treatment.