中药治疗卒中后抑郁的作用机制研究进展

Research progress on the mechanism of Chinese medicinals in the treatment of post-stroke depression

卒中后抑郁(post-stroke depression,PSD)是一种由血栓形成或出血性事件引起的永久性组织损伤的疾病,也是脑卒中发病后常见的情感障碍性疾病。PSD不仅可导致患者认知功能障碍、神经功能恢复延迟,影响其治疗有效率及康复疗效,还显著增加卒中复发率、致残率和死亡率,并给患者、家属及社会带来沉重的经济负担。PSD的发病机制复杂多样且具有关联性,而早期识别和积极防治PSD意义重大。中医药改善PSD症状疗效确切,具有个性化、多靶点、多通路联合治疗、不良反应少等优势。文章通过检索近五年中药治疗PSD的基础研究文献,从单味中药提取物及中药复方降低白细胞介素类、肿瘤坏死因子-α等细胞炎症反应,调节单胺类神经递质及氨基酸能神经递质,调节神经营养因子,抑制神经细胞凋亡,提高海马神经元可塑性,调节下丘脑-垂体-肾上腺轴,调节脑-肠轴等方面进行综述,旨在为单味中药提取物的研发及中药复方治疗PSD的实验研究提供新思路。

Post-stroke depression(PSD)is a disease of permanent tissue damage caused by thrombosis or hemorrhagic events,and it is also a common emotional disorder after stroke.PSD can not only lead to cognitive dysfunction and delayed recovery of neurological function in patients,but also affect the treatment efficiency and rehabilitation efficacy.It also significantly increases the recurrence rate,disability rate and mortality of stroke,and brings heavy economic burden to patients,family members and society.The pathogenesis of PSD is complex and related.Early identification and active prevention of PSD is of great significance.Chinese meidicinals is effective in improving PSD symptoms,and has the advantages of personalized,multi-target,multi-channel combined treatment,and less adverse reactions.In this paper,the basic research literature on the treatment of PSD by Chinese medicinals in the past five years was searched,and the single Chinese medicinal extract and compound of Chinese medicinals were reviewed from the aspects of reducing the inflammatory response of cells such as interleukins and tumor necrosis factor-α,regulating monoamine neurotransmitters and amino acid neurotransmitters,regulating neurotrophic factors,inhibiting neuronal apoptosis,improving the plasticity of hippocampal neurons,regulating the hypothalamus-pituitary-adrenal axis,and regulating the brain-gut axis.The purpose was to provide new ideas for the research and development of single Chinese medicinal extract and the experimental research on the treatment of PSD by compound of chinese herbal medicine.