利培酮联合活血化瘀汤治疗脑卒中后抑郁的疗效及对脑部血液流变学和血清GDNF、5-HT的影响

The effect of risperidone combined with Huoxue Huayu Decoction on post-stroke depression and its effect on brain Hemorheology and serum GDNF,5-HT

目的观察利培酮联合活血化瘀汤治疗脑卒中后抑郁的疗效及对脑部血液流变学和血清胶质源性神经营养因子(GDNF)、5-羟色胺(5-HT)的影响。方法选取2020年8月—2022年10月武汉市武东医院精神重症一科收治脑卒中后抑郁患者98例为研究对象,随机数字表法分为对照组48例和观察组50例。对照组给予活血化瘀汤治疗,观察组给予利培酮联合活血化瘀汤治疗。比较2组疗效、不良反应,治疗前后脑部血液流变学指标、汉密尔顿抑郁评定量表(HAMD)、神经功能缺损评定量表(NHISS)评分及血清GDNF、5-HT水平。结果观察组治疗总有效率高于对照组(92.00%vs.70.83%,χ^(2)/P=7.318/0.007);2组治疗后血液流变学指标(全血黏度低切、全血黏度高切、血液黏度、纤维蛋白原)、HAMD、NIHSS评分均较治疗前降低,且观察组降低幅度大于对照组[t(Z)/P=5.342/<0.001,4.328/<0.001,12.014/<0.001,11.270/<0.001,8.607/<0.001,8.520/<0.001];治疗后2组血清GDNF、5-HT水平均升高,且观察组升高幅度大于对照组(t/P=4.119/<0.001,4.666/<0.001);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论利培酮联合活血化瘀汤治疗脑卒中后抑郁可有效改善患者血液流变学水平、抑郁症状及神经功能缺损程度,疗效显著。

Objective To observe the therapeutic effect of risperidone combined with Huoxue Huayu Decoction on post-stroke depression and its effect on brain Hemorheology and serum glial derived Neurotrophin(GDNF)and 5-hydroxytryptamine(5-HT).Methods Ninety-eight patients with post-stroke depression admitted to the Department of Psychiatric Intensive Care at Wuhan Wudong Hospital from August 2020 to October 2022 were selected as the study subjects.They were randomly divided into a control group of 48 cases and an observation group of 50 cases.The control group was treated with Huoxue Huayu Decoction,while the observation group was treated with risperidone combined with Huoxue Huayu Decoction.The efficacy,adverse reactions,brain Hemorheology indexes,Hamilton Depression Rating Scale(HAMD),Neurological Deficiency Rating Scale(NHISS)scores,and serum GDNF and 5-HT levels were compared between the two groups before and after treatment.Results The total effective rate of the observation group was higher than that of the control group(92.00%vs.70.83%,χ^(2)/P=7.318/0.007);After treatment,the Hemorheology levels(whole blood viscosity low shear,whole blood viscosity high shear,blood viscosity,fibrinogen),HAMD,NIHSS scores in both groups were lower than those before treatment,and the reduction in the observation group was greater than that in the control group(t(Z)/P=5.342/<0.001,4.328/<0.001,12.014/<0.001,11.270/<0.001,8.607/<0.001,8.520/<0.001);After treatment,the levels of serum GDNF and 5-HT in both groups increased,and the observed group showed a greater increase than the control group(t/P=4.119/<0.001,4.666/<0.001);There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Risperidone combined with Huoxue Huayu Decoction can effectively improve the level of Hemorheology,depressive symptoms and neurological impairment in patients with post-stroke depression.