增强型体外反搏联合舍曲林对卒中后抑郁患者抑郁状态和血清TNF-α、BDNF、VEGF水平的影响

Effect of EECP combined with sertraline on depression and serum TNF-α, BDNF, and VEGF in patients with IPSD

目的:观察增强型体外反搏(EECP)联合舍曲林对缺血性脑卒中后抑郁(IPSD)患者抑郁状态、血清肿瘤坏死因子(TNF-α)、血清脑源性神经营养因子(BDNF)和血管内皮生长因子(VEGF)水平的影响。方法:80例IPSD患者随机分为对照组和观察组,每组40例。对照组患者在常规治疗(包括基础疾病的药物治疗和综合康复训练)的基础上给予口服盐酸舍曲林治疗,观察组患者在对照组治疗的基础上进行EECP治疗。2组患者在治疗前后均进行汉密顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NIHSS)和改良Barthel指数(MBI)评定,以及血清TNF-α、VEGF和BDNF和VEGF含量检测。结果:治疗7周后,2组患者HAMD评分、NIHSS评分均较治疗前显著下降(P<0.01),而MBI评分较治疗前显著上升(P<0.01);观察组患者的HAMD评分、NIHSS评分均显著低于对照组(P<0.01),而MBI评分显著高于对照组(P<0.01)。2组患者血清TNF-a含量较治疗前显著下降(P<0.01),而BDNF和VEGF含量较治疗前显著上升(P<0.01);观察组患者的血清TNF-α含量显著低于对照组(P<0.01),而BDNF和VEGF含量均显著高于对照组(P<0.01)。结论:EECP联合舍曲林能显著缓解IPSD患者的抑郁情绪,促进神经功能恢复和提高日常生活能力,而其作用机制可能与调节IPSD患者血清TNF-α、BDNF和VEGF含量有关。

Objective:To investigate the intervention effect of enhanced external counterpulsation(EECP)combined with sertraline on depression and serum TNF-α,BDNF,and VEGF in patients with post-ischemic stroke depression(IPSD).Methods:A total of 80 patients with IPSD were randomly divided into the control group and observation group,40 cases in each group.The control group received routine treatment(including medication for underlying diseases and comprehensive rehabilitation training)and oral sertraline hydrochloride(50 mg/day)for 7 weeks.The observation group received routine treatment,oral sertraline hydrochloride,and ECCP treatment(30 min per session,2 sessions per day,5 days per week)for 7 weeks.The Hamilton depression scale(HAMD),National institute of health stroke scale(NIHSS),Modified Barthel index(MBI),and serum TNF-α,BDNF,and VEGF were recorded and evaluated before and after the intervention,respectively.Results:After 7 weeks of treatment,the HAMD score and NIHSS score of both groups significantly decreased compared to before treatment(P<0.01),and the MBI score significantly increased compared to before treatment(P<0.01).The HAMD score and NIHSS score were significantly lower(P<0.01),and the MBI score was significantly higher(P<0.01)in the observation group than in the control group.The serum TNF-a levels in both groups decreased significantly before treatment(P<0.01),and the levels of BDNF and VEGF increased significantly compared to before treatment(P<0.01).The serum TNF-a levels in the observation group were significantly lower(P<0.01),and the levels of BDNF and VEGF were significantly higher(P<0.01)than those in the control group.Conclusion:EECP combined with sertraline can significantly alleviate depression in patients with IPSD,promote neural function recovery,and improve daily living ability,and its mechanism of action may be related to regulating serum BDNF,VEGF,and TNF-a levels in patients with IPSD.