清肝化瘀饮加减联合常规西医治疗肝热血瘀型脑卒中后抑郁患者疗效及对血清神经递质水平的影响

Efficacy of modified Qinggan Huayu drink combined with conventional western medicine on patients with post-stroke depression of liver heat and blood stasis type and its influence on serum neurotransmitters levels

目的:研究清肝化瘀饮加减联合常规西医治疗肝热血瘀型脑卒中后抑郁(PSD)患者疗效及对血清神经递质水平的影响。方法:纳入2022年1月~2023年1月期间我院收治的肝热血瘀型PSD患者120例,随机分为两组,对照组(n=60)实施常规西医治疗,观察组(n=60)在其基础上联合清肝化瘀饮加减治疗,均连续治疗2个疗程。比较两组患者临床疗效。比较两组患者治疗前后中医症候积分、血清神经递质、血清神经营养因子、脑动脉血流动力学指标水平。结果:观察组治疗总有效率显著高于对照组(P<0.05)。治疗2个疗程后,两组心绪不宁、易哭易怒、失眠不安中医症候积分及血管阻力指数(RI)较治疗前显著降低,且观察组低于同期对照组(P<0.05);两组血清5-羟色胺(5-HT)、多巴胺(DA)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)、大脑动脉血流最大峰值(Vs)、平均流速(Vm)显著高于治疗前,且观察组高于同期对照组(P<0.05)。结论:清肝化瘀饮加减联合常规西医治疗肝热血瘀型PSD患者疗效显著,可缓解患者抑郁症状,调节其血清神经递质、神经营养因子水平,有利于改善患者脑血流灌注情况。

Objective:To study the efficacy of modified Qinggan Huayu drink combined with conventional western medicine in the treatment of patients with post-stroke depression(PSD)of liver heat and blood stasis type and the influence on the levels of serum neurotransmitters.Methods:120 patients with liver heat and blood stasis type of PSD admitted to the hospital from January 2022 to January 2023 were included and randomly divided into two groups.The control group(n=60)received conventional western medicine treatment,and the observation group(n=60)was treated with modified Qinggan Huayu drink on this basis,and both groups were continuously treated for 2 courses.The clinical efficacy,and TCM symptoms scores,serum neurotransmitters,serum neurotrophic factors and cerebral artery hemodynamic indicators before and after treatment were compared between the two groups of patients.Results:The total effective rate of treatment in observation group was significantly higher than that in control group(P<0.05).After 2 courses of treatment,the scores of TCM symptoms of restlessness,easiness of crying and irritability and insomnia and vascular resistance index(RI)in both groups were significantly decreased compared with those before treatment,and the above indicators in observation group were lower than those in control group(P<0.05).Serum 5-hydroxytryptamine(5-HT),dopamine(DA),brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),cerebral artery blood flow peak velocity(Vs)and mean flow velocity(Vm)in the two groups were significantly higher than those before treatment,and the above indicators in observation group were higher compared with those in control group(P<0.05).Conclusion:Modified Qinggan Huayu drink combined with conventional western medicine has a significant efficacy in the treatment of patients with liver heat and blood stasis type of PSD,and it can alleviate the depressive symptoms,adjust the levels of serum neurotransmitters and neurotrophic factors,and help improve the cerebral blood perfusion.