栀子厚朴汤治疗老年脑卒中后抑郁伴失眠临床研究

Clinical Study on Zhizi Houpo Decoction(栀子厚朴汤)in Treatment of Senile Patients with Post-Stroke Depression and Insomnia

目的:探究栀子厚朴汤治疗老年脑卒中后抑郁伴失眠临床疗效。方法:将90例老年脑卒中后抑郁伴失眠患者按随机数字表法分成对照组和观察组各45例。对照组接受常规西药治疗,观察组在对照组基础上加用栀子厚朴汤治疗。两组均治疗4周。比较两组患者治疗前后的中医证候积分、抑郁焦虑情况、认知功能、睡眠质量、多导睡眠图数据、血清炎症因子及神经递质水平,评价两组临床疗效。结果:治疗后,两组患者各中医证候积分均较治疗前降低,且观察组低于对照组(P<0.01);两组精神状态评估相关量表[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、Barthel指数评分量表(BI)、简易精神状态检查量表(MMSE)、匹兹堡睡眠质量指数量表(PSQI)]评分、美国国立卫生研究院卒中量表(NIHSS)评分均较治疗前改善,且观察组改善优于对照组(P<0.01)。治疗后两组炎症因子[血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平均较治疗前降低,且观察组低于对照组(P<0.01);血清神经递质[5-羟色胺(5-HT)、P物质(SP)、神经肽Y(NPY)、多巴胺(DA)、去甲肾上腺素(NE)、脑源性神经营养因子(BDNF)、同型半胱氨酸(HCY)]水平均较治疗前改善,且观察组改善优于对照组(P<0.01)。治疗后两组多导睡眠图数据指标[总睡眠时间(TST)、快速眼动睡眠期(REM)持续时间、睡眠效率(SE)及睡眠潜伏时间(SL)]均较治疗前改善,且观察组改善优于对照组(P<0.01)。结论:栀子厚朴汤可有效改善老年脑卒中后抑郁伴失眠患者的临床症状、抑郁焦虑状态、认知功能、生活品质及睡眠质量,其作用机制与抑制炎症反应及改善血清神经递质水平相关。

Objective:To explore the clinical effect of Zhizi Houpo Decoction(栀子厚朴汤)in the treatment of senile patients with post-stroke depression and insomnia.Methods:A total of 90 senile patients with post-stroke depression and insomnia were divided into the control group and the observation group by random number table method,with 45 cases in each group.The control group received conventional western medicine treatment,and the observation group was treated with Zhizi Houpo Decoction on the basis of the treatment of the control group.Both groups were treated for 4 weeks.Traditional Chinese medicine(TCM)syndrome scores,depression and anxiety situation,cognitive function,sleep quality,polysomnography data,serum inflammatory factors and neurotransmitter levels of the two groups were compared before and after treatment,evaluate the clinical efficacy of the two groups.Results:After treatment,TCM syndrome scores in both groups were lower than those before treatment,and those of the observation group were lower than the control group(P<0.01).The mental state assessment related scales[Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),Barthel index(BI),mini-mental state examination(MMSE),Pittsburgh sleep quality index(PSQI)]scores and national institutes of health stroke scale(NIHSS)score of the two groups were all improved compared to those before treatment,and the observation group showed better improvement than the control group(P<0.01).After treatment,levels of the inflammatory factors[serum interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]in both groups were lower than those before treatment,and those of the observation group were lower than the control group(P<0.01).The levels of serum neurotransmitters[5-hydroxytryptophan(5-HT),substance P(SP),neuropeptide Y(NPY),dopamine(DA),norepinephrine(NE),brain-derived neurotrophic factor(BDNF),homocysteine(HCY)]in both groups were improved compared with those before treatment,and the improvements in the observation group were better than those in the control group(P<0.01).After treatment,the indexes of polysomnography data[total sleep time(TST),duration of rapid eye movement(REM)sleep duration,sleep efficiency(SE)and sleep latency time(SL)]in both groups were improved compared with those before treatment,and the improvements in the observation group were better than those in the control group(P<0.01).Conclusions:Zhizi Houpo Decoction can effectively relieve the clinical symptoms,depression and anxiety state,improve cognitive function,quality of life and sleep quality of senile patients with post-stroke depression and insomnia.Its mechanism of action is related to inhibiting inflammation and improving serum neurotransmitter levels.