天麻钩藤饮加减辅助帕利哌酮缓释片、重复经颅磁刺激治疗肝郁痰结证精神分裂症患者的疗效及安全性观察

Clinical Efficacy and Safety of Tianma Gouteng Decoction in Combination with Paliperidone Sustained-Release Tablets and rTMS in the Treatment of Schizophrenia

目的 探讨天麻钩藤饮加减辅助帕利哌酮缓释片、重复经颅磁刺激(Repeat transcranial magnetic stimulation, rTMS)治疗肝郁痰结证精神分裂症患者的疗效及安全性。方法 选取2021年1月—2022年9月期间重庆市大足区人民医院收治的107例肝郁痰结证精神分裂症患者,采用随机数字表法分为对照组53例和试验组54例。对照组给予帕利哌酮缓释片、rTMS治疗,试验组在对照组基础上给予天麻钩藤饮加减。治疗4周后,观察比较两组患者临床疗效、安全性及治疗前后中医证候积分、阳性与阴性症状量表(Positive and Negative Syndrome, PANSS)评分、神经递质全脑相对功率[5-羟色胺(5-hydroxytryptamine, 5-HT)、谷氨酸(Glutamic acid, Glu)、乙酰胆碱(Acetylcholine, Ach)]水平。结果 (1)临床疗效:治疗后试验组总有效率94.44%(51/54)明显高于对照组80.77%(42/52),差异有统计学意义(P<0.05)。(2)中医证候积分:治疗后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。(3)PANSS评分:治疗后两组患者精神症状PANSS评分均较治疗前降低,差异有统计学意义(P<0.05);且试验组精神症状PANSS评分明显低于对照组,差异有统计学意义(P<0.05)。(4)神经递质:治疗后两组患者神经递质5-HT、Glu、Ach水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组神经递质5-HT、Glu、Ach水平均明显低于对照组,差异有统计学意义(P<0.05)。(5)安全性:治疗期间,两组患者均未发生严重或影响治疗不良反应,仅对照组出现1例刺痛感,调整频率后,刺痛感消失。结论 天麻钩藤饮加减辅助帕利哌酮缓释片、rTMS治疗肝郁痰结证精神分裂症效果显著,安全性高,有利于精神症状控制,且可能与调节神经递质表达有关。

Objective To evaluate the efficacy and safety of modified Tianma Gouteng Decoction(TMGD)combined with Paliperidone sustained-release tablets and repetitive transcranial magnetic stimulation(rTMS)for treating patients with schizophrenia characterized by liver depression and phlegm accumulation.Methods A total of 107 schizophrenia patients diagnosed with liver depression and phlegm accumulation treated at The People′s Hospital of Dazu,Chongqing from January 2021 to September 2022 were recruited.They were randomly allocated into a control group(n=53)and an experimental group(n=54)using a random number table method.The control group received Paliperidone sustained-release tablets and rTMS,while the experimental group additionally received modified TMGD.After 4 weeks of treatment,clinical efficacy,safety,changes in traditional Chinese medicine(TCM)syndrome scores,Positive and Negative Syndrome Scale(PANSS)scores,and neurotransmitter levels(5-hydroxytryptamine[5-HT],glutamic acid[Glu],and acetylcholine[Ach])in the whole brain were evaluated between the two groups.Results The total effective rate in the experimental group was 94.44%(51/54),significantly higher than the 80.77%(42/52)in the control group(P<0.05).TCM syndrome scores decreased after treatment in both groups(P<0.05),with the experimental group showing a lower score than the control group(P<0.05).Both groups exhibited a reduction in PANSS scores after treatment(P<0.05),and the experimental group demonstrated a more significant decrease than the control group(P<0.05).The 5-HT,Glu,and Ach were down-regulated in both groups after treatment,and the experimental group had a more pronounced reduction(P<0.05).No serious adverse reactions occurred during treatment in either group.Only one case of tingling sensation was reported in the control group,which resolved after adjusting the frequency.Conclusion TMGD combined with Paliperidone sustained-release tablets and rTMS was found to be markedly effective and safe for treating schizophrenia with liver depression and phlegm accumulation.This approach may contribute to better control of psychotic symptoms,potentially through modulation of neurotransmitters.