双心方治疗经皮冠状动脉介入治疗术后合并抑郁状态的临床疗效观察

Clinical observation of Shuangxin Formula in the treatment of depression after percutaneous coronary intervention

目的:观察双心方治疗经皮冠状动脉介入治疗术后合并抑郁状态的临床疗效。方法:选取2021年4月至12月就诊于北京中医药大学东方医院门诊及病房的患者72例,采用随机数表法分为对照组和试验组,每组36例。对照组采用西医基础治疗加安慰剂治疗,试验组采用西医基础治疗加服双心方颗粒,两组均治疗4周。观察治疗前后两组患者的汉密尔顿抑郁量表24项(HAM D-24)、西雅图心绞痛量表(SAQ)、抑郁自评量表(SDS)及匹兹堡睡眠质量指数(PSQI)评分。ELISA法检测外周血清中磷脂酰肌醇3-激酶(PI3K)、蛋白激酶B(Akt)、糖原合酶激酶-3β(GSK3β)的含量。结果:临床疗效:比较两组的抑郁状态疗效,试验组的总有效率可达到94.44%(34/36),显著高于对照组的38.89%(14/36)(P<0.01)。比较两组的心绞痛疗效,试验组总有效率为97.22%(35/36),显著高于对照组的33.33%(12/36)(P<0.01)。主要疗效指标:两组患者治疗后HAMD-24评分均较治疗前显著降低(P<0.01)。治疗后,试验组HAMD-24评分显著低于对照组(P<0.01),试验组治疗前后HAMD-24评分差值显著高于对照组(P<0.01)。两组患者治疗后SAQ五个维度的评分均较治疗前升高(P<0.05,P<0.01)。治疗后,试验组SAQ五个维度的评分均显著高于对照组(P<0.01)。试验组治疗前后SAQ五个维度的评分差值均显著低于对照组(P<0.01)。次要疗效指标:两组患者治疗后SDS、PSQI评分均较治疗前显著降低(P<0.01,P<0.05)。治疗后,试验组SDS、PSQI评分显著低于对照组(P<0.01)。试验组治疗前后SDS、PSQI评分差值显著高于对照组(P<0.01)。血清学指标:对照组患者治疗后血清中Akt含量显著低于治疗前(P<0.05),试验组患者治疗后血清中PI3K、Akt、GSK3β含量均显著低于治疗前(P<0.01)。治疗后,试验组血清中PI3K含量显著低于对照组(P<0.05)。试验组治疗前后血清中PI3K、Akt、GSK3β含量差值显著高于对照组(P<0.05,P<0.01)。结论:双心方能过够减轻患者的抑郁状态和心绞痛程度,改善睡眠状况,提高生活质量,降低血清中PI3K、Akt、GSK3β的含量。

Objective:To observe the clinical efficacy of Shuangxin Formula in the treatment of depressive state after percutaneous coronary intervention(PCI).Methods:Seventy-two patients who attended outpatient clinics and wards of Dongfang Hospital,Beijing University of Chinese Medicine from April to December 2021 were selected and divided into the control group and the treatment group by randomized number table method,with 36 cases in each group.The control group was treated with western basic therapy plus placebo,and the treatment group was treated with western basic therapy plus Shuangxin Formula granules,and both groups were treated for 4 weeks.Hamilton depression scale 24(HAMD-24),Seattle angina questionnaire(SAQ),self-rating depression scale(SDS)and Pittsburgh sleep quality index(PSQI)scores of the two groups were observed before and after treatment.The levels of PI3K,Akt and GSK3βin peripheral serum were detected by ELISA.Results:Clinical efficacy:Comparing the efficacy of depressive state in the two groups,the total effective rate of the treatment group could reach 94.44%(34/36),which was obviously higher than that of the control group,which was 38.89%(14/36)(P<0.01).Comparing the angina efficacy of the two groups,the effective rate of the treatment group is 97.22%(35/36),which was obviously higher than that of the control group 33.33%(12/36)(P<0.01).Main efficacy indexes:the HAMD-24 score in both groups was significantly lower than that before treatment(P<0.01).After treatment,the HAMD-24 score of the treatment group was significantly lower than that of the control group(P<0.01),and the difference between the HAMD-24 score before and after treatment of the treatment group was significantly higher than that of the control group(P<0.01).The scores of five dimensions of SAQ in both groups were significantly higher after treatment than those before treatment(P<0.05,P<0.01).After treatment,the SAQ scores of the treatment group were all significantly higher than those of the control group(P<0.01).The difference in SAQ scores before and after treatment was significantly lower in the treatment group than those in the control group(P<0.01).Secondary efficacy indexes:SDS and PSQI scores of patients after treatment in both groups were lower than those before treatment(P<0.01,P<0.05).After treatment,SDS and PSQI scores of the treatment group were significantly lower than those of the control group(P<0.01).The difference between the SDS and PSQI scores of the treatment group before and after treatment was significantly higher than those of the control group(P<0.01).Serological indexes:The levels of Akt in the serum of patients in the control group was significantly lower than that before treatment(P<0.05),and the levels in the serum of PI3K,Akt and GSK3βin the treatment group were significantly lower than that before treatment(P<0.01).After treatment,the levels of PI3K in the serum of patients in the treatment group was significantly lower than that in the control group(P<0.05).The differences levels in the serum of PI3K,Akt and GSK3βbefore and after treatment in the treatment group were significantly higher than those in the control group(P<0.05,P<0.01).Conclusion:Shuangxin Formula can relieve depressive state and the degree of angina pectoris of patients,improve the sleep condition,improve the quality of life and reduce the expression of PI3K,Akt and GSK3βin the serum.