柴胡达郁汤联合针灸醒脑开窍法治疗老年脑卒中后抑郁症的疗效观察

Efficacy of Chaihu Dayu decoction combined with Xingnao Kaiqiao method with acupuncture and moxibustion in treating elderly post-stroke depression

目的探讨柴胡达郁汤联合针灸醒脑开窍法治疗老年脑卒中后抑郁症(post-stroke depression,PSD)的疗效。方法选118例老年PSD病人随机分为针灸组和针药结合组各59例,针灸组给予醒脑开窍针刺,针药结合组基于以上加予柴胡达郁汤治疗,观察两组治疗前后的中医症状积分变化和中医证候疗效,对比不同时间点的抑郁状态[汉密尔顿抑郁量表(Items Hamilton Depression Scale,HAMD)]、治疗前后的血清脑肠肽[五羟色胺(5-hydroxytryptamine,5-HT)、生长抑素(somatostatin,SS)、血管活性肠肽(vasoactive intestinal peptide,VIP)]及同型半胱氨酸(homocysteine,Hcy)及神经肽Y(neuropeptide Y,NPY)水平。结果针药结合组治疗后中医症状总积分较治疗前和针灸组有显著性降低(P<0.05);针药结合组中医证候疗效显著高于针灸组(P<0.05);两组HAMD评分的时间点效应、组间效应及交互效应均具有显著性差异(P<0.05),针药结合组在治疗2、4、8周后的上述评分均显著低于治疗前和针灸组(P<0.05);针药结合组治疗后血清5-HT、SS、VIP、NPY水平较治疗前和针灸组显著提高(P<0.05),血清Hcy水平较治疗前和针灸组显著降低(P<0.05)。结论柴胡达郁汤联合针灸醒脑开窍法治疗老年PSD疗效显著,能改善病人相关中医症状、抑郁状态,纠正其血清脑肠肽水平紊乱,抑制血清Hcy含量,增强血清NPY表达含量,抗抑郁效果显著。

Objective To explore the efficacy of Chaihu Dayu decoction combined with Xingnao Kaiqiao method with acupuncture and moxibustion in the treatment of elderly post-stroke depression(PSD).Methods 118 patients with PSD were selected and randomly divided into acupuncture group and acupuncture-medication group,with 59 cases in each group.Acupuncture group was treated with Xingnao Kaiqiao acupuncture,while acupuncture-medication group was additionally given Chaihu Dayu decoction on this basis.The changes in TCM symptoms scores before and after treatment and efficacy of TCM syndromes were observed in the two groups.The depression status[Hamilton Depression Scale(HAMD)]at different time points,serum brain-gut peptides[5-hydroxytryptamine(5-HT),somatostatin(SS),vasoactive intestinal peptide(VIP)],homocysteine(Hcy)and neuropeptide Y(NPY)before and after treatment were compared between both groups.Results After treatment,the total score of TCM symptoms in acupuncture-medication group was significantly decreased compared with that in acupuncture group(P<0.05).The efficacy of TCM syndromes was significantly higher in acupuncture-medication group than that in acupuncture group(P<0.05).HAMD-24 score at different time points between the two groups showed a significant difference from the aspects of time-point effect,between-group effect and interaction effect(P<0.05),and the score after 2,4 and 8 weeks of treatment in acupuncture-medication group was significantly lower than that before treatment and that in acupuncture group(P<0.05).The levels of serum 5-HT,SS,VIP and NPY in acupuncture-medication group after treatment were significantly enhanced compared with those before treatment and acupuncture group(P<0.05)while serum Hcy level was significantly reduced compared to before treatment and acupuncture group(P<0.05).Conclusion Chaihu Dayu decoction combined with Xingnao Kaiqiao method with acupuncture and moxibustion has significant efficacy in the treatment of PSD.It can improve the TCM symptoms and depression status,correct the disorder of serum brain-gut peptide,inhibit the level of serum Hcy,and enhance the expression of serum NPY,and it has a significant antidepressant effect.