栀子豉汤联合阿米替林对心肌梗死后抑郁患者血清CysC水平、PLR的影响

Effect of Zhizichi Decoction(栀子豉汤)Combined with Amitriptyline on Serum CysC and PLR in Patients with Post-Myocardial Infarction Depression

目的探究栀子豉汤联合阿米替林对心肌梗死后抑郁患者血清胱抑素C(cystatin C,CysC)水平、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)的影响。方法选取2022年6月—2023年4月收治的63例心肌梗死后抑郁患者作为研究对象。根据治疗方法不同分为联合组(32例,栀子豉汤联合阿米替林治疗)和对照组(31例,阿米替林治疗),治疗4周后,观察两组临床疗效、中医证候积分、CysC、PLR、5-羟色胺(5-hydroxytryptamine,5-HT)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、汉密尔顿抑郁量表、心率变异性指标、不良反应。结果联合组总有效率96.88%(31/32)高于对照组80.65%(25/31)(P<0.05)。联合组情志不畅、烦躁、兴趣索然、失眠得分低于对照组(P<0.05)。联合组CysC、PLR低于对照组(P<0.05)。联合组5-HT、BDNF高于对照组(P<0.05)。联合组汉密尔顿抑郁量表评分少于对照组(P<0.05)。联合组连续24 h内正常RR间期均值标准差(standard deviation of all normal to normal RR intervals,SDNN)、每5 min窦性RR间期均值标准差(standard deviation of 5-min mean RR intervals,SDANN)、相邻正常RR间期差值均方根(root-mean square of difference of successive RR intervals,rMSSD)高于对照组(P<0.05)。两组不良反应比较差异无统计学意义(P>0.05)。结论栀子豉汤联合阿米替林治疗心肌梗死后抑郁患者效果明显,能明显改善临床症状,降低血清CysC水平及PLR,改善5-HT和BDNF,提升心脏功能,且不会增加不良反应。

Objective To explore the effect of Zhizichi Decoction(栀子豉汤)combined with amitriptyline on serum cystatin C(CysC)and platelet to lymphocyte ratio(PLR)in patients with post-myocardial infarction depression.Methods Sixty-three patients with post-myocardial infarction depression in the hospital from June 2022 to April 2023 were selected,and assigned into two groups according to different treatment methods.The combined group(32 cases)received Zhizichi Decoction combined with amitriptyline,whereas the control group(31 cases)were given amitriptyline.After 4 weeks of treatment,the clinical efficacy,TCM syndrome score,CysC,PLR,5-hydroxytryptamine(5-HT),brain-derived neurotrophic factor(BDNF),Hamilton depression rating scale,heart rate variability indexes and adverse reactions were observed in both groups.Results The combined group reported a higher overall efficacy rate than the control group[96.88%(31/32)vs 80.65%(25/31),P<0.05].The TCM syndrome scores including dysphoria,irritability,lack of interest and insomnia were lower in the combined group than those in the control group(P<0.05).Compared with the control group,the combined group had lower levels of CysC and PLR and higher levels of 5-HT and BDNF,with statistical difference(all P<0.05).The combined group scored lower on Hamilton depression rating scale than the control group(P<0.05).The values of standard deviation of all normal to normal RR intervals(SDNN),the standard deviation of 5-min mean RR intervals(SDANN)and root-mean square of difference of successive RR intervals(RMSSD)were larger in the combined group than those in the control group(P<0.05).No statistical difference was demonstrated between two groups in adverse reaction rate(P>0.05).Conclusion Application of Zhizichi Decoction combined with amitriptyline in patients with post-myocardial infarction depression can effectively ameliorate the clinical symptoms,reduce the levels of serum CysC and PLR,improve the levels of 5-HT and BDNF and enhance cardiac function without increasing adverse effects.