经方调控下丘脑-垂体-肾上腺轴治疗卒中后抑郁研究进展

Research Progress of Regulating HPA Axis by Prescription in the Treatment of Post-stroke Depression

卒中后抑郁(post-stroke depression,PSD)是卒中发生后,出现的一种以情绪低落、兴趣缺失为特征的情感障碍综合征。PSD是卒中最常见的精神障碍并发症之一,极大地影响了患者的生活质量。其发病机制十分复杂,涉及生理、心理、社会、遗传等多个层面,临床症状多样。下丘脑-垂体-肾上腺(HPA)轴参与了抑郁症的病理生理过程,尤其是重型抑郁症中HPA轴会过度活跃,所以HPA轴可能在PSD的发生中起重要作用。中医经典方剂具有药少、力宏、效佳的作用,在治疗精神障碍类疾病拥有悠久的历史以及确切的疗效。该文结合国内外研究,对HPA轴在PSD中的作用机制进行探讨,以六经体系为线索,对相关经典方剂调控HPA轴治疗PSD进行综述,为经方的进一步应用和临床新药的开发提供参考。

Post-stroke depression(PSD)is a kind of emotional disorder syndrome characterized by low mood and loss of interest after stroke.PSD is one of the most common complications of stroke,which greatly affects the quality of life of patients.Its pathogenesis is very complex,involving physiological,psychological,social,genetic and other aspects,clinical symptoms are diverse.The hypothalamicpituitary-adrenal(HPA)axis is involved in the pathophysiological process of depression,especially the HPA axis is overactive in major depression,so the HPA axis may play an important role in the occurrence of PSD.Traditional Chinese medicine prescriptions have a long history and exact curative effect in the treatment of mental disorders.In this paper,based on domestic and foreign studies,the mechanism of action of HPA axis in PSD was discussed,and the relevant classical prescriptions regulating HPA axis for PSD were reviewed with the six channels system as a clue,so as to provide references for the further application of classical prescriptions and the development of clinical new drugs.