疏肝和胃汤治疗肿瘤相关性抑郁肝胃不和证的疗效观察

Shugan Hewei decoction in treatment of tumor-associated depression of liver-stomach disharmony

目的观察疏肝和胃汤改善肿瘤相关性抑郁肝胃不和证患者抑郁情绪的效果及安全性。方法使用随机平行对照方法,选取本中心2014年12月-2015年12月收治的已完成肿瘤针对性治疗,处于随访观察期的肿瘤相关性抑郁肝胃不和证患者92例,随机分成治疗组和对照组,每组46例。治疗组予疏肝和胃汤,对照组予盐酸氟西汀分散片,治疗6周。观察患者的汉密尔顿抑郁量表(Hamilton depression scale,HAMD)减分有效率、血清脑源性神经营养因子(brain-derived neuro-trophic factor,BDNF)含量变化,比较治疗前后各组中医证候积分变化,评定中医证候疗效。结果两组患者性别(男性:28例vs 30例)、年龄[(41.1±9.78)岁vs (44.7±9.65)岁]、病程[(9.27±4.12)个月vs (7.98±5.66)个月]及治疗前汉密尔顿抑郁量表评分[(22.10±4.71) vs (21.86±5.6)]、血清BDNF含量[(19.18±3.25) pg/ml vs (18.63±3.99) pg/ml]、肝胃不和证候积分[(16.53±4.33) vs (15.19±3.17)]差异均无统计学意义(P> 0.05)。治疗后治疗组HAMD评分较对照组更低[(10.16±5.13) vs(14.12±4.97),P=0.003],肝胃不和证候积分明显低于对照组[(8.98±5.37) vs (13.21±4.65),P=0.008]。治疗组及对照组HAMD减分有效率分别为65.2%、47.8%,差异无统计学意义(P> 0.05);血清BDNF分别为(30.16±4.92) pg/ml、(23.64±3.78) pg/ml,中医证候改善评分总有效率分别为95.7%、56.5%,差异均有统计学意义(P <0.05)。两组均无严重不良反应发生。结论疏肝和胃汤能有效治疗肝胃不和型肿瘤相关性抑郁,改善患者症状,增加患者血清BDNF含量,较为安全。

Objective To observe the clinical curative effect and safety of traditional Chinese medicine Shugan Hewei decoction on tumor-associated depression with liver-stomach disharmony.Methods This study used a randomized controlled design.Totally 92 patients with tumor-associated depression admitted to our hospital from December 2014 to December 2015 were randomly divided into treatment group(n=46)and control group(n=46).The patients had completed general anti-cancer therapy.The traditional Chinese medicine Shugan Hewei decoction was given to the patients in the treatment group and fluoxetine hydrochloride dispersible tablets was given to those in the control group for 6 weeks.After treatment,the HAMD(Hamilton Depression Scale)score reduction and the change of serum brain-derived neuro-trophic factor(BNDF)levels were observed and compared,and liverstomach disharmony syndromes were also assessed.Results There was no significant difference in gender(male,28 vs 30),age[(41.1±9.78)years vs(44.7±9.65)years],course of disease[(9.27±4.12)months vs(7.98±5.66)months]between two groups(P>0.05).At the same time,there was no significant difference in HAMD score[(22.10±4.71)vs(21.86±5.6)],the serum BNDF levels[(19.18±3.25)pg/ml vs(18.63±3.99)pg/ml]and the syndrome score[(16.53±4.33)vs(15.19±3.17)]before treatment in two groups(P>0.05).After treatment,HAMD score and syndrom score in treatment group were less than those in control group((10.16±5.13)vs(14.12±4.97),P=0.03;(8.98±5.37)vs(13.21±4.65),P=0.08)The HAMD score decreased by 65.2%in the treatment group,and 47.8%in the control group(P=0.094).The serum BNDF levels was(30.16±4.92)pg/ml in the treatment group,and(23.64±3.78)pg/ml in the control group;the total effective rate calculated by syndrome score reduction was 95.7%in the treatment group,and 56.5%in the control group(P<0.05,respectively).No severe adverse events occurred.Conclusion Traditional Chinese medicine Shugan Hewei decoction can treat tumor-associated depression with liver-stomach disharmony effectively and safely,relieve clinical symptoms and increase serum BDNF level of patients.