礞石滚痰汤辅助治疗颅脑损伤后躁狂型精神障碍痰火扰神证19例临床观察

Clinical Observation on Mengshi Guntan Decoction( 礞石滚痰汤) in the Adujuctive Treatment of 19 Cases of Manic Agitation with Phlegm-Fire Disturbing Mind Syndrome after Traumatic Brain Injury

目的观察礞石滚痰汤辅助治疗颅脑损伤(TBI)后躁狂型精神障碍痰火扰神证的临床疗效。方法37例TBI后躁狂型精神障碍痰火扰神证患者按随机数字表法分为治疗组(19例)和对照组(18例),并选取同时期健康管理中心15例健康体检者作为正常组。治疗组与对照组均给予西医常规基础治疗,治疗组加用礞石滚痰汤口服或鼻饲,每日1剂,两组疗程均为7天。观察两组治疗前后神经行为量表(NRS)评分、中医证候积分;治疗组与对照组治疗前后和正常组采用酶联免疫吸附法检测血浆中S-100B蛋白(S-100B)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)和脑源性神经营养因子(BDNF)水平变化。结果治疗前治疗组和对照组患者血浆S-100B、TNF-α、NSE水平均高于正常组,BDNF水平低于正常组(P <0. 05)。与对照组比较,治疗组治疗后NRS评分、中医证候积分及血浆S-100B、TNF-α、NSE水平明显降低,血浆BDNF水平显著升高(P <0. 05)。结论礞石滚痰汤辅助治疗TBI后躁狂型精神障碍痰火扰神证可提高临床疗效,其作用机制可能与降低血浆中S-100B、TNF-α、NSE水平,升高BDNF水平有关。

Objective To investigate the clinical effects of Mengshi Guntan Decoction( 礞石滚痰汤,MGD) on manic agitation with phlegm-fire disturbing mind syndrome following traumatic brain injury( TBI). Methods A total of 37 patients with manic agitation with phlegm-fire disturbing mind syndrome following TBI were recruited and randomly assigned into a treatment group( 19 cases) and a control group( 18 cases). Fifteen healthy subjects from physical examination center were selected as normal group. Both patients groups received the conventional western medicine treatment. In addition,the treatment group received oral administration or nasal feeding of MGD,once a day for 7 days. The neurobehavioural rating scale( NRS) scores,traditional Chinese medicine( TCM) syndrome scores were observed before and after treatment. The levels of S-100 B protein( S-100 B),tumor necrosis factor alpha( TNF-α),neuron-specific enolase( NSE) and brain derived neurotrophic factor( BDNF) were detected with enzyme-linked immunosorbent assay( ELISA) for both treated groups before and after treatment as well as the normal group. Results Before treatment,plasma S-100 B,TNF-α and NSE levels of the two TBI groups of agitation were higher than those of the normal group( P < 0. 05),while BDNF level was lower than that of the normal group( P <0. 05). After treatment,compared with those of the control group,the NRS scores,the TCM syndrome scores,plasma S-100 B,TNF-α and NSE level was significantly decreased( P < 0. 05),while BDNF levels of the treatment group were significantly increased( P < 0. 05). Conclusion Mengshi Guntan Decoction in the adjuctive treatment of manic agitation with phlegm-fire disturbing mind syndrome following TBI could improve clinical effects,its mechanism may be associated with decrease of plasma level of S-100 B,TNF-α,NSE and increase of level of BDNF.