Research Progress in the Treatment of Poststroke Depression with Traditional Chinese Medicine

In recent years,the incidence rate of stroke has increased year by year.Post stroke depres‐sion is one of its main complications,which seriously affects the recovery of physiological functions and quality of life of stroke patients.Traditional Chinese medicine has signifi‐cant therapeutic effects in treating this disease.This article provides a classification and review of traditional Chinese medicine treatment methods for post-stroke depression,and looks forward to the current problems.

miR-137, a new target for post-stroke depression?

Expression of miR-137 is downregulated in brain tissue from patients with depression and suicidal behavior, and is also downregulated in peripheral blood from stroke patients. However, it is not yet known if miR-137 acts as a bridge between stroke and depression. To test this, we used middle cerebral artery occlusion and chronic mild stress to establish a post-stroke depression model in rats. Compared with controls, we found significantly lower miR-137 levels in the brain and peripheral blood from post-stroke depression rats. Injection of a miR-137 antagonist into the brain ventricles upregulated miR-137 levels, and improved behavioral changes in post-stroke depression rats. Luciferase assays showed miR-137 bound to the 3＇UTR of Grin2A, regulating Grin2A expression in a neuronal cell line. Grin2A gene overexpression in the brain of post-stroke depression rats, no- ticeably suppressed the inhibitory effect of miR-137 on post-stroke depression. Overall, our results show that miR-137 suppresses Grin2A protein expression through binding to Grin2A mRNA, thereby exerting an inhibitory effect on post-stroke depression. Our results offer a new therapeutic direction for post-stroke depression.

The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine

The Xingnao Jieyu capsule has been shown to effectively relieve neurologic impairments and les- sen depression. It remains poorly understood whether this capsule can be used to treat post-stroke depression. Thus, in the present study, we established a rat model of post-stroke depression using left middle cerebral artery occlusions in combination of chronic unpredictable stress and solitary housing during development. Experimental rats received intragastric perfusion with 0.82, 0.41, and 0.20 g/kg Xingnao Jieyu capsules separately dissolved in 2 mL distilled water. Fluoxetine served as a positive control. The treatment was conducted over 28 days. Sugar water consumption test, open-field test, real-time fluorescent quantitative PCR and immunohistochemical staining results demonstrated that intragastric perfusion with various doses of Xingnao Jieyu capsules increased sugar water consumption, voluntary behaviors and synaptotagmin mRNA and protein expression in rats with post-stroke depression. These therapeutic effects were similar to those of fluoxetine. These results indicate that Xingnao Jieyu capsules upregulate synaptotagmin expression in hip pocampi of rats with post-stroke depression, and exert antidepressant effects.

Electroacupuncture at the Wangu (GB 12) acupoint suppresses expression of inflammatory factors in the hippocampus and frontal lobe of rats with post-stroke depression

Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.

Apolipoprotein E polymorphisms increase the risk of post-stroke depression

Recent reports have shown that apolipoprotein E （APOE） polymorphisms are involved in neurodegenerative disease. However, it is unclear whether APOE affects post-stroke depression. Accordingly, we hypothesized that APOE polymorphisms modify the risk of post-stroke depression. Here, we performed a hospital-based case-control study （including 76 cerebral infarction cases with post-stroke depression, 88 cerebral infarction cases without post-stroke depression, and 109 controls without any evidence of post-stroke depression or cerebral infarction） to determine possible association between APOE rs429358 and rs7412 polymorphisms and risk of post-stroke depression. Our findings show no difference among the groups with regards genotype distribution of the rs7412 polymorphism. In contrast, APOE genotypes with rs429358-C alleles increased the risk of post-stroke depression. Further, the rs429358 polymorphism was associated with significantly decreased regional cerebral blood flow values in the left temporal lobe of post-stroke depression cases. Additionally, the rs429358 polymorphism was not only associated with depression severity, but with increasing serum levels of total cholesterol. These resuits suggest that the APOE rs429358 polymorphism is associated with increased risk of developing post-stroke depression, and that APOE rs429358-C allele genotypes may be detrimental to recovery of nerve function after stoke. Indeed, these findings provide clinical data for future post-stroke depression gene interventions.

Metabolic changes of prefrontal cerebral lobe,white matter and cerebellum in patients with post-stroke depression A proton magnetic resonance spectroscopy study

BACKGROUND： Proton magnetic resonance spectroscopy （IH-MRS） non-invasively detects changes in chemical substances in the brain, which reflects the pathological metabolism.OBJECTIVE： To investigate changes in N-acetyl-aspartate （NAA）, choline （Cho）, creatine （Cr）, and myoinositol （MI） in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression （PSD） using ^1H-MRS. DESIGN： A case control study. SETTING： The First Affiliated Hospital of the Dalian Medical University. PARTICIPANTS： A total of 38 patients with stroke （28 male and l0 female patients, aged 40 to 79 years） were selected from the Department of Neurology, 1st Affiliated Hospital, Dalian Medical University, from February to October in 2004. All subjects met the DSM-IV criteria for cerebrovascular disease and depression. The degree of depression was defined according to Hamilton criteria. 38 patients with PSD were divided into two groups according to the time after ischemia, 20 patients in the acute group with less than 10 days after ischemic attack （mild： 16 patients, moderate/severe： 4 patients） and 18 patients in the chronic group with more than l l days after ischemic attack （mild： 15 patients, moderate/severe： 3 patients）. Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group. The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht, and each participant signed an informed consent form. METHODS： Spectra were acquired by multi-voxel point-resolved spectroscopy （PRESS） sequence with GE signal.5T MR/i, localized in prefrontal cerebral lobe and cerebellum. Values of NAA, Cho, MI, and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS 11.5. MAIN OUTCOME MEASURES： Metabolite concentration in different brain regions of interest. Difference in metabolites between distinctly graded PSD patients and control subjects. Exclusion of age-effects on metabolites. RESULTS： Metabolite concentrations of different brain regions： A significant rise in the Cho/Cr ratio was detected in the acute and chronic group compared to the control group. The ratio change was more significant in the acute group （P 〈 0.05）. There was no significant difference between these three groups for other metabolites detected by IH-MRS in the right frontal white matter, bilateral frontal grey matter, and cerebellum （P 〉 0.05）. Comparison of metabolite levels among differently graded PSD patients and control subjects： a significant increase in the Cho/Cr ratio was detected in the left frontal white matter compared to the control group （P 〈 0.05）. There was no significant difference in age between patients in the stroke groups and the control group （P 〉 0.05）, and similarly, there was no significant correlation between age and absolute or relative values in the control group （P 〉 0.05）. CONCLUSION： Abnormalities of frontal lobe in PSD were located in the white matter. There was early abnormality of metabolic substance in PSD.

CLINICAL STUDY ON ACUPUNCTURE IN THE TREATMENT OF POST-STROKE DEPRESSION WITH THE METHOD OF ACTIVATING THE DU MERIDIAN AND CLEARING THE MIND

Objective: To observe the therapeutic effect of acupuncture in the treatment of post-stroke depression (PSD) with the method of activating the Du Meridian and clearing the mind. Methods: Two hundred and thirty one cases of PSD were randomly divided into two groups, acupuncture and control groups. In acupuncture group, Baihui (百会 GV 20), Dazhui (大椎 GV 14), Neiguan (内关 PC 6), Taichong (太冲 LR 3) and Shenmen (神门 HT 7) were selected as the main points to invigorate flow of qi in the Du Meridian and clear the mind. Patients in the control group received Fluoxetine orally, 20 mg once per-day. In addition, the same routine treatments were given to both groups, strengthened with rehabilitation exercises as early as possible; 8 weeks constituted one therapeutic course. HAMD and severity of neuro-functional defect of each case were evaluated before and 8-week after the treatment. Results: The total effective rate of acupuncture group was 92.37%, the control group, 72.88%. According to χ2 test, the difference between the two groups was remarkably significant (P<0.05). Conclusion: Acupuncture therapy of activating the Du Meridian and clearing the mind in the treatment of PSD was safe and effective.

Role of Transcranial Direct Current Stimulation in the Management of Post-Stroke Depression

Study Objectives: Stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. Post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation;techniques;transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the Stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and Stroke Specific Quality Of Life in treated group in comparison to group B, p = 0.000. Conclusion: tDCS was effective for post- stroke depression and might be a favorable option for treating post-stroke patients.

Ginkgo Leaf Extract and Armillariella Mellea Powders Oral(银杏蜜环口服溶液) attenuates inflammation of microglia in habenular nucleus through CX3CL1-CX3CR1 axis in post stroke depression

OBJECTIVE The Ginkgo Leaf Extract and Armillariella Mellea Powders Oral(Yinxingmihuan Koufu Rongye,YXMH),a representative drug for"Treating both Brain and Heart",showed considerable clinical effects in isch⁃emic cardiovascular and cerebral vascular diseases.Recently,it is reported that YXMH has the potential for treating myocardial and cerebral ischemia related mental disorders,such as post stroke depression(PSD)and chronic heart disease(CHD)associated anxiety disorder.However,its mechanism has not been clearly elucidated.Meanwhile,increasing evidence revealed that there are close functional links between depression and habenular nucleus.The present study investigates the underlying mechanism of YXMH on attenuating the inflammation of microglia in habenular nucleus through CX3CL1-CX3CR1 axis in in a rat model of PSD.METHODS Rats were randomly devided into sham group,model group,Ginaton group(18 mg·kg^-1),Armillariella Mellea group(600 mg·kg-1),Fluoxetine group(10 mg·kg^-1),YXMH high-dose group(618 mg·kg^-1)and YXMH low-dose group(309 mg·kg^-1).The PSD model was induced by transarterial microembolization combined with sleep deprivation(2-Chloro-D-phenylalanine,PCPA,IH,200 mg·kg^-1,for 3 times,before the behavior test)in SD male rats.Then rats were treated with corresponding medicaments through gavage once a day until 3 weeks later,followed by body mass measurement,neurological deficit score evaluation,gripping strength and thermal withdrawl latency measurement,as well as depression related behavioral indicators,the open field test(OFT)and sucrose preference test.The pathological morphological changes of habenular nucleus was observed by HE staining,the expression of IBA-1 was measured and analyzed by immunohistochemistry staining,and alterations of proteins and genes related to the CX3CL1-CX3CR1 axis were analyzed using Western blotting(CX3CL1,CX3CR1)and real-time polymerase chain reaction(PCR)(CX3CL1,CX3CR1).RESULTS Compared with the sham group,rats in the model group manifested as decreased body mass,deficient neurological behavior and gripping strength,reduced loco⁃motor activity and sugar water consumption,as well as elevated thermal withdrawl latency(P<0.05,P<0.01).Mean⁃while,the pathological morphology of the habenular nucleus on the ischemic hemisphere showed significant neuronal degeneration,microglial proliferation,inflammatory cells and glia cells infiltration,together with up-regualted expression of IBA-1,CX3CL1,CX3CR1 protein and CX3CL1,CX3CR1 mRNA.YXMH attenuated inflammation of microglia in habenular nucleus through improving pathological morphology,inhibiting IBA-1 activation,down-regulating the expres⁃sion of CX3CL1 and CX3CR1 proteins and genes,and thus improved the behavior performance of ischemic injury and depression.CONCLUSION YXMH ameliorates neurological deficit and depressive behavior in rat model of PSD induced by transarterial microembolization combined with sleep deprivation,and the mechanism is probably related to attenu⁃ating inflammation of microglia in habenular nucleus through CX3CL1-CX3CR1 axis.

Sociodemographic profile and social support for post-stroke depression in Kinshasa: A rehabilitation based cross-sectional study

The World Health Organization has highlighted the emergence of non-communicable chronic diseases, including stroke, in developing countries. As a cause of death, stroke ranks first in Africa. Stroke is the foremost cause of neuropsychiatric disease, including post-stroke depression (PSD) which is a very common disease. Surveys of this condition in Congolese pa tients are virtually non-existent. The objectives of this study were to assess the prevalence of PSD in Congolese patients and identify associated sociodemographic factors. Age, sex, address, province of origin, social and professional status, education, religion and consumption habits were chosen as indicators or parameters of interest to be examined in this study. The results of descriptive analyses are presented as frequencies for categorical variables and as mean ± standard deviation for quantitative variables. The association between different variables was assessed using tables of comparisons of proportions and the Chi-square test. Logistic regression was performed to predict the occurrence of PSD. There were more male than female patients. The mean age was 54.67 ± 12.51 years. Nearly 3 fourths of the patients were aged less than 65. The family was the primary source of social support. The majority was satisfied by the social support received from the family. Just over half the study patients (53.6%) had mild to severe depression as assessed by the PHQ9. Univariate analysis and logistic regression indicated a statistically significant association between low educational level and the occurrence of PSD. However, there was no relationship between age, sex or drinking habits and the onset of PSD. The majority of the subjects were satisfied by the social support from their families. Depression was common after stroke with the occurrence of 53.6%. These results highlight the need to investigate, diagnose and treat PSD, which is a risk factor for morbidity and mortality after stroke.

Melatoninergic Antidepressant in Post-Stroke Depression Therapy

This paper presents the results of the effects of Melitor (25 mg during two months) on the psychic-emotional state, cerebral hemodynamic and bioelectrical activity of the brain in 30 patients (average age 66.2 ± 3.2 years) with ischemic post-stroke depression. It has been found that this drug possesses a multimodal action which is characterized by the decrease of the level of depression, widening of the range of social-environmental activity, improvement of the cerebral blood circulation and harmonization of the brain electrogenesis. In the patients with right versus left hemisphere stroke, the effect of Melitor on the functional state of the brain was more pronounced. Based on the results obtained in our study, we can recommend Melitor to use it in complex scheme of rehabilitation care of patients of the given nosological category.

Predictive power of abnormal electroencephalogram for post-cerebral infarction depression

Electroencephalography is a sensitive indicator for measuring brain condition, and can reflect early changes in brain function and severity of cerebral ischemia. However, it is not yet known whether electroencephalography can predict development of post-cerebral infarc- tion depression. A total of 321 patients with ischemic stroke underwent electroencephalography and Hamilton Depression Rating Scale assessment to analyze the relationship between electroencephalography and post-cerebral infarction depression. Our results show that electroencephalograms of ischemic stroke patients with depression exhibit low-amplitude alpha activity and slow theta activity. In con- trast, electroencephalograms of ischemic stroke patients without depression show fast beta activity and slow delta activity. ＂Ihese findings confirm that low-amplitude alpha activity and slow theta activity can be considered as independent predictors for post-cerebral infarction depression.

迷迭香精油吸嗅对PSD大鼠的神经行为学影响

目的探讨迷迭香吸入对脑卒中后抑郁(PSD)大鼠行为学的影响。方法采用线栓法制备局灶性脑缺血大鼠模型后予以孤养、应激处理复合制备PSD大鼠模型,随机分为迷迭香组、文拉法辛组和对照组,观察PSD大鼠蔗糖水消耗量、旷野试验等行为学指标。结果与对照组相比,迷迭香组和文拉法辛组PSD大鼠蔗糖水消耗量、旷野实验水平和垂直运动次数均有所增加(P<0.01);而两组效果亦有差异(P<0.01),文拉法辛组更为明显。结论迷迭香吸入对PSD大鼠神经行为学变化有一定的改善。

探讨“针药并举”治疗卒中后抑郁症(PSD)的临床研究

目的:评价"针药并举"治疗卒中后抑郁症临床疗效。方法:选取天津市中医药研究院附属医院2015年1月至2016年12月100例PSD患者按随机数字表法分为针药组和西药组各50例,分别于治疗前及治疗8周后给予HAMD及因子、SDS、NIHSS、ADL评分,并于治疗4、8周后予SERS评分。结果:针药组与西药组总有效率为86%和66%,2组比较差异有统计学意义。经HAMD及其因子、SDS、NIHSS及ADL评分,2组比较差异有统计学意义,说明在抗抑郁和改善神经功能及提高日常生活能力上,针药组明显优于西药组。经4、8周治疗后SERS评分,2组比较差异有统计学意义,说明针药组治疗副作用小。结论:针药组不仅能够改善抑郁症状,同时改善神经功能情况,提高日常生活能力且不良反应少,总体疗效上优于西药组。

电针“四关”穴及相应单穴对PSD大鼠海马5-HT、NE的影响

目的:观察电针"四关"穴及其相应单穴对脑卒中后抑郁(post-stroke depression,PSD)模型大鼠海马5-HT、NE的影响,研究电针"四关穴"治疗PSD的机制,同时探索对穴的效应机制。方法:40只大鼠采用随机数字表法分为空白组8只、待造PSD模型组32只,采用经典Koizumi线栓改良法结合笼内孤养、CUMS法制作PSD模型,再将造模成功的PSD大鼠根据随机数字表法分为模型组、"四关"穴组、"合谷"穴组和"太冲"穴组,每组8只。"四关"穴组、"合谷"穴组、"太冲"穴组分别于造模成功后第1天开始采取相应的电针处理,连续干预3周。采用敞箱试验观察大鼠行为学变化,采用RP-HPLC-荧光检测法测定大鼠海马组织5-HT、NE含量。结果:干预后四关穴组及太冲穴组大鼠敞箱试验爬行格子数及直立次数均高于模型组(P<0.01),太冲穴组直立次数明显高于四关穴组(P<0.05),而合谷穴组大鼠干预后与模型组比较,差异无统计学意义(P>0.05)。干预后与模型组比较,四关穴组与太冲穴组大鼠海马组织中5-HT、NE含量均显著增加(P<0.01),且太冲穴组增加更明显(P<0.05);合谷穴组大鼠海马组织中NE、5-HT含量与四关穴组及太冲穴组比较,差异有统计学意义(P<0.01),而与模型组比较,差异无统计学意义(P>0.05)。结论:电针四关穴及太冲穴均能提高PSD模型大鼠的行为学指标,其作用机制可能与海马组织中5-HT、NE含量增加有关,但四关穴治疗该病的协同效应并不突出,其机理有待进一步研究。

针灸联合加味补阳还五汤治疗PSD的疗效及对HAMD SDS BECK量表结果的影响

目的:探讨针灸联合加味补阳还五汤治疗卒中后抑郁(PSD)的疗效及对汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)、贝克抑郁自评量表(BECK)结果的影响。方法:本研究对象选取84例PSD患者,按照随机数字表法分成2组,每组42例。对照组患者给予口服加味补阳还五汤治疗,观察组患者给予针灸联合加味补阳还五汤治疗。连续治疗4周,对比两组临床疗效、血清炎症因子水平、HAMD、SDS、BECK量表结果的差异。结果:治疗后对照组显效15例、有效18例、无效9例,总有效率为78.57%。观察组显效21例、有效19例、无效2例,总有效率为95.24%,组间有显著的统计学差异(P<0.05)。治疗前两组患者HAMD、SDS、BECK量表评分无统计学差异(P>0.05);治疗后观察组患者HAMD、SDS、BECK量表评分均低于对照组,组间有显著的统计学差异(P<0.05)。结论:采用针灸联合加味补阳还五汤治疗卒中后抑郁的疗效显著,可降低抑郁评分,使患者的抑郁症状得到更好的改善。

rTMS对急性缺血性PSD患者5-HIAA、氨基酸类神经递质及5-HT的影响

目的 研究低频重复经颅磁刺激(rTMS)治疗对急性缺血性脑卒中后抑郁(PSD)患者5-羟吲哚乙酸(5-HIAA)、氨基酸类神经递质[谷氨酸(Glu)、天冬氨酸(Asp)、甘氨酸(Gly)、γ-氨基丁酸(GABA)]及5-羟色胺(5-HT)的影响。方法 选取2021年1月至2021年12月宜兴市人民医院收治的88例急性缺血性PSD患者的临床资料进行分析,分为研究组(n=45,常规治疗结合低频重复经颅磁刺激治疗)和对照组(n=43,常规治疗),比较两组临床疗效、5-HIAA、神经递质、5-HT及不良反应。结果 研究组总有效率(93.33%)高于对照组(76.74%),差异有统计学意义(P<0.05)。治疗后研究组Glu、Asp低于对照组,Gly、GABA、5-HIAA、5-HT高于对照组,差异均有统计学意义(P<0.05)。研究组不良反应率(13.33%)与对照组(11.63%)比较差异无统计学意义(P>0.05)。结论 r TMS治疗可有效提升急性缺血性脑卒中后抑郁患者的临床疗效,对患者神经递质等改善效果良好,且安全性高。

卒中后抑郁大鼠PSD-95表达调控与认知功能障碍关系的研究

目的 探讨卒中后抑郁大鼠突触后致密蛋白-95(PSD-95)表达调控与认知功能损伤的关系。方法 筛选50只行为学评分均一的大鼠,随机分为4组,正常组、卒中组、抑郁组、卒中后抑郁组,每组最终达到6只以上。采用线栓法制备大脑中动脉阻塞模型(MCAO),在此基础上综合孤养、慢性不可预见的温和应激(CUMS)复合制备卒中后抑郁大鼠模型。运用被动躲避实验评定大鼠的学习记忆能力,采用荧光定量PCR技术和免疫组织化学技术检测大鼠海马PSD-95基因和蛋白的表达变化。结果 造模成功后(术后36天),与正常组比较,抑郁组与卒中后抑郁组大鼠体重、糖水消耗量、OFT水平、PSD-95蛋白及mRNA表达水平均减少,被动规避缺陷,差异均有统计学意义(均P<0.05)。结论 卒中后抑郁大鼠海马区PSD-95表达下降可导致认知功能障碍。

从“胆气春升”探析卒中后抑郁

总结“胆气春升”的理论本质及生理功能,结合形神一体观进一步探讨该理论在卒中后抑郁(PSD)中的发生发展规律及其对临床的指导意义。“胆气春升”基本内涵有二:一是指其为人体提供阳气和能量,二是指其为气机始动之枢。其生理功能有三:化生人体阳气、枢转周身气机、司控精神情志“。胆气春升”对形神系统作用途径有三:化生阳气以养神、少阳枢转以维持形神稳态、温养元气以使气纳神存。PSD属形神俱病,卒中阶段偏于形病,抑郁阶段偏于神病。PSD初期胆气过度升发,以形病为主,症状表现偏于亢奋;中期胆气升发受阻,形神共病,症状常伴轻度阳虚和消化系统功能紊乱;后期胆气长期升发不及,以神病为主,常伴阳虚及气郁血结。PSD未病时需因时春治,选用清凉之品;初期用药宜升中有降,以维持胆气升降有序;中期宜升发肝胆之气,调养脾胃;后期需升阳、培元,以复胆气升发之职。

ROC分析卒中早期各因素对预测PSD的价值

目的对缺血性卒中早期各相关因素及中医证侯要素的演变进行初步的研究,从中医证素角度早期预测卒中后抑郁(PSD)的发生。方法回顾性调查研究急性缺血性卒中患者,研究首发急性缺血性中风患者的中医证候要素的动态演变规律及与PSD发生之间的关系,寻找可能促成PSD发生的危险因素。结果通过ROC分析中医证候要素对早期预测PSD的价值可知,发病初期的痰证积分>9.5分,血瘀积分>13.5分的患者其以后发生PSD事件可能性较大。到14 d时通过痰湿、血瘀、气虚等证素预测PSD灵敏度及特异度均较好。结论动态观察急性缺血性卒中患者中医证候要素演变,尤其对疾病发展过程中痰湿、血瘀、气虚证明显的患者积极做好PSD的二级预防工作,减少PSD事件的发生。