脑梗死后并发抑郁应用舒肝颗粒治疗的疗效观察

doi:10.3969/j.issn.1674-490X.2018.03.005

摘要/Abstract

摘要： 目的观察脑梗死后并发抑郁患者应用舒肝颗粒治疗的临床疗效。方法将80例脑梗死后抑郁患者按机械抽样法随机分为2组,各40例。治疗组,在心理干预治疗的基础上给予舒肝颗粒1袋/次,2次/日;对照组只给予心理干预治疗。治疗时间均为60 d。应用汉密尔顿抑郁量表(hamilton depression scale,HAMD)对患者治疗前和治疗后60 d进行评估,日常生活能力评分应用日常生活活动量表(barther index,BI)评定,同时测定患者治疗前和治疗后的肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C-反应蛋白含量(C-reactive protein,CRP)。结果治疗组和对照组的有效率分别为85.0%和30.0%,2组差异有统计学意义(P<0.05)。治疗组和对照组治疗前的HAMD评分差异无统计学意义(P>0.05),治疗组治疗60 d后的HAMD评分较治疗前降低(P<0.05),对照组治疗60 d后HAMD评分较治疗前降低(P<0.05),治疗60 d后治疗组与对照组比较HAMD评分降低(P<0.05)。治疗组治疗后TNF-α和C-CRP明显低于对照组(P<0.05)。不良反应在2组均不明显。结论舒肝颗粒治疗脑梗死后并发抑郁治疗效果较好,不良反应不明显,因此在临床应用中安全性较高。

关键词: 脑梗死, 抑郁, 心理疗法, 舒肝颗粒, 肿瘤坏死因子-α, C-反应蛋白

Abstract: Objective To evaluate the effects of Shugan Granule on cerebral infarction followed depression. Methods 80 patients with cerebral infarction followed depression were randomly divided into two groups by mechanical sampling. 40 cases of the treatment group were treated with psychological intervention and combined with orally Shugan Granule 1 bag/time, 2 times a day. 40cases of the control group were only given psychological intervention. The treatment time was 60 d. The treatment effects were assessed using Hamilton anxiety scale(HAMD)before and after treatment at the 60 th day. Results The treatment group's effective rate of the and the control group's effective rate were respectively 85.0%(34/40)and 30.0%(12/40), the difference was statistically significant between the two groups(P<0.05). The HAMD score before treatment showed no significant difference between the two groups［(28.10±3.42)vs(27.50±2.30)］(P>0.05), the score of the treatment group after treatment at days 60 was(6.35±3.05), compared with prior treatment has statistically significant(P<0.05), the score of the control group after treatment at days 60 was(13.01±3.01), compared with prior treatment has statistically significant(P<0.05), which indicated that there was statistically significant between the treatment group after treatment at 60th day and the control group(P<0.05). The levels of tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in the treatment group decreased significantly than that in the controls(P<0.05). Neither group had significant adverse reactions. Conclusion Shugan Granule has positive treatment effects in patients with cerebral infarction followed depression. There are fewer adverse reactions, so there are high security in clinical applications.

Key words: cerebral infarction, depression, psychotherapy, Shugan Granule, tumor necrosis factor-α, C-reactive protein

中图分类号:

刘晓溪,孙海民,李会敏,史福平,张杏红,宋月平. 脑梗死后并发抑郁应用舒肝颗粒治疗的疗效观察[J]. 医学研究与教育, 2018, 35(3): 30-34.

参考文献

[1] 万其容, 胡亚荣, 刘浩, 等. 舍曲林早期预防卒中后抑郁对急性脑梗死患者功能康复的影响[J]. 中国医院药学杂志, 2015, 35(19): 1768-1771. DOI:10.13286/j.cnki.chinhosppharmacyj.2015.19.15.
[2] 刘福仁, 顾翠华. 关于 50 例脑卒中后抑郁症的临床分析[J]. 中国社区医师, 2013, 15(22): 58. DOI:10.3969/j.issn.1007-614x.2014.22.42.
[3] ŽIKIC' T R, DIVJAK I, JOVIC'EVIC' M, et al. The effect of post stroke depression on functional outcome and quality of life[J]. Acta Clin Croat, 2014, 53(3): 294-301.
[4] HU J F, CHEN C J, BI X L, et al. Effect of early intervention of liver-smoothing and blood-activating decoction combined with acupuncture on patients with post-stroke depression[J]. China Journal of Chinese Materia Medica, 2013, 38(14): 2403-2405.
[5] SUN N, LI Q J, LV D M, et al. A survey on 465 patients with post-stroke depression in China[J]. Archives of psychiatric nursing, 2014, 28(8): 368-371. DOI:10.1016/j.apnu.2014.08.007.
[6] SCHILLING C, GILLES M, BLUM W F, et al. Leptin plasma concentrations increase during antidepressant treatment with amitriptyline and mirtazapine, but not paroxetine and venlafaxine: leptin resistance mediated by antihistaminergic activity?[J]. Journal of Clinical Psychopharmacology, 2013, 33(1): 99-103. DOI:10.1097/JCP.0b013e31827cb179.
[7] 徐晓燕, 贺丹军. 抗抑郁药物在老年脑卒中患者中的应用[J]. 实用老年医学, 2016,30(7): 599-600. DOI:10.3969/j.issn.1003-9198.2016.07.022.
[8] 程丰, 邵国富, 包仕尧. 氟西汀对脑卒中抑郁患者不同时期神经功能康复的作用[J]. 中国临床康复, 2003, 7(1): 108-109. DOI:10.3321/j.issn:1673-8225.2003.01.086.
[9] 郭敏, 李惠兰, 黄影柳, 等. 脑卒中后抑郁与血清细胞因子的相关性[J]. 中国心理卫生杂志, 2008, 22(2): 101-104. DOI:10.3321/j.issn:1000-6729.2008.02.008.
[10] 庞剑月, 郭慧荣, 石永香, 等. 舒肝颗粒治疗焦虑障碍的疗效[J]. 神经疾病与精神卫生, 2013, 13(1): 33-36. DOI:10.3969/j.issn.1009-6574.2013.01.010.
[11] 侯玉涛, 林亚明. 舒肝颗粒组方抗抑郁机制研究进展[J]. 实用中医药杂志, 2014, 30(11): 1071-1073. DOI:10.3969/j.issn.1004-2814.2014.11.079.
[12] 戈宏焱, 陈博, 许丹, 等. 柴胡皂苷 A 对抑郁模型大鼠脑中单胺类神经递质及其代谢产物含量的影响[J]. 高等学校化学学报, 2008, 29(8): 1535-1538. DOI:10.3321/j.issn:0251-0790.2008.08.008.
[13] LU C N, YUAN Z G, ZHANG X L, et al. Saikosaponin a and its epimer saikosaponin d exhibit anti-inflammatory activity by suppressing activation of NF-κB signaling pathway[J]. International Immunopharmacology, 2012, 14(1): 121-126. DOI:10.1016/j.intimp.2012.06.010.
[14] HAN N R, KIM H M, JEONG H J. Inactivation of cystein-aspartic acid protease(caspase)-1 by saikosaponin A[J]. Biological and Pharmaceutical Bulletin, 2011, 34(6): 817-823. DOI:10.3390/ijms140612806.
[15] 崔广智, 金树梅. 芍药苷对利血平诱导抑郁模型的影响[J]. 中国实验方剂学杂志, 2012, 18(22): 272-274.
[16] OFIR R, TAMIR S, KHATIB S, et al. Inhibition of serotonin re-uptake by licorice constituents[J]. Journal of molecular neuroscience, 2003, 20(2): 135-140. DOI:10.1385/JMN:20:2:135.
[17] 王君明, 张月月, 张蓓, 等. 牡丹皮水提物抗抑郁活性研究[J]. 时珍国医国药, 2013, 24(7): 1579-1581. DOI:10.3969/j.issn.1008-0805.2013.07.016.
[18] TORIIZUKA K, KAMIKI H, OHMURA N Y, et al. Anxiolytic effect of Gardeniae Fructus-extract containing active ingredient from Kamishoyosan(KSS), a Japanese traditional Kampo medicine[J]. Life Sciences, 2005, 77(24): 3010-3020. DOI:10.1016/j.lfs.2004.12.054.
[19] BOUAYED J, RAMMAL H, DICKO A, et al. Chlorogenic acid, a polyphenol from Prunus domestica(Mirabelle), with coupled anxiolytic and antioxidant effects[J]. Journal of the Neurological Sciences, 2007, 262(1): 77-84. DOI:10.1016/j.jns.2007.06.028.