摘要
目的基于“脑-肠轴”理论探讨舒肝解郁胶囊治疗肝郁脾虚型卒中后抑郁(PSD)的临床疗效。方法选取118例PSD患者,随机分为研究组与对照组各59例,对照组进行常规西医治疗,研究组在对照组基础上应用舒肝解郁胶囊治疗,治疗12周,比较两组临床疗效、24项汉密尔顿抑郁量表(HAMD-24)评分、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力评定(ADL)评分及血清P物质(SP)、5-羟色胺(5-HT)、神经肽Y(NPY)水平,并进行安全性评估,采用Pearson检验分析血清SP、NPY、5-HT与PSD患者HAMD-24评分的关系,ROC分析血清SP、NPY、5-HT与PSD治疗效果的关系。结果研究组治疗总有效率高于对照组(P<0.05)。治疗后第4、12周末两组HAMD-24、NIHSS评分及血清SP水平均较各自治疗前降低(P<0.05),研究组HAMD-24、NIHSS评分及血清SP水平均低于对照组(P<0.001)。治疗后第4、12周末两组ADL评分及血清NPY、5-HT水平均较各自治疗前升高(P<0.05),研究组ADL评分及NPY、5-HT水平均高于对照组(P<0.05)。相关性结果显示,PSD患者HAMD-24评分与血清SP水平呈正相关(P<0.001),与NPY、5-HT水平呈负相关(P<0.001)。与有效组比较,无效组入院时血清SP水平升高(P<0.05),NPY、5-HT水平下降(P<0.05)。ROC曲线显示,血清SP、NPY、5-HT联合预测PSD治疗效果的AUC、灵敏度、特异度依次为0.841、85.00%、87.01%。结论舒肝解郁胶囊有助于改善肝郁脾虚型卒中后抑郁患者抑郁症状、神经功能及日常生活活动能力,调节多种脑肠肽因子水平,改善机体脑-肠轴紊乱状况,且脑肠肽因子SP、NPY、5-HT与PSD病情及疗效关系密切。
Objective To explore the clinical efficacy of Shugan Jieyu Capsule in the treatment of post-stroke depression(PSD)of liver depression and spleen deficiency type based on the theory of"brain-gut axis".Methods 118 PSD patients were randomly divided into study group(n=59)treated with routine medications combined with Shugan Jieyu Capsule and control group(n=59)treated with routine medications.The treatment lasted for 12 weeks.The clinical efficacy,scores of 24-items Hamilton Depression Scale(HAMD-24),National Institute of Health Stroke Scale(NIHSS),Activities of Daily Living(ADL)and levels of serum substance P(SP),5-hydroxytryptamine(5-HT),neuropeptide Y(NPY)were compared between two groups,and their safety was evaluated.Pearson's test was used to analyze the relationships among serum SP,NPY,5-HT and HAMD-24.The relationships among serum SP,NPY,5-HT and PSD treatment efficacy were analyzed through ROC analysis.Results The total effective rate of clinical efficacy in study group was significantly higher than that in control group(P<0.05).At the ends of 4'h and 12 weeks after treatment,the ADL score,NPY,and 5-HT in both groups significantly increased compared with those before treatment(P<0.05),while the HAMD-24 score,NIHSS score,and serum SP significantly decreased compared with those before treatment(P<0.05);the ADL score,NPY,and 5-HT in study group were higher than those in control group(P<0.05),while the HAMD-24 score,NIHSS score,and serum SP in study group were lower than those in control group(P<0.001).Pearson's correlation test showed that the HAMD-24 score in PSD patients was positively correlated with serum SP(P<0.001),and negatively correlated with NPY and 5-HT(P<0.001).Compared with the effective group,the ineffective group showed a significant increase in serum SP level upon admission(P<0.05),while the levels of NPY and 5-HT decreased significantly(P<0.05).The ROC curve showed that the AUC,sensitivity,and specificity of the combined prediction of serum SP,NPY,and 5-HT for PSD treatment efficacy were 0.841,85.00%,and 87.01%,respectively.Conclusion Shugan Jieyu Capsules can help improve depression symptoms,neurological function,and daily living activities in PSD patients with liver depression and spleen deficiency,regulate the levels of various brain-gut peptide factors,and improve the disorder of the brain-gut axis in the body.Moreover,the levels of brain-gut peptide factors SP,NPY,and 5-HT are closely related to the condition and efficacy of PSD.
作者
吴存虎
王岱
王玉兰
窦新涛
何曼曼
WU Cunhu;WANG Dai;WANG Yulan(Hengshui Hospital of Traditional Chinese Medicine,Hengshui 053000,China)
出处
《精神医学杂志》
2024年第4期337-341,共5页
Journal of Psychiatry
基金
国家自然科学基金资助项目(编号:81603417)
河北省中医药管理局计划内项目(编号:2021270)。
关键词
脑-肠轴
舒肝解郁胶囊
肝郁脾虚型
卒中后抑郁
P物质
5-羟色胺
神经肽Y
Brain-gut axis
Shugan Jieyu Capsules
Liver depression and spleen deficiency type
Post-stroke depression
Substance P
5-hydroxytryptamine
Neuropeptide Y
