摘要
目的逍遥解郁方治疗脑卒中后抑郁的疗效及对血清细胞因子、P13K/Akt信号通路蛋白的影响。方法选取2018年3月—2019年6月期间就诊于河北省沧州中西医结合医院脑病科的150例脑卒中后抑郁患者,采用随机双盲安慰剂对照法,将其随机分为安慰剂对照组、盐酸氟西汀对照组、逍遥解郁方治疗组3组,每组各50例。3组患者均给予脑卒中的基础治疗,在此基础上,安慰剂对照组给予安慰剂胶囊+安慰剂汤剂;盐酸氟西汀对照组患者给予盐酸氟西汀口服+安慰剂汤剂;逍遥解郁方治疗组给予盐酸氟西汀+逍遥解郁方。3组患者均连续治疗8周,并随访至12周。分别于治疗前、治疗4周末、治疗8周末以及随访第12周末,检测汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、日常生活能力(Activity of Daily Living Scale,ADL)量表Barthel指数、中医证候积分,检测脑脊液蛋白[BCL2-Associated X蛋白质(BCL2 associated X protein,Bax)、B淋巴瘤基因(B-cell lymphoma,Bcl)、磷酸化丝氨酸/苏氨酸蛋白激酶(Phosphorylated serine/threonine protein kinase,pAkt)、磷脂酰肌醇3激酶(Phosphoinositide 3-kinase,PI3K)]水平、相关血清细胞因子[肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(Hypersensitive c-reactive protein,hs-CRP)、同型半胱氨酸(Homocysteine,Hcy)]水平,并进行临床疗效评价。结果治疗后安慰剂对照组、盐酸氟西汀对照组、逍遥解郁方治疗组总有效率分别为70.45%、81.40%、93.18%,盐酸氟西汀对照组、逍遥解郁方治疗组与安慰剂对照组比较,差异有统计学意义(P<0.05);逍遥解郁方治疗组与盐酸氟西汀对照组比较,差异有统计学意义(P<0.05)。治疗4、8周、随访至第12周后逍遥解郁方治疗组HAMD、NIHSS评分、中医证候积分均低于安慰剂对照组和盐酸氟西汀对照组,差异有统计学意义(P<0.05);ADL评分高于安慰剂对照组和盐酸氟西汀对照组,差异有统计学意义(P<0.05);脑脊液Bcl、Bax、P13k、PAkt含量均明显高于安慰剂对照组、盐酸氟西汀对照组,差异有统计学意义(P<0.05);血清TNF-α、hs-CRP、Hcy含量均明显低于安慰剂对照组、盐酸氟西汀对照组,差异有统计学意义(P<0.05)。结论逍遥解郁方能够有效改善脑卒中后抑郁患者的心理状态、神经功能、日常生活能力,减轻临床症状,其机制与介导P13K/Akt信号通路蛋白水平表达、改善炎症状态等有关,值得推广。
Objective To observe the effect of Xiaoyao Jieyu Recipe on post-stroke depression,serum cytokines,and P13 K/Akt signaling pathway.Methods A total of 150 patients with post-stroke depression treated in the Department of Encephalopathy of Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine in Hebei Province from March 2018 to June 2019 were randomly assigned into a placebo control group,a fluoxetine hydrochloride group,and a Xiaoyao Jieyu Recipe group,with 50 patients in each group.On the basis of the routine treatment for stroke,patients in the three groups were administrated with placebo capsule+placebo decoction,fluoxetine hydrochloride(oral)+placebo decoction,and fluoxetine hydrochloride+Xiaoyao Jieyu Recipe,respectively.The patients were treated for 8 weeksand followed up until the 12week.Hamilton Depression Scale(HAMD),National Institutes of Health Stroke Scale(NIHSS),Barthel Index for Activity of Daily Living(ADL),and traditional Chinese medicine(TCM)syndrome scores were evaluated before treatment and at the 4,8,and 12weeks.At the same time,the levels of cerebrospinal fluid proteins(BCL2-associated X protein,Bax;B-cell lymphoma,Bcl;phosphorylated serine/threonine protein kinase,pAkt;phosphoinositide 3-kinase,P13 K)and related serum cytokines(tumor necrosis factor-α,TNF-α;hypersensitive C-reactive protein,hs-CRP;homocysteine,Hcy)were measured and the clinical efficacy were evaluated.Results The effective rates of the placebo group,fluoxetine hydrochloride group,and Xiaoyao Jieyu Recipe group were 70.45%,81.40%,and 93.18%,respectively(P<0.05).At the 4,8,and 12 weeks,Xiaoyao Jieyu Recipe group had lower HAMD,NIHSS,and TCM syndrome scores and higher ADL score than the other two groups(P<0.05).Additionally,Xiaoyao Jieyu Recipe group had higher levels of Bcl,Bax,P13 K,and pAkt in cerebrospinal fluid and lower levels of TNF-α,hs-CRP,and Hcy in serum than the other two groups(P<0.05).Conclusion Xiaoyao Jieyu Recipe may improve the psychological state,neural function,and daily living and alleviate the clinical symptoms of patients with post-stroke depression by regulating the expression of proteins involved in P13 K/Akt signaling pathway and mitigating the inflammatory state,which is worthy of popularization.
作者
纪立霞
毕春露
李腾
贾志卫
杨景超
杨尚依
JI Li-xia;BI Chun-lu;LI Teng;JIA Zhi-wei;YANG Jing-chao;YANG Shang-yi(Department of Encephalopathy,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou Hebei 061000)
出处
《世界中西医结合杂志》
2022年第6期1228-1233,共6页
World Journal of Integrated Traditional and Western Medicine
基金
河北省沧州市科技局基础项目(162302209)。
关键词
卒中后抑郁
逍遥解郁方
脑脊液蛋白
肿瘤坏死因子
C-反应蛋白
同型半胱氨酸
Post-stroke Depression
Xiaoyao Jieyu Recipe
Cerebrospinal Fluid Protein
Tumor Necrosis Factor
C-Reactive Protein
Homocysteine
