摘要
目的:观察柴胡疏肝散合半夏厚朴汤联合五行针灸对脑卒中后焦虑抑郁患者的神经调控作用及对免疫炎症反应、认知功能损害和下丘脑-垂体-性腺轴(HPG)、下丘脑-垂体-甲状腺轴(HPT)的影响。方法:选择2021年3月至2023年5月于该院治疗的脑卒中后焦虑抑郁患者102例,根据随机数字表法分组,其中五行针灸组51例(脱落2例,最终纳入49例),方剂联合组51例(脱落2例,最终纳入49例)。两组患者同时给予常规西医基础治疗,五行针灸组患者在常规西医基础治疗的基础上给予五行针灸治疗,方剂联合组患者在五行针灸组的基础上给予柴胡疏肝散合半夏厚朴汤治疗。观察两组患者的临床疗效,比较患者治疗前后的中医证候评分、简易精神状态量表(MMSE)评分、广泛性焦虑障碍量表(GAD-7)评分、汉密顿抑郁量表(HAMD)评分和简明幸福与生活质量满意度问卷(Q-LES-Q-SF)评分,检测患者治疗前后血清神经生长因子(NGF)、白细胞介素1β(IL-1β)、胶质纤维酸性蛋白(GFAP)、白细胞介素17a(IL-17a)、促甲状腺激素(TSH)、5-羟色胺(5-HT)和雌二醇(E2)水平。结果:方剂联合组患者的总有效率为97.96%(48/49),高于五行针灸组的81.63%(40/49),差异有统计学意义(P<0.05)。治疗后,方剂联合组患者精神焦虑抑郁、脘痞、胸胁作胀、善太息和嗳气频作等中医证候评分较五行针灸组降低,HAMD、GAD-7评分较五行针灸组降低,MMSE、Q-LES-Q-SF评分较五行针灸组升高,差异均有统计学意义(P<0.05)。治疗后,方剂联合组患者的IL-1β、IL-17a和GFAP水平较五行针灸组降低,NGF水平较五行针灸组升高,5-HT、E2和TSH水平较五行针灸组升高,差异均有统计学意义(P<0.05)。结论:柴胡疏肝散合半夏厚朴汤联合五行针灸治疗脑卒中后焦虑抑郁患者,可减少免疫炎症反应,减少神经及认知功能损害,调节HPG、HPT,改善焦虑及抑郁情绪,缓解病情,提高生活质量及临床疗效。
OBJECTIVE:To observe the neuroregulatory effects of Chaihu Shugan powder and Banxia Houpo decoction combined with Wuxing acupuncture on anxiety and depression after stroke and its effects on immune inflammatory response,cognitive function impairment,hypothalamic-pituitary-gonadal axis(HPG)and hypothalamic-pituitary-thyroid axis(HPT).METHODS:A total of 102 patients with post-stroke anxiety and depression admitted into the hospital from Mar.2021 to May 2023 were extracted to be divided into 51 cases in the Wuxing acupuncture group(2 cases were shed and 49 cases were eventually included),and 51 cases in the prescription combination group(2 cases were shed and 49 cases were eventually included)according to the random number table method.Both groups were given conventional Western medicine basic treatment,the Wuxing acupuncture group received Wuxing acupuncture treatment based on the conventional Western medicine basic treatment,and the prescription combination group was treated with Chaihu Shugan powder and Banxia Houpo decoction on the basis of the Wuxing acupuncture group.Clinical efficacy of two groups was compared.Traditional Chinese medicine syndrome score,Mini-Mental State Examination(MMSE)score,Generalized Anxiety Disorder Scale(GAD-7)score,Hamilton Depression Scale(HAMD)score and Quality of Life Enjoyment and Satisfaction Ques-tionnaire,Short Form(Q-LES-Q-SF)score of two groups before and after treatment were compared.Serum levels of nerve growth factor(NGF),interleukin-1β(IL-1β),glial fibrillary acidic protein(GFAP),interleukin-17A(IL-17a),thyroid stimulating hormone(TSH),5-hydroxytryptamine(5-HT)and estradiol 2(E2)were measured before and after treatment.RESULTS:The total effective rate of the prescription combination group was 97.96%(48/49),higher than 81.63%(40/49)of the Wuxing acupuncture group,the difference was statistically significant(P<0.05).After treatment,the scores of anxiety and depression,epigastric fullness,chest and hypochondriac distension,frequent sighing in the prescription combination group were lower than those in the Wuxing acupuncture group,the scores of HAMD and GAD-7 were lower than those in Wuxing acupuncture group,and the scores of MMSE and Q-LES-Q-SF were higher than those in Wuxing acupuncture group,with statistically significant differences(P<0.05).After treatment,levels of of IL-1β,IL-17a and GFAP in prescription combination group were lower than those in Wuxing acupuncture group,and levels of NGF in prescription combination group were significantly higher than those in Wuxing acupuncture group,levels of 5-HT,E2 and TSH in prescription combination group were higher than those in Wuxing acupuncture group,with statistically significant differences(P<0.05).CONCLUSIONS:Chaihu Shugan powder and Banxia Houpo decoction combined with Wuxing acupuncture in the treatment of patients with post-stroke anxiety and depression can reduce the immune inflammatory response and neurological and cognitive function damage,regulate HPG and HPT,improve anxiety and depression,relieve the disease,improve quality of life and clinical efficacy.
作者
王珊珊
薛秀娟
王文刚
相希
赵鑫
王亚静
陈爱霞
董文静
WANG Shanshan;XUE Xiujuan;WANG Wengang;XIANG Xi;ZHAO Xin;WANG Yajing;CHEN Aixia;DONG Wenjing(Dept.of Encephalopathy,Qinhuangdao Hospital of Traditional Chinese Medicine,Hebei Qinhuangdao 066000,China)
出处
《中国医院用药评价与分析》
2024年第3期303-307,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
河北省中医药管理局科研计划项目(No.2019526)
河北省秦皇岛市科学技术研究与发展计划项目(No.202301A067)。
关键词
柴胡疏肝散合半夏厚朴汤
五行针灸
脑卒中后焦虑抑郁
免疫炎症反应
下丘脑-垂体-性腺轴
下丘脑-垂体-甲状腺轴
Chaihu Shugan powder and Banxia Houpo decoction
Wuxing acupuncture
Post-stroke anxiety and depression
Immunoinflammatory response
Hypothalamic-pituitary-gonadal axis
Hypothalamic-pituitary-thyroid axis
