通腑解郁方治疗痰热扰神型卒中后抑郁临床研究

Clinical Study on Tongfu Jieyu Prescription for Post-Stroke Depression with Phlegm- Heat Disturbing the Spirit Type

摘要:

目的：观察通腑解郁方辅助治疗痰热扰神型卒中后抑郁（PSD） 的临床疗效。方法：选择2024年1—9月浙江中医药大学附属温州市中医院收治的106例痰热扰神型PSD患者，按随机数字表法分为中医组和西医组各53例。西医组给予盐酸氟西汀胶囊口服，中医组给予通腑解郁方治疗。治疗8周后，比较2组临床疗效和不良反应发生率，以及治疗前后抑郁评分［汉密尔顿抑郁量表（HAMD） 和抑郁自评量表（SDS）］、中医证候评分、匹兹堡睡眠质量指数（PSQI） 评分、神经递质［5 羟色胺（5-HT）、去甲肾上腺素（NE）、多巴胺（DA）］ 水平。结果：治疗后，中医组总有效率为84.91%（45/53），对照组为79.25%（42/53），2组比较，差异无统计学意义（P＞0.05）。治疗后，2组HAMD评分、SDS评分均较治疗前降低（P＜0.05），2组HAMD评分、SDS评分比较，差异无统计学意义（P＞0.05）。治疗后，2组中医证候主、次症评分及总分均较治疗前降低（P＜0.05），且中医组2 项评分及总分均低于西医组（P＜0.05）。治疗后，2 组PSQI 评分均较治疗前降低（P＜0.05）， 且中医组评分低于西医组（P＜0.05）。治疗后， 2 组5-HT、NE、DA 水平均较治疗前升高（P＜0.05），且中医组NE、DA 水平均高于西医组（P＜0.05）；2 组5-HT 水平比较，差异无统计学意义（P＞0.05）。治疗期间，中医组不良反应发生率为3.77%（2/53），西医组为20.75%（11/53），组间比较，差异有统计学意义（P＜0.05）。结论：通腑解郁方治疗痰热扰神型PSD可调节血清神经递质水平，减轻患者抑郁症状，进一步改善中医证候和睡眠质量，提高临床疗效，且不良反应相对较少。

Abstract:

Abstract：Objective：To observe the clinical efficacy of Tongfu Jieyu Prescription as adjuvant therapy for poststroke depression （PSD） of phlegm-heat disturbing the spirit type. Methods：A total of 106 PSD patients of phlegmheat disturbing the spirit type treated at Wenzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University from January to September 2024 were randomly divided into a traditional Chinese medicine group （n=53， treated with Tongfu Jieyu Prescription） and a western medicine group （n=53， treated with Fluoxetine Hydrochloride Tablets）. After eight weeks of treatment， clinical efficacy， incidence of adverse reactions， as well as depression scores [Hamilton Depression Scale （HAMD） and Self-Rating Depression Scale （SDS）]， traditional Chinese medicine syndrome scores， Pittsburgh Sleep Quality Index （PSQI） scores， and neurotransmitter levels [5- hydroxytryptamine （5-HT）， norepinephrine （NE）， dopamine （DA）] before and after treatment were compared between the two groups. Results： After treatment， the total effective rate was 84.91% （45/53） in the traditional Chinese medicine group and 79.25% （42/53） in the western medicine group，with no significant difference （P＞0.05）. HAMD and SDS scores decreased in both groups（ P＜0.05），with no significant difference between the two groups（ P＞ 0.05）. The traditional Chinese medicine syndrome scores （primary symptoms，secondary symptoms，and total scores） decreased in both groups （P＜0.05）， with lower scores in the traditional Chinese medicine group （P＜0.05）. PSQI scores decreased in both groups （P＜0.05）， with lower scores in the traditional Chinese medicine group （P＜0.05）. Levels of 5-HT，NE，and DA increased in both groups （P＜0.05），with higher NE and DA levels in the traditional Chinese medicine group （P＜0.05）； no significant difference was found in 5-HT levels between groups （P＞0.05）. During treatment，the incidence of adverse reactions was 3.77% （2/53） in the traditional Chinese medicine group and 20.75% （11/53） in the western medicine group， showing a significant difference （P＜0.05）. Conclusion： Tongfu Jieyu Prescription can regulate serum neurotransmitter levels， alleviate depressive symptoms， improve traditional Chinese medicine syndrome manifestations and sleep quality，and enhance clinical efficacy in PSD patients of phlegmheat disturbing the spirit type，and has relatively fewer adverse reactions.