乌灵胶囊联合西药治疗脑卒中抑郁患者临床疗效及对患者血清炎性反应因子和NPY的影响

谢燕 高志玉 王雪花 李小钧 王雪芹

摘要 目的：探討乌灵胶囊联合西药治疗脑卒中后抑郁患者临床疗效及对患者血清炎性反应因子和神经肽Y（NPY）的影响。方法：选取2014年12月至2016年12月北京大学国际医院收治的脑卒中后抑郁患者98例，按照随机表法分为观察组49例与对照组49例。对照组采用盐酸舍曲林治疗，观察组在对照组基础上结合乌灵胶囊治疗。2组疗程均为8周。比较2组治疗疗效，治疗前后HAMD评分、NIHSS评分、血清炎性反应因子和NPY水平变化，及不良反应情况。结果：观察组治疗总有效率（91.84%）高于对照组（73.47%）（P<0.05）。2组治疗后HAMD评分和NIHSS评分降低（观察组：t=31.1627、17.5090，对照组：t=24.2748、9.2482，P<0.05）;观察组治疗后HAMD评分和NIHSS评分低于对照组（t=10.2514、8.4123，P<0.05）。对照组治疗后血清IL-6、IL-8和TNF-α水平无明显变化（t=0.8293、0.8261、0.7223，P>0.05）;观察组治疗后血清IL-6、IL-8和TNF-α水平降低（t=9.8965、15.8601、13.7221，P<0.05）;观察组治疗后血清IL-6、IL-8和TNF-α水平低于对照组（t=8.4032、15.5007、13.2612，P<0.05）。对照组治疗后NPY水平无明显变化（t=0.7242，P>0.05）;观察组治疗后NPY水平增加（t=9.8646，P<0.05）;观察组治疗后NPY水平高于对照组（t=8.5904，P<0.05）。结论：乌灵胶囊联合西药治疗脑卒中后抑郁患者临床疗效明显，可降低炎性反应因子IL-6、IL-8和TNF-α水平，及提高NPY水平，且不良反应少，故而具有重要研究价值，值得进一步推广应用。

关键词 乌灵胶囊;西药;脑卒中后抑郁;疗效;白介素-6;白介素-8;肿瘤坏死因子-α;神经肽Y

Clinical Efficacy of Wuling Capsule Combined with Western Medicine in the Treatment

of Stroke Depression and Its Effects on Serum Inflammatory Factors and NPY

Xie Yan1， Gao Zhiyu2， Wang Xuehua3， Li Xiaojun1， Wang Xueqin4

（1 Department of Psychology and Behavioral Medicine， International Hospital， Peking University， Beijing 102206，

China; 2 Department of Neurology， International Hospital， Peking University， Beijing 102206， China;

3 Upenn-PKU Sleep Center， International Hospital， Peking University， Beijing 102206， China;

4 Ethics Office of No.6 Hospital of Peking University， Beijing 100191， China）

Abstract Objective：To investigate the clinical efficacy of Wuling capsule combined with western medicine in the treatment of post-stroke depression and the influence of serum inflammatory factors and neuropeptide Y （NPY） on the patients. Methods：A total of 9.8 patients with post-stroke depression treated in our hospital from December 2014 to December 2016 were randomly divided into an observation group （49 cases） and a control group （49 cases）. The control group was treated with sertraline hydrochloride， and the observation group was treated with Wuling Capsule on the basis of the control group. The two groups were treated for .8 weeks. The therapeutic effects of the two groups were compared before and after treatment， and HAMD score， NIHSS score， serum inflammatory factors and NPY levels， and adverse reactions were observed. Results：The total effective rate of the observation group （91.84%） was higher than that of the control group （73.47%） （P<0.05）. The HAMD score and NIHSS score decreased in two groups after treatment （observation group：t=31.1627， 17.5090， the control group：t=24.274.8， 9.24.82， P<0.05）; HAMD score and NIHSS score of the observation group were lower than the control group （t=10.2514， .8.4123， P<0.05） after treatment. No obvious change of serum IL-6， IL-.8 and TNF-α levels in control group were found （t=0.8293， 0.8261， 0.7223， P>0.05） after treatment; the serum IL-6， IL-.8 and TNF-α levels decreased after treatment in observation group （t=9.8965， 15.8601， 13.7221， P<0.05）; the serum IL-6， IL-.8 and TNF-α levels after treatment in the observation group were lower than in the control group （t=.8.4032， 15.5007， 13.2612， P<0.05）. The level of NPY in the control group did not change significantly after treatment （t=0.7242， P<0.05）; the level of NPY in the observation group increased （t=9.8646， P<0.05）; after treatment， the level of NPY in the observation group was higher than that in the control group （t=.8.5904， P<0.05）. Conclusion：The clinical efficacy of Wuling capsule combined with western medicine in the treatment of patients with depression after stroke is significant， which can reduce the inflammatory cytokines IL-6， IL-.8 and TNF-levels， and increase the level of NPY， with few adverse reactions， so it has important research value， and is worth popularizing.

Key Words Wuling capsule; Western medicine; Post stroke depression; Curative effect; Interleukin-6; Interleukins-.8; Tumor necrosis factor-α; Neuropeptide Y

中图分类号：R255.2文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.03.034

脑卒中是常见一种疾病，其发病率呈不断上升趋势，且脑卒中后伴多种后遗症，而抑郁是其中最常见的一种[1]。脑卒中后抑郁主要是指患者脑卒中后出现的以主观能动性缺乏、情绪低落、睡眠障碍及兴趣丧失等为主要特征的一类情感障碍[2-3]。近年来脑卒中后抑郁症发病率呈不断增加趋势，严重影响人们生命质量和生存治疗，且给社会和家庭带来经济和精神负担[4-6]。目前，西医治疗脑卒中后抑郁以抗抑郁药为主，但不良反应较为明显，患者不易耐受[7]。中药治疗脑卒中后抑郁具有疗效明显，不良反应小及易被患者接受等特点，已于临床开展运用[8-9]。本文研究旨在探讨乌灵胶囊联合西药治疗脑卒中后抑郁患者临床疗效及对患者血清炎性反应因子和神经肽Y（NPY）的影响。……