健脾疏肝汤结合氟西汀治疗卒中后抑郁(肝郁脾虚证)的疗效及对血清5-HT、NSE、BDNF的影响

吴旭杰 赵娜 朱政羽

[摘要] 目的 探讨健脾疏肝汤结合氟西汀治疗卒中后抑郁（PSD）的临床价值。 方法 以随机数字表法将2016年10月至2018年10月收治的60例PSD（肝郁脾虚证）患者分为对照组30例，观察组30例，对照组给予氟西汀治疗，观察组在对照组基础上，加用健脾疏肝汤治疗，观察两组治疗前、治疗8周后抑郁程度、生活活动能力、神经功能及血清5-羟色胺（5-HT）、神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）水平变化，并记录不良反应发生情况。 结果 治疗前，两组汉密尔顿抑郁量表（HAMD）、Barthel指数（BI）评分比较，差异无统计学意义（P>0.05），治疗8周后，观察组HAMD评分与同期对照组比较，明显较低，BI评分与同期对照组比较，明显较高，差异有统计学意义（P<0.05）;治疗前，两组美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）评分比较，差异无统计学意义（P>0.05），治疗8周后，观察组上述评分与同期对照组比较，明显较低，差异有统计学意义（P<0.05）;治疗前，两组血清5-HT、NSE、BDNF水平比较，差异无统计学意义（P>0.05），治疗8周后，观察组上述指标情况与同期对照组比较，明显较好，差异有统计学意义（P<0.05）;观察组不良反应总发生率为13.33%，与对照组6.67%比较，差异无统计学意义（P>0.05）。 结论 健脾疏肝汤结合氟西汀治疗肝郁脾虚型PSD，可有效減轻患者抑郁症状，改善患者神经功能，提高患者生活活动能力，并能调节血清5-HT、NSE、BDNF水平，且安全性高，值得推广。

[关键词] 卒中后抑郁;氟西汀;健脾疏肝汤;神经递质;神经营养因子

[中图分类号] R277.79          [文献标识码] A          [文章编号] 1673-9701（2021）30-0013-05

[Abstract] Objective To explore the clinical value of Jianpi Shugan Decoction combined with fluoxetine in the treatment of post-stroke depression （PSD）. Methods A total of 60 patients with PSD （liver stagnation and spleen deficiency syndrome） admitted to our hospital from October 2016 to October 2018 were divided into the control group and the observation group using random number table method， with 30 patients in each group. The control group were treated with fluoxetine， while the observation group were treated with Jianpi Shugan Decoction combined with fluoxetine. The depression degree， life activity ability， nerve function， and changes in levels of serum 5-hydroxytryptamine （5-HT）， neuron-specific enolase （NSE） and brain-derived neurotrophic factor （BDNF） were observed before and after 8 weeks of treatment in the two groups， and the incidences of adverse events were recorded. Results Before treatment， there were no significant differences in the scores of Hamilton Depression Scale （HAMD） and Barthel Index （BI） between the two groups（P>0.05）. After 8 weeks of treatment， the HAMD score of the observation group were significantly lower than that of the control group during the same period， and the BI score was significantly higher than that of the control group during the same period，the difference was statistically significant （P<0.05）. Before treatment， there were no significant differences in the scores of National Institutes of Health Stroke Scale （NIHSS） and Modified Rankin Scale （mRS） between the two groups （P>0.05）. After 8 weeks of treatment， the above two scores of the observation group were significantly lower than those of the control group during the same period， the difference was statistically significant （P<0.05）. Before treatment， there were no significant differences in the levels of serum 5-HT， NSE and BDNF between the two groups （P>0.05）. After 8 weeks of treatment， the above three indicators in the observation group were significantly better than those in the control group during the same period ，the difference was statistically significant （P<0.05）. The total incidence of adverse events in the observation group was 13.33%， and that in the control group was 6.67%， without significant difference（P>0.05）. Conclusion Jianpi Shugan Decoction combined with fluoxetine can effectively relieve the symptoms of depression， improve the neurological function， and strengthen the life activity ability of the patients with PSD （liver stagnation and spleen deficiency syndrome）， and also regulate the levels of serum 5-HT， NSE and BDNF， with high safety. It is worthy of promotion.

[Key words] Post-stroke depression; Fluoxetine; Jianpi Shugan Decoction; Neurotransmitter; Neurotrophic factor

卒中后抑郁（Post stroke depression，PSD）是临床较为常见的情感障碍综合征，患者以兴趣下降、情绪低落、思维迟钝为主要表现，部分患者可出现躯体症状，有数据显示，卒中患者5年内PSD发生率达31%[1]。……