2022 年第 1 期 第 17 卷

加味柴胡桂枝汤联合草酸艾司西酞普兰对脑卒中后抑郁的疗效及对血清视黄醇结合蛋白4和P物质表达的影响

Curative effect of modified Chaihuguizhi decoction combined with escitalopram oxalate on post-stroke depression and its influence on serum retinol binding protein 4 and substance P expressions

作者：范穗强1孟春想2张凯娜3张柏芳4金英花5王叶青6

英文作者：Fan Suiqiang1 Meng Chunxiang2 Zhang Kaina3 Zhang Baifang4 Jin Yinghua5 Wang Yeqing6

单位：1广东药科大学附属第一医院中西医结合代谢病科，广州510080；2广东燕岭医院康复医学科，广州510517；3广东药科大学附属第一医院病案统计科，广州510080；4广东药科大学附属第一医院心理科，广州510080；5广东药科大学附属第一医院名中医工作室，广州510080；6广东药科大学附属第一医院中医科，广州510080

英文单位：1Department of Metabolic Diseases of Integrated Chinese and Western Medicine the First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou 510080 China; 2Department of Rehabilitation Medicine Guangdong Yanling Hospital Guangzhou 510517 China; 3Department of Medical Record Statistics the First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou 510080 China; 4Department of Psychology the First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou 510080 China; 5Traditional Chinese Medicine Studio the First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou 510080 China; 6Department of Traditional Chinese Medicine the First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou 510080 China

关键词：

英文关键词：Post-strokedepression;ModifiedChaihuguizhidecoction;Escitalopramoxalate;Retinolbindingprotein4;SubstanceP

• 摘要：

• 目的 探讨加味柴胡桂枝汤联合草酸艾司西酞普兰对脑卒中后抑郁（PSD）的疗效及对血清视黄醇结合蛋白4（RBP4）及P物质表达的影响。方法 选取广东药科大学附属第一医院2018年8月至2021年4月收治的PSD患者80例，应用随机数字表法分为对照组和观察组，各40例。对照组在脑血管病常规治疗基础上联合草酸艾司西酞普兰治疗,观察组在对照组的治疗基础上联合加味柴胡桂枝汤颗粒剂治疗，2组均治疗6周。比较2组治疗前后抑郁、焦虑、神经功能缺损、日常生活能力评分，血清炎症因子和单胺类神经递质水平，以及临床疗效和不良反应发生情况。结果 治疗前，2组汉密尔顿抑郁量表（HAMD）评分、抑郁自评量表(SDS)评分、Barthel指数、汉密尔顿焦虑量表(HAMA)评分、美国国立卫生研究院卒中量表（NIHSS）评分以及血清白细胞介素6（IL-6）、IL-18和肿瘤坏死因子α水平比较差异均无统计学意义（均P>0.05）；治疗后，2组患者HAMD评分、SDS评分、HAMA评分、NIHSS评分以及血清IL-6、IL-18 和TNF-α水平均显著降低，Barthel指数均显著增加，且观察组降低或增加幅度均高于对照组（均P<0.05）。治疗前，2组血清P物质和RBP4水平比较差异均无统计学意义（均P>0.05）；治疗后，2组血清P物质和RBP4水平均较治疗前降低，且观察组均低于对照组［(46±5)ng/L比（51±6）ng/L，（29±5）g/L比（37±4）g/L］（均P<0.05）。治疗6周后，观察组总有效率高于对照组［92.5%(37/40)比75.0%(30/40)］（P=0.034），但2组治疗期间不良反应发生率比较差异无统计学意义（P＞0.05）。结论  加味柴胡桂枝汤联合草酸艾司西酞普兰治疗PSD效果显著，可显著改善患者抑郁状态和日常生活能力，降低血清RBP4和P物质水平，且具有较高的安全性。

• Objective   To investigate the curative effect of modified Chaihuguizhi decoction combined with escitalopram oxalate on post-stroke depression (PSD) and its influence on serum retinol binding protein 4 (RBP4) and substance P expressions. Methods  From August 2018 to April 2021, 80 patients with PSD admitted to the First Affiliated Hospital of Guangdong Pharmaceutical University were enrolled. They were randomly divided into control group and observation group, with 40 cases in each group. The control group was treated with escitalopram oxalate on the basis of routine treatment of cerebrovascular diseases, and the observation group was treated with modified Chaihuguizhi decoction granules on the basis of the control group. Both groups were treated for 6 weeks. The scores of depression, anxiety, neurological deficit, ability of daily living, serum levels of inflammatory factors, monoamine neurotransmitters, clinical efficacy and adverse reactions were compared between the two groups before and after treatment. Results  Before treatment, there were no significant differences in scores of Hamilton Depression Scale(HAMD) score, self-rating depression scale (SDS) score, Barthel index, Hamilton Anxiety Scale (HAMA) score, National Institutes of Health Stroke Scale(NIHSS) score, and serum levels of interleukin-6(IL-6), IL-18, tumor necrosis factor-α（TNF-α）between the two groups (all P>0.05); after treatment, HAMD score, SDS score, HAMA score, NIHSS score and serum levels of IL-6, IL-18 and TNF-α in the two groups decreased significantly， Barthel index increased significantly, and the decrease or increase in the observation group was higher than those in the control group (all P＜0.05). Before treatment, there were no significant differences in serum levels of substance P and RBP4 between the two groups (both P>0.05). After treatment, serum levels of substance P and RBP4 in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group ［(46±5)ng/L vs (51±6)ng/L, (29±5)g/L vs (37±4)g/L］(all P<0.05). After 6 weeks of treatment, the total effective rate in the observation group was higher than that in the control group ［92.5%(37/40) vs 75.0%(30/40)］(P=0.034), but there was no significant difference in the incidence of adverse reactions between the two groups during treatment (P>0.05). Conclusions  Modified Chaihuguizhi decoction combined with escitalopram oxalate has a significant effect on the treatment of PSD, which can significantly improve patients′ depression and ability of daily living, and reduce serum levels of RBP4 and substance P.