摘要

目的 探讨柴胡达郁汤联合针灸醒脑开窍法治疗老年脑卒中后抑郁症(PSD)疗效及对神经功能、抑郁评分和血清脑肠肽、同型半胱氨酸(Hcy)及神经肽Y(NPY)水平的影响。

方法 选择118例老年PSD病人随机分为针灸组和针药结合组，每组59例，针灸组给予单纯醒脑开窍针刺法治疗，针药结合组在以上治疗基础上加予柴胡达郁汤治疗，治疗8周，观察两组治疗前后的中医症状积分变化和治疗8周的中医证候疗效，对比两组治疗前及治疗8周后的抑郁状态[汉密尔顿抑郁量表(HAMD)]、神经功能损伤程度[改良爱丁堡一斯堪的纳维亚卒中量表(MESSS)]、血清生化指标[五羟色胺(5-HT)、生长抑素(SS)、血管活性肠肽(VIP)及Hcy、NPY]水平。

结果 治疗8周后，两组关于抑郁善忧、静而少动、情绪不宁、失眠善忘、易烦善哭、表情淡漠共6项中医症状积分及总积分较治疗前显著降低(P<0.05)，针药结合组显著低于针灸组(P<0.05)；治疗8周后，针药结合组中医证候疗效显著高于针灸组(94.92% vs 81.36%，P<0.05)；两组不同时间点的HAMD-24评分、MESSS评分的时间点效应、组间效应及交互效应比较发现，均具有显著性差异(P<0.05)，其中两组在治疗2、4、8周后的上述评分均显著低于治疗前(P<0.05)，针药结合组显著低于针灸组(P<0.05)；治疗8周后，两组血清5-HT、SS、VIP、NPY水平较治疗前显著提高(P<0.05)，其中针药结合组显著高于针灸组(P<0.05)；两组血清Hcy水平较治疗前有显著性降低(P<0.05)，其中针药结合组显著低于针灸组(P<0.05)。

结论 柴胡达郁汤联合针灸醒脑开窍法治疗老年PSD疗效显著，能改善病人相关中医症状、抑郁状态和神经功能损伤，纠正其血清脑肠肽水平紊乱，抑制血清Hcy含量，增强血清NPY表达含量，从而发挥显著抗抑郁效果。 关键词：柴胡达郁汤；醒脑开窍针刺法；老年脑卒中后抑郁症患者；神经功能；抑郁状态；血清5-HT；血清Hcy；血清NPY

关键词：柴胡达郁汤；醒脑开窍针刺法；老年脑卒中后抑郁症患者；神经功能；抑郁状态；血清5-HT；血清Hcy；血清NPY

ABSTRACT

Objective To explore the efficacy of Chaihu Dayu decoction combined with Xingnao Kaiqiao method with acupuncture and moxibustion in the treatment of elderly post-stroke depression (PSD) and its influence on neurological function, depression score and levels of serum brain-gut peptide, homocysteine (Hcy) and neuropeptide Y(NPY).

Methods 118 patients with PSD were selected and randomly divided into acupuncture group and acupuncture-medication group, with 59 cases in each group. Acupuncture group was treated with Xingnao Kaiqiao method with acupuncture and moxibustion, and acupuncture-medication group was treated with Chaihu Dayu decoction on the basis of above treatment. After 8 weeks of treatment, the changes in TCM symptoms scores before and after treatment and efficacy of TCM syndromes after 8 weeks of treatment were observed in the two groups. The depression status [Hamilton Depression Scale (HAMD)], neurological impairment degree [Modified Edinburgh-Scandinavian Stroke Scale (MESSS)] and serum biochemical indicators [5-hydroxytryptamine (5-HT), somatostatin (SS), vasoactive intestinal peptide (VIP), Hcy, NPY] were compared between the two groups before treatment and after 8 weeks of treatment.

Results After 8 weeks of treatment, the scores of six items of TCM symptoms of depression and worry, quietness, restlessness, insomnia and forgetfulness, irritability and crying and indifferent expression and total score in the two groups were significantly decreased compared with those before treatment (P<0.05), and the scores in acupuncture-medication group were significantly lower than those in acupuncture group (P<0.05). After 8 weeks of treatment, the efficacy of TCM syndromes of depression in acupuncture-medication group was significantly higher than that in acupuncture group (94.92% vs 81.36%) (P<0.05). Comparisons of HAMD-24 score and MESSS score at different time points between the two groups showed significant differences from the aspects of time-point effect, between-group effect and interaction effect (P<0.05), and the above scores after 2, 4 and 8 weeks of treatment in both groups were significantly lower than those before treatment (P<0.05), and the scores in acupuncture-medication group were significantly lower compared with those in acupuncture group (P<0.05). The levels of serum 5-HT, SS, VIP and NPY in the two groups after 8 weeks of treatment were significantly enhanced compared with those before treatment (P<0.05), and the levels in acupuncture-medication group were significantly higher than those in acupuncture group (P<0.05). Serum Hcy level in the two groups was significantly reduced compared to before treatment (P<0.05), and serum Hcy level was significantly lower in acupuncture-medication group than that in acupuncture group (P<0.05).

Conclusion   Chaihu Dayu decoction combined with Xingnao Kaiqiao method with acupuncture and moxibustion has significant efficacy in the treatment of PSD. It can improve the TCM symptoms, depression and neurological impairment, correct the disorder of serum brain-gut peptide, inhibit the level of serum Hcy, and enhance the expression of serum NPY so as to play a significant antidepressant effect. Key words: Chaihu Dayu decoction; Xingnao Kaiqiao method with acupuncture and moxibustion; Post-stroke depression; Neurological function; Depressive status; Serum 5-HT; Serum Hcy; Serum NPY

Key words: Chaihu Dayu decoction; Xingnao Kaiqiao method with acupuncture and moxibustion; Post-stroke depression; Neurological function; Depressive status; Serum 5-HT; Serum Hcy; Serum NPY