目的 观察开心解郁方治疗血管性抑郁症(VD)的临床效果,初步揭示其作用机制.方法 自2012年3月～2014年2月完成观察中国中医科学院广安门医院门诊60例VD患者,采用实用性随机对照,按3∶2比例入组,分为治疗组(35例)和对照组(25例),治疗组服用中药开心解郁方,对照组服用氢溴酸西酞普兰片.两组患者分别于治疗前和治疗后2、4、8周记录汉密尔顿抑郁量表(HAMD)、中医症状积分表观察疗效,治疗前后进行血清5-羟色胺(5-HT)、脑源性神经营养因子(BDNF)浓度检测及血、尿常规、肝肾功能检查.结果 两组患者治疗2、4、8周后HAMD量表评分均较治疗前显著降低(均P＜0.01),两组治疗后组间比较差异无统计学意义(P＞0.05).两组抑郁疗效比较,治疗组总有效率为88.57％,对照组总有效率为88.00％,差异无统计学意义(P＞0.05).两组治疗2、4、8周后中医症状积分均较治疗前显著降低(均P＜ 0.01),两组治疗2、4周后中医症状积分比较差异均无统计学意义(P＞0.05),但治疗8周后治疗组明显低于对照组(P＜0.01).从中医症状综合疗效来看,治疗组总有效率为85.71％,对照组总有效率为64.00％,差异无统计学意义(P＞0.05).治疗组在改善不思饮食、善太息、乏力、失眠等症状方面较对照组更具优势(P＜0.05).两组治疗后5-HT、BDNF均较治疗前明显升高(P＜0.01),但两组治疗后组间比较差异无统计学意义(P＞ 0.05).结论 开心解郁方具有较好的抗抑郁作用,疗效与氢溴酸西酞普兰相当,而在缓解中医症状方面更具优势,可能与促进5-HT、BDNF的合成或释放有关.%Objective To observe the clinical effects of Kaixin Jieyu Decoction in the treatment of vascular depression and to explore its mechanism preliminarily.Methods Sixty patients with vascular depression in Outpatient Department of Guang'anmen Hospital,China Academy of Chinese Medical Sciences finished the observation from March 2012 to February 2014,they were divided into the treatment group (35 cases) and the control group (25 cases) by practical randomized control and proportion of 3:2.The treatment group was treated with Kaixin Jieyu Decoction,and the control group was treated with Citalopram Hydrobromide Tablets.The scores of Hamilton depression scale (HAMD) and TCM symptom scores in the two groups were recorded before treatment and after treatment for 2,4,8 weeks.The concentrations of serum 5-hydroxytryptamine (5-HT),brain-derived neurotrophic factor (BDNF) and routine blood and urine test,hepatic and renal function were tested before and after treatment.Results After treatment for 2,4,8 weeks,the scores of HAMD scale in the two groups were all significantly lower than those before treatment (all P ＜ 0.01),while there were no significant differences between the two groups after treatment (P ＞ 0.05).The results of depression efficacy showed that the total effective rate of the treatment group was 88.57％,which of control group was 88.00％,there was no significant difference between the two groups (P ＞ 0.05).After treatment for 2,4,8 weeks,the scores of TCM symptoms in the two groups were all significantly lower than those before treatment (all P ＜ 0.01),there were no significant differences between the two groups after treatment for 2,4 weeks (P ＞ 0.05),but the score of TCM symptoms in the treatment group after treatment for 8 weeks was significantly lower than that of control group (P ＜ 0.01).The comprehensive curative effect of TCM symptoms showed that the total effective rate in the treatment group was 85.71％,which of the control group was 64.00％,there was no significant difference between the two groups (P ＞ 0.05).The treatment group had more advantages in improving poor appetite,preference for sighing,lacking in strength,insomnia than control group (P ＜ 0.05).After treatment,the concentration of 5-HT and BDNF in the two groups were significantly higher than those before treatment (P ＜ 0.01),while there were no significant differences between the two groups after treatment (P ＞ 0.05).Conclusion Kaixin Jieyu Decoction has good anti-depression effects,which is comparable to Citalopram Hydrobromide,while it has more advantages in improving TCM symptoms,whilch may be related to promoting the synthesis or release of 5-HT,BDNF.
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