*：青海大学附属医院中青年科研基金项目(ASRF-2011-04)

藏西药联合对卒中后抑郁的预防性研究*

王兰桂，赵秀丽**，黄茜，马丽萍，鄂维建，铁婷婷，张璟

(青海大学附属医院，西宁 810001)

摘要目的探讨藏药红景天和抗抑郁药盐酸帕罗西汀对卒中后抑郁(PSD)的预防作用及其可能机制。方法收集西宁地区脑卒中汉族患者，随机分为对照组、盐酸帕罗西汀组、联合用药组(盐酸帕罗西汀+红景天)，各40例，所有患者在治疗前，治疗30天、60天进行汉密尔顿抑郁量表评分(HAMD评分)、神经功能缺损程度评分(NIHSS评分)、日常生活能力量表评分(Barthel指数)，计算3组治疗30天、60天PSD发生率，同时检测所有患者在治疗前，治疗30天、60天血浆hs-CRP水平。并对上述结果行相关分析。结果1)联合用药组在治疗30天时PSD发生率低于对照组，差异具有统计学意义(P<0.05)，盐酸帕罗西汀组和联合用药组在治疗60天时PSD发生率低于对照组，差异具有统计学意义(P<0.05)，联合用药组在治疗30天和60天时PSD发生率低于盐酸帕罗西汀组，但差异无统计学意义(P>0.05)；2)联合用药组和盐酸帕罗西汀组治疗30天和60天时HAMD评分、NIHSS评分及Barthel指数低于对照组，同时联合用药组低于盐酸帕罗西汀组，差异具有统计学意义(P<0.05)；3)联合用药组和盐酸帕罗西汀组治疗30天和60天时血浆hs-CRP水平低于对照组，联合用药组低于盐酸帕罗西汀组，差异具有统计学意义(P<0.05)。结论藏药红景天和抗抑郁药盐酸帕罗西汀对西宁地区卒中后抑郁有一定预防作用，同时可改善卒中患者神经功能和生活质量，且联合应用效果更佳；预防作用可能机制之一：通过减轻炎症反应来实现。

关键词卒中后抑郁预防红景天盐酸帕罗西汀

通讯作者王兰桂(1971～)，女，汉族，青海籍，副主任医师.**：，教授，主任医师，E-mail：zhaoxl6@aliyun.com

中图分类号R743.3

文献标识码A

DOI：10.13452/j.cnki.jqmc.2015.03.009

AbstractObjectiveTo investigate the preventive effect and possible mechanism of combining traditional Tibetan medicine Salidroside with western medicine Paroxetine hydrochloride to treat patients with post-stroke depression(PSD).Methods 120 Han nationality patients with stroke were randomly divided into three groups：control，Paroxetine and combination group were selected from Qinghai university affiliated hospital.HAMD，NIHSS and ADL were scored and Nephelometry was used to determine the concentration of plasma hs-CRP in three groups before treatment and 30 and 60 days after treatment.PSD incidence of three groups were calculated after 30 and 60 days of treatment.Results 1)PSD incidence in combination group were lower than that in control group after 30 days of treatment.PSD incidence in Paroxetine and combination group were lower than that in control group after 60 days of treatment and they showed statistical differences(P<0.05).PSD incidence in combination group were lower than Paroxetine group after 30 and 60 days of treatment，but the differences had no statistical significance(P>0.05).2)HAMD scores，NIHSS scores and ADL scores in combination group and Paroxetine group were lower than those in control group after 30 and 60 days of treatment.HAMD scores，NIHSS scores and ADL scores in combination group were lower than those in Paroxetine group after 30 and 60 days of treatment，the differences had statistical significance(P<0.05).3)The plasma level of hs-CRP in combination group and Paroxetine group were lower than those in control group after 30 and 60 days of treatment；the plasma level of hs-CRP in combination group were lower than those in Paroxetine group after 30 and 60 days of treatment，the differences had statistical significance(P<0.05).Conclusions Traditional Tibetan medicine Salidroside and western medicine Paroxetine hydrochloride have preventive effect on patients with PSD in Xining area，and they may improve the neurological function and the quality of life，combination of both medicine is better，one of preventive mechanism may be related to reducing the inflammatory response.

KeywordsPost-stroke depressionPreventionSalidrosideParoxetine hydrochloride

收稿日期2015-01-06

PREVENTIVE RESEARCH ON COMBINATION OF TRADITIONAL

TIBETAN MEDICINE SALIDROSIDE WITH WESTERN MEDICINE

PAROXETINE HYDROCHLORIDE TO TREAT PATIENTS

WITH POST-STROKE DEPRESSION

Wang Langui，Zhao Xiuli**，Huang Qian，Ma Liping，E Weijian，Tie Tingting，Zhang Jing

(Department of Neurology，Qinghai University Affiliated Hospital， Xining， 810001，China.)

卒中后抑郁(post-stroke depression，PSD)患病率高，有研究结果显示，卒中患者最初1年内 PSD的累计发生率为41.8%[1]，而且PSD患者卒中再发和死亡的风险增加[2]，严重影响卒中后患者康复和预后。近年来，大量研究证明SSRI类药物包括盐酸帕罗西汀对PSD有肯定疗效[3-4]，而对PSD的预防性作用尚不明确，尤其是联合用药[5]。本研究拟观察藏药红景天和西药盐酸帕罗西汀对西宁地区PSD患者预防效果并行一般性安全评估，探讨可能机制。……