叶碧军 叶妲妮

[摘要] 目的 探讨舍曲林对缺血性脑卒中后抑郁症（PISD）患者下丘脑-垂体-肾上腺素轴及认知功能的影响。 方法 选择2015年1月～2016年2月就诊的PISD患者92例，随机分为观察组和对照组。两组均予以缺血性脑卒中常规对症治疗，观察组在此基础上加用舍曲林，对照组在此基础上加用阿米替林片，两组疗程均为8周。评估两组治疗前后HPA轴功能[血清促肾上腺皮质激素释放激素（CRH）、促肾上腺皮质激素（ACTH）及皮质醇（Cor）]水平的变化，并比较其神经、抑郁症状及认知功能的变化。 结果 治疗8周后，两组血清CRH、ACTH及Cor水平均较前下降（P<0.05或P<0.01），且观察组下降幅度更明显（P<0.05）；同时两组CSS及HAMD评分较前明显下降，而MMSE评分较前明显上升（P<0.05或P<0.01），且观察组变化更明显（P<0.05）。 结论 舍曲林治疗PISD患者的疗效肯定，安全性较佳，能更明显促进神经功能的恢复，改善抑郁症状，并能改善其认知功能，其作用机制与其能降低血清CRH、ACTH及Cor水平，纠正HPA轴功能紊乱密切相关。

[关键词] 缺血性脑卒中后抑郁症；舍曲林；下丘脑-垂体-肾上腺素轴；认知

[中图分类号] R749.4 [文献标识码] B [文章编号] 1673-9701（2018）25-0038-04

[Abstract] Objective To investigate the effects of sertraline on hypothalamic-pituitary-adrenergic axis and cognitive function in the patients with post-ischemic stroke depression（PISD）. Methods A total of 92 patients with PISD who were admitted from January 2015 to February 2016 were selected and randomly divided into observation group and control group. Both groups were given routine symptomatic treatment of ischemic stroke. The observation group was further given sertraline on this basis， and the control group was further given amitriptyline tablets on this basis. The duration of treatment in both groups was 8 weeks. The changes of the levels of HPA axis functions [serum corticotropin-releasing hormone （CRH）， adrenocorticotropic hormone （ACTH） and cortisol （Cor）] before and after treatment were evaluated， the changes in nerves， depressive symptoms， and cognitive function were compared in both groups. Results After 8 weeks of treatment， the serum levels of CRH， ACTH and Cor were decreased in both groups （P<0.05 or P<0.01）， and the observation group decreased more significantly（P<0.05）； at the same time， CSS and HAMD scores in the two groups were significantly lower than before treatment. The MMSE score was significantly higher than before treatment（P<0.05 or P<0.01）， and the observation group had more significant changes （P<0.05）. Conclusion Sertraline is effective and safe in the treatment of PISD patients， which can significantly promote the recovery of neurological function， improve depressive symptoms， and improve their cognitive function. Its mechanism of action is closely related to its ability to reduce serum CRH， ACTH and Cor levels， and to correct the HPA axis dysfunction.

[Key words] Post-ischemic stroke depression （PISD）； Sertraline； Hypothalamic-pituitary-adrenergic axis； Cognitive

缺血性腦卒中后抑郁症（post-ischemic stroke depression，PISD）是缺血性脑卒中后常见的情绪障碍，发生率约35%～55%，常伴有不同程度的认知功能受损，这不仅影响其神经和肢体运动，而且影响其日常生活[1]。近年来研究发现PISD伴认知功能障碍与下丘脑-垂体-肾上腺素（HPA）轴功能紊乱密切有关[2，3]。舍曲林是一种临床上常用的5-羟色胺（HT）再摄取剂，临床治疗PSD效果较好[4，5]。本研究观察了舍曲林对PISD患者HPA轴及认知功能的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取PISD患者92例，均为2015年1月～2016年2月我院神经科就诊病例。纳入标准：①符合《中国急性缺血性脑卒中诊治指南》制定诊断标准[6]，均经头颅CT或磁共振确诊；②均符合《中国精神障碍分类与诊断标准（第3版）》中抑郁症诊断标准[7]，且17项汉密尔顿抑郁量表（HAMD）总评分≥18分；③简易智力状况评估量表（MMSE）≤20分。……