吴志敏 赵娜 胡万华

[摘要] 目的 基于脑-肠轴理论探讨解郁1号方联合大黄膏敷脐治疗脑卒中后抑郁（PSD）的临床效果及作用机制。方法 选取2016年12月至2017年12月我院神经内科住院患者100例随机单盲法分成两组，每组各50例。两组患者均进行常规西药及解郁1号方内服治疗，试验组加用大黄膏敷脐治疗。分别采用汉密尔顿抑郁量表（HAMD）、中国卒中量表（CSS）对两组PSD患者抑郁情况及神经功能情况进行评价，两组患者治疗前、治疗后2周、4周和第8周分别评价1次;治疗前、治疗后4周检测两组患者血清中5-HT、NE水平。 结果 试验组患者治疗的总有效率为91.11%，对照组为78.26%，组间比较差异有统计学意义（P<0.05）。治疗后4周和第8周隨访，试验组HAMD、CSS评分均低于对照组，差异均有统计学意义（P<0.05）。治疗后4周两组5-HT和NE水平均较治疗前明显提高，差异均有统计学意义（P<0.05），且试验组治疗后4周5-HT和NE水平均高于对照组，差异均有统计学意义（P<0.05）。结论 解郁1号方联合大黄膏敷脐治疗PSD的临床疗效显著，其机制可能与上调5-HT、NE的表达有关。

[关键词] 解郁1号方;大黄膏敷脐;脑-肠轴;脑卒中后抑郁

[Abstract] Objective To explore the clinical effect and mechanism of Jieyu No. 1 Recipe combined with umbilicus-applying Rheum Officinale Ointment in the treatment of post-stroke depression（PSD） based on the theory of brain-gut axis. Methods From December 2016 to December 2017， 100 inpatients in the department of neurology were randomly divided into two groups based on the single-blinded method， with 50 patients in each group. Both groups of patients were orally given conventional western medicine and Jieyu No. 1 Recipe. The experimental group was further given umbilicus-applying Rheum Officinale Ointment for treatment. The Hamilton Depression Scale（HAMD） and the Chinese Stroke Scale（CSS） were used to evaluate the depression and neurological impairment of PSD patients; two groups of patients were evaluated once before treatment， and at 2， 4 and 8 weeks after treatment; the levels of serum 5-hydroxytryptamine（5-HT） and norepinephrine （NE） in the patients were measured before treatment and 4 weeks after treatment. Results The total effective rate of treatment in the experimental group was 91.11%， and that in the control group was 78.26%. The difference was statistically significant（P<0.05）. According to the follow-up visits at 4 weeks and 8 weeks after treatment， the HAMD and CSS scores in the experimental group were lower than those in the control group， and the differences were statistically significant（P<0.05）. After 4 weeks of treatment， the expression levels of 5-HT and NE were significantly higher than those before treatment， and the differences were statistically significant （P<0.05）. The levels of 5-HT and NE in the experimental group after 4 weeks of treatment were higher than those in the control group， and the differences were statistically significant（P<0.05）. Conclusion Jieyu No. 1 Recipe combined with umbilicus-applying Rheum Officinale Ointment has a significant clinical effect on PSD， and its mechanism may be related to the up-regulation of 5-HT and NE expression.

[Key words] Jieyu No. 1 Recipe; Umbilicus-applying Rheum Officinale Ointment; Brain-gut axis; Post-stroke depression

卒中后抑郁（Post-stroke depression，PSD）是急性脑血管病发生后较常见的精神症状之一，以卒中后情绪低落、兴趣下降为特点的心境障碍，PSD与卒中不良预后密切相关，严重影响卒中患者的神经功能恢复，降低生活质量，延长住院时间及增加诊疗费用，甚至提升卒中的致残率及死亡率。在卒中发生后最初3个月内卒中后抑郁的患病率约为27.3%[1]。卒中后患者极易导致胃肠功能障碍，其中以结肠动力下降导致大便难解为最主要临床表现，卒中后便秘占整个卒中人群发生率的30%～60%[2]，卒中后1个月内的便秘发生率约为55%，与致残高度相关，中、重度卒中在发病3个月内便秘的存在强烈提示预后不良[3]。本研究从现代医学中PSD发生的机制出发，基于脑-肠轴之“脑病治肠”理论，观察中药解郁1号方联合大黄膏敷脐治疗PSD患者的客观临床疗效指标及评价其安全性，为PSD患者预防和治疗探索中西医结合新思路，现报道如下。……