田静彬 李雨 李要军 冯倩 尹霞

【摘要】目的：觀察中西医结合治疗老年女性抑郁障碍的疗效，并分析治疗前后对甲状腺激素的影响。方法：57例患者随机分为对照组（舍曲林）28例、观察组（益肾温胆汤联合舍曲林）29例，分别于基线及治疗后第2、4、6、8周末检测血清甲状腺激素（血清甲状腺素T4、三碘甲状腺原氨酸T3、游离甲状腺素FT4、游离三碘甲状腺原氨酸FT3、促甲状腺激素TSH）水平变化情况，记录汉密尔顿抑郁量表（HAMD-24）评分。 结果：对照组在第4、6、8周HAMD量表评分总有效率显著低于观察组（P＜0.01）；对照组治疗后T3、T4、FT4水平不同程度低于观察组，而TSH水平显著高于观察组，组间差异有统计学意义（P＜0.05），相关分析提示HAMD评分与FT4、FT3呈负相关。结论：中西医结合治疗可有效改善老年女性抑郁状态，提高HAMD量表总有效率评分，对甲状腺功能有正向调节作用，疗效优于单纯应用舍曲林。

【关键词】老年抑郁；郁病；肝郁痰阻；甲状腺激素

【中图分类号】R592【文献标志码】 A【文章编号】1007-8517（2023）10-0115-04

Clinical Observation on 29 Cases of Senile Female Depressive Disorder Treated

by Integrated Traditional Chinese and Western MedicineTIAN JingBin1LI Yu2LI YaoJun1FENG Qian1YIN Xia1*

1.Beijing Changping Hospital of Integrated Chinese and Western Medicine ， Beijing 100208，China；

2.Beijing Changping Hospital， Beijing 102200，ChinaAbstract：Objective To observe the curative effect of integrated traditional Chinese and western medicine in the treatment of elderly women with depressive disorder， and analyze the influence on thyroid hormone before and after treatment.Methods Fifty-seven patients were randomly divided into two groups： the observ-ation group （29 cases with tonifying kidney and clearing gallbladder-heat decoction combined with sertraline） and the control group （28 cases with sertraline）. Serum thyroid hormone changes （Serum thyroid hormone T4， triiodothyronine T3， free thyroxine FT4， free triiodothyronine FT3， and Thyroid Stimulating Hormone （TSH）） were separately measured at baseline and the weekend of the 2nd， 4th， 6th and 8th week after treatment. To Record Hamilton Depression scale（HAMD-24） score.Results The total effective rate of HAMD score in the control group was significantly lower than that in the observation group at 4， 6 and 8 weeks （P<0.01）; After treatment， the levels of T3， T4 and FT4 in the control group were lower than those in the observation group， while the levels of TSH in the control group were significantly higher than those in the observation group， and the differences between the groups were statistically significant （P<0.05）; correlation analysis suggested that the HAMD score was negatively correlated with FT4 and FT3. Conclusion The combined treatment of traditional Chinese and western medicine can effectively improve the depression state of elderly women， improve the total effective rate score of HAMD scale， and have a positive regulating effect on thyroid function， which is better than the application of sertraline alone.

Keywords：Senile Depression；Liver Depression and Phlegm Obstruction；Thyroid Hormone

老年抑郁障碍是多發于老年人的情感精神障碍，表现为情绪障碍伴发多种躯体症状，具有一定隐匿性［1］。近年来随着人均寿命的增加及老年躯体疾病患病率的增长，老年抑郁患病率呈逐年上升趋势，成为威胁老年人身心健康和促发自杀行为的危险因素。早期识别和有效干预是众多研究者亟待解决的问题，研究［2］表明甲状腺功能异常与抑郁障碍之间存在一定相关性，同时多项研究［3］证实中医药诊疗手段在抑郁障碍的治疗中具有多靶点、多层次的优势。……