Abstract：Objective To explore the clinical efficacy of Modified Huanglian Wendan Decoction in treating post-stroke depression (PSD) and its effect on the changes of brain neurometabolites in patients. Methods A total of 96 patients with PSD admitted to Tangshan Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were selected and randomly divided into the observation group and the control group according to random number table method, 48 cases in each group. The control group was treated with Sertraline Hydrochloride Tablets orally, and the observation group was added with Modified Huanglian Wendan Decoction on the basis of the control group. All patients were treated for 8 weeks. The clinical efficacy of the two groups was compared. The depression symptoms [17 Hamilton depression scale (HAMD), Zung self-rating depression scale (SDS)], cognitive function [minimum mental state examination (MMSE)], the quality of sleep [Pittsburgh sleep quality index (PSQI)], daily living ability[improved Barthel index (MBI)] in the two groups were evaluated once before and after treatment. At the same time, the levels of brain neurometabolism indexs [norepinephrine (NE), dopamine (DA), the ratio of 5-hydroxytryptophan (5-HT) to 5-hydroxyindoleacetic acid (5-HIAA) (5-HT/5-HIAA ratio), and the ratio of 3,4-dihydroxyphenylacetic acid (DOPAC) to high vanillic acid (HVA) (DOPAC/HVA ratio)] were measured. Results The total effective rate of the observation group was significantly higher than that of the control group (P ＜ 0.05). Compared with before treatment, the scores of HAMD, SDS and PSQI were significantly lower, while the scores of MMSE and MBI were significantly increased (all P ＜ 0.05). Compared with the control group, the improvement was more obvious in the observation group (P ＜ 0.05). The concentrations of serum NE, DA and the ratios of 5-HT/5-HIAA and DOPAC/HVA were significantly higher in the two groups after treatment (all P ＜ 0.05). Compared with the control group, the improvement was more obvious in the observation group ( P ＜ 0.05). Conclusion The overall efficacy of Modified Huanglian Wendan Decoction in treating PSD is effective, which is helpful to relieve depressive symptoms, improve cognitive function and sleep quality of patients, which may be related to the significant positive regulation of the expression level of relevant cerebral nerve metabolites by this clinical experience prescription.
王雅娟 刘玉洁 段红莉 张娟. 黄连温胆汤加味治疗卒中后抑郁症的效果及对脑神经代谢物表达水平的影响[J]. 中国医药导报, 2019, 16(32): 75-78,94.
WANG Yajuan LIU Yujie DUAN Hongli ZHANG Juan. Effect of Modified Huanglian Wendan Decoction on post-stroke depression and its influence on the expression level of neurometabolites in brain. 中国医药导报, 2019, 16(32): 75-78,94.
[1] Wei C，Gao J，Chen L，et al. Factors associated with post-stroke depression and emotional incontinence： lesion location and coping styles [J]. Int J Neurosci，2016，126（7）：623-629.
[2] 郑君芙.黄连温胆汤临床应用研究进展[J].湖南中医杂志，2017，33（6）：210-213.
[3] 王少石，周新雨，朱春燕.卒中后抑郁临床实践的中国专家共识[J].中国卒中杂志，2016，11（8）：685-693.
[4] 周仲瑛.中医内科学[M].北京：中国中医药出版社，2003：392-400.
[5] 江开达.抑郁障碍防治指南[M].北京：北京大学医学出版社，2007：17-20.
[6] Bobo WV，Angleró GC，Jenkins G，et al. Validation of the 17-item Hamilton Depression Rating Scale definition of response for adults with major depressive disorder using equipercentile linking to Clinical Global Impression scale ratings：analysis of Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study（PGRN-AMPS）data [J]. Hum Psychopharmacol，2016，31（3）：185-192.
[7] Zung WW，Richards CB，Short MJ. Self-rating depression scale in an outpatient clinic. Further validation of the SDS [J]. Arch Gen Psychiatry，1965，13（6）：508-515.
[8] Fu C，Jin X，Chen B，et al. Comparison of the Mini-Mental State Examination and Montreal Cognitive Assessment executive subtests in detecting post-stroke cognitive impairment [J]. Geriatr Gerontol Int，2017，17（12）：2329-2335.
[9] Oliveira GDP，Vago ERL，Prado GFD，et al. The critical influence of nocturnal breathing complaints on the quality of sleep after stroke： the Pittsburgh Sleep Quality Index and STOP-BANG [J]. Arq Neuropsiquiatr，2017，75（11）：785-788.
[10] Ohura T，Hase K，Nakajima Y，et al. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients [J]. BMC Med Res Methodol，2017，17（1）：131.
[11] 刘斌.卒中后抑郁的中医研究进展[J].中西医结合心脑血管病杂志，2016，14（23）：2779-2782.
[12] 林宏.氟西汀联合行为认知疗法对脑卒中后抑郁症患者总体康复的影响[J].当代医学，2017，23（2）：115-116.
[13] 徐丽丽，王云甫，王娜，等.丙戊酸镁缓释片联合帕罗西汀治疗卒中后抑郁的临床效果[J].中国医药，2017，12（5）：746-749.
[14] 程英.文拉法辛缓释片对老年卒中后抑郁症的疗效[J].当代医学，2018，24（11）：140-141.
[15] 李雨庭，范琳琳，袁茵，等.黄连温胆汤药理作用及临床应用研究进展[J].中医药学报，2018，46（2）：115-119.
[16] 张丽萍，武丽，张曼，等.加味温胆汤对抑郁模型大鼠海马神经细胞内钙离子浓度的影响[J].中国实验方剂学杂志，2013，19（1）：188-191.
[17] Wang L，Tao Y，Chen Y，et al. Association of post stroke depression with social factors，insomnia，and neurological status in Chinese elderly population [J]. Neurol Sci，2016， 37（8）：1305-1310.
[18] 刘得水，李丽波，荣华，等.艾司西酞普兰联合黛力新治疗卒中后抑郁患者临床疗效分析[J].中国医药科学，2018，8（20）：7-10.
[19] 张熠，童卫杭，胡霜霜，等.健脾益气方联合氟哌噻吨美利曲辛片治疗卒中后抑郁症的效果观察[J].中国医药，2019，14（6）：879-883.
[20] 叶碧军，叶妲妮.舍曲林对缺血性脑卒中后抑郁症患者下丘脑-垂体-肾上腺素轴及认知功能的影响[J].中国现代医生，2018，56（25）：38-41.
[21] Zhang FY，Li JJ，Zhou Y，et al. [Review for sedative and hypnotic mechanism of sedative traditional Chinese medicine and relative active components on neurotransmitters] [J]. Zhongguo Zhong Yao Za Zhi，2016，41（23）：4320-4327.
2019, Vol. 16 
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