健脾化痰方联合针刺治疗卒中后抑郁的疗效及对患者血清肾素-血管紧张素系统的影响

李智申; 王岱; 郭芮彤; 安静; 何曼曼

doi:10.16766/j.cnki.issn.1674-4152.004102

健脾化痰方联合针刺治疗卒中后抑郁的疗效及对患者血清肾素-血管紧张素系统的影响

doi: 10.16766/j.cnki.issn.1674-4152.004102

石家庄市中医院(石家庄市医院)脑病科，河北石家庄 050000

基金项目:

河北省中医药管理局课题 2021270

详细信息

通讯作者:
李智申，E-mail：15030193787@163.com

中图分类号: R245.31 R749.13
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出版历程
- 收稿日期: 2024-09-06
- 网络出版日期: 2025-10-25

The efficacy of Jianpi Huatan Formula combined with acupuncture in the treatment of post-stroke depression and its influence on serum renin-angiotensin system

Department of Encephalopathy, Shijiazhuang Hospital of Traditional Chinese Medicine (Shijiazhuang Hospital), Shijiazhuang, Hebei 050000, China

摘要

摘要: 目的探究健脾化痰方联合针刺治疗卒中后抑郁(PSD)的疗效，并从血清肾素-血管紧张素系统(RAS)方面分析其机制。方法选取石家庄市中医院2021年6月—2023年12月收治的150例PSD患者，按随机数字表法分为汤方组(健脾化痰方口服)、针刺组与联合组(健脾化痰方联合针刺治疗)，每组50例。比较3组治疗效果及治疗前后各项评分、血清神经递质[5-羟色胺(5-HT)、P物质(SP)、脑源性神经营养因子(BDNF)、视黄醇结合蛋白4(RBP4)]及RAS[肾素活性(PRA)、血管紧张素(Ang)Ⅱ、Ang 1-7]指标。结果 3组治疗总有效率比较差异有统计学意义[47例(94.0%) vs. 38例(76.0%) vs. 36例(72.0%)，χ²=8.806，P=0.012]。联合组治疗4周中医证候总积分、汉密尔顿抑郁量表(HAMD)-17、美国国立卫生研究院卒中量表(NIHSS)评分、血清SP、RBP4及血浆PRA、Ang Ⅱ水平均显著低于汤方组、针刺组(P＜0.05)，日常生活活动能力(ADL)评分、血清5-HT、BDNF、Ang 1-7水平均显著高于汤方组、针刺组(P＜0.05)，汤方组与针刺组各指标比较差异均无统计学意义(P＞0.05)。3组不良反应比较差异均无统计学意义(P＞0.05)。结论健脾化痰方联合针刺治疗PSD安全有效，RAS及神经递质调控为其可能作用机制。
- 卒中后抑郁 /
- 健脾化痰方 /
- 针刺 /
- 神经递质 /
- 肾素-血管紧张素系统
Abstract: Objective To investigate the curative effect of Jianpi Huatan Formula combined with acupuncture on post-stroke depression (PSD) and to analyze its mechanism from the aspect of serum renin-angiotensin system (RAS). Methods A total of 150 patients diagnosed with PSD were treated at Shijiazhuang Hospital of Traditional Chinese Medicine from June 2021 to December 2023. These patients methodically divided into three groups for the purpose of this study: a decoction group (n=50, Jianpi Huatan Formula oral), an acupuncture group (n=50) and a combined group (n=50, Jianpi Huatan Formula + acupuncture). The randomization method was employed to ensure the equitable distribution of subjects across the three groups. A comparison was made of the therapeutic effect, scores before and after treatment, and serum neurotransmitters [5-hydroxytryptamine (5-HT), substance P (SP), brain-derived neurotrophic factor (BDNF), retinol-binding protein 4 (RBP4)] and RAS [plasma renin activity (PRA), angiotensin (Ang) Ⅱ, Ang 1-7] were compared among the three groups. Results A statistically significant disparity was observed in the total effective rate among the three groups [47 cases (94.0%) vs. 38 cases (76.0%) vs. 36 cases (72.0%), χ²=8.806, P=0.012]. The total TCM syndrome score, Hamilton depression scale (HAMD) -17, National Institutes of Health stroke scale (NIHSS) score, serum SP, RBP4, plasma PRA and Ang Ⅱ levels were significantly lower in the combined group after four weeks of treatment than in the other two groups (P < 0.05), while activity of daily living (ADL) score, serum 5-HT, BDNF, Ang 1-7 levels were significantly higher (P < 0.05). No statistically significant difference was found in various indexes between the decoction group and the acupuncture group (P>0.05). The investigation revealed no statistically significant difference in adverse reactions among the three groups (P>0.05). Conclusion The combination of Jianpi Huatan Formula and acupuncture has been demonstrated to be both safe and effective in the treatment of PSD. The potential mechanisms underlying this efficacy include regulation of the RAS and neurotransmitters.
- Post-stroke depression /
- Jianpi Huatan Formula /
- Acupuncture /
- Neurotransmitter /
- Renin-angiotensin system

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表 1 3组PSD患者疗效比较[例(%)]

Table 1. Comparison of efficacy among three groups of PSD patients [case (%)]

组别	例数	临床痊愈	显效	有效	无效	总有效
联合组	50	15(30.0)	20(40.0)	12(24.0)	3(6.0)	47(94.0)^b
汤方组	50	10(20.0)	14(28.0)	14(28.0)	12(24.0)	38(76.0)
针刺组	50	9(18.0)	13(26.0)	14(28.0)	14(28.0)	36(72.0)
统计量		9.226^a				8.806^c
P值		0.010				0.012
注：^a为Z值，^c为χ²值。与汤方组和针刺组比较，^bP＜0.05。

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表 2 3组PSD患者治疗前后中医证候总积分、HAMD-17评分比较(x ± s，分)

Table 2. Comparison of total TCM syndrome scores and HAMD-17 scores among PSD patients in the three groups (x ± s, points)

组别	例数	中医证候总积分		HAMD-17评分
组别	例数	治疗前	治疗4周	治疗前	治疗4周
联合组	50	42.57±8.13	11.18±3.02^ab	22.00±2.08	13.10±2.57^ab
汤方组	50	43.00±7.65	20.50±4.26^a	22.03±2.14	16.45±3.49^a
针刺组	50	42.68±8.04	21.73±4.54^a	21.94±2.03	17.00±3.38^a
F值		0.040	104.105	0.024	23.002
P值		0.961	＜0.001	0.976	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同时间点汤方组和针刺组比较，^bP＜0.05。

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表 3 3组PSD患者治疗前后NIHSS评分、ADL评分比较(x ± s，分)

Table 3. Comparison of changes in NIHSS and ADL scores among PSD patients across three groups (x ± s, points)

组别	例数	NIHSS评分		ADL评分
组别	例数	治疗前	治疗4周	治疗前	治疗4周
联合组	50	12.20±2.04	4.35±1.00^ab	56.30±7.28	84.03±11.32^ab
汤方组	50	12.14±2.43	7.20±2.05^a	56.18±7.43	73.67±10.49^a
针刺组	50	12.16±2.27	7.63±2.16^a	56.22±7.34	74.10±11.06^a
F值		0.009	48.526	0.003	14.315
P值		0.991	＜0.001	0.997	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同时间点汤方组和针刺组比较，^bP＜0.05。

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表 4 3组PSD患者治疗前后血清神经递质相关指标比较(x ± s)

Table 4. Comparison of serum neurotransmitter related indexes among PSD patients in the three groups (x ± s)

组别	例数	5-HT(ng/mL)		SP(pg/mL)		BDNF(mg/L)		RBP4(g/L)
组别	例数	治疗前	治疗4周	治疗前	治疗4周	治疗前	治疗4周	治疗前	治疗4周
联合组	50	78.00±11.38	136.87±16.53^ab	82.14±7.39	48.76±6.02^ab	9.34±2.56	20.01±4.34^ab	41.12±8.67	28.20±5.62^ab
汤方组	50	77.93±10.25	115.14±13.43^a	81.95±7.26	60.13±6.34^a	9.28±2.64	14.23±3.50^a	40.75±9.16	35.03±5.34^a
针刺组	50	76.86±10.09	116.02±12.97^a	83.03±7.30	61.40±6.28^a	9.25±2.70	14.98±3.68^a	42.00±9.05	36.14±5.47^a
F值		0.182	36.749	0.310	62.830	0.015	34.158	0.257	31.026
P值		0.834	＜0.001	0.734	＜0.001	0.985	＜0.001	0.774	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同时间点汤方组和针刺组比较，^bP＜0.05。

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表 5 3组PSD患者治疗前后RAS相关指标比较(x ± s)

Table 5. Comparison of changes of RAS-related indicators among PSD patients in the three groups (x ± s)

组别	例数	PRA[ng/(mL·h)]		Ang Ⅱ(pg/L)		Ang 1-7(pg/L)
组别	例数	治疗前	治疗4周	治疗前	治疗4周	治疗前	治疗4周
联合组	50	1.05±0.34	0.73±0.22^ab	218.34±18.57	100.49±21.63^ab	273.83±16.17	394.00±18.76^ab
汤方组	50	1.08±0.30	0.84±0.26^a	219.07±18.63	132.38±20.12^a	273.54±16.30	334.63±19.02^a
针刺组	50	1.06±0.32	0.85±0.27^a	220.10±19.18	133.54±20.31^a	274.01±15.24	332.49±18.25^a
F值		0.114	4.128	0.111	40.952	0.011	175.026
P值		0.893	0.032	0.895	＜0.001	0.989	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同时间点汤方组和针刺组比较，^bP＜0.05。

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