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赵伟东, 赵娜, 窦荣花, 王爱卿, 张万辉.加味柴胡疏肝方联合宁静贴片穴位贴敷治疗脑梗死后睡眠障碍-抑郁的效果[J].湖南中医药大学学报,2025,45(2):280-287[点击复制] |
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| 加味柴胡疏肝方联合宁静贴片穴位贴敷治疗脑梗死后睡眠障碍-抑郁的效果 |
| 赵伟东,赵娜,窦荣花,王爱卿,张万辉 |
| (河北省沧州中西医结合医院脑病科, 河北 沧州 061000) |
| 摘要: |
| 目的 探讨加味柴胡疏肝方联合宁静贴片穴位贴敷治疗脑梗死后睡眠障碍与抑郁共病的临床疗效，并分析其对神经递质、炎症因子、下丘脑-垂体-肾上腺（HPA）轴的影响。方法 选取2021年9月至2023年10月河北省沧州中西医结合医院收治的150例脑梗死后睡眠障碍与抑郁共病患者进行单盲试验设计，按照随机数字表法分为3组，每组50例。3组均给予常规对症治疗，在此基础上外敷组予以穴位贴敷，内服组予以加味柴胡疏肝方内服，联合组予以加味柴胡疏肝方联合穴位贴敷，疗程均为2周。观察3组临床疗效、不良反应及治疗前后睡眠状况、睡眠质量、抑郁焦虑状态。观察3组治疗前后中医证候积分、神经递质[脑源性神经营养因子（BDNF）、5-羟色胺（5-HT）、多巴胺（DA）]、炎症因子[超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1、IL-6]及HPA轴关键因子[皮质醇（CORT）、去甲肾上腺素（NE）]。结果 联合组总有效率高于内服组和外敷组（P<0.05），内服组总有效率高于外敷组（P<0.05）；联合组治疗1周、2周后SRSS评分、PSQI评分、HAMA评分、HAMD评分、中医证候积分均低于内服组及外敷组（P<0.05），且内服组低于外敷组（P<0.05）；联合组治疗后BDNF、5-HT、DA水平高于内服组及外敷组（P<0.05），且内服组高于外敷组（P<0.05）；联合组治疗后hs-CRP、TNF-α、IL-1、IL-6水平低于内服组及外敷组（P<0.05），且内服组低于外敷组（P<0.05）；联合组治疗后CORT水平低于内服组（P<0.05），NE水平高于内服组（P<0.05）；3组不良反应比较，差异无统计学意义（P＞0.05）。结论 加味柴胡疏肝方联合穴位贴敷治疗脑梗死后睡眠障碍与抑郁共病的疗效确切，可改善抑郁、睡眠状态，促进神经递质恢复，缓解炎症反应，抑制HPA轴过度活化，且具有一定安全性。 |
| 关键词: 脑梗死 睡眠障碍 抑郁 加味柴胡疏肝方 穴位贴敷 下丘脑-垂体-肾上腺轴 神经递质 炎症因子 |
| DOI：10.3969/j.issn.1674-070X.2025.02.012 |
| 投稿时间：2024-08-01 |
| 基金项目:河北省中医药管理局中医药类科研计划课题（2022599）。 |
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| Effects of modified Chaihu Shugan Formula combined with acupoint application of Ningjing Patch on sleep disorders and depression after cerebral infarction |
| ZHAO Weidong, ZHAO Na, DOU Ronghua, WANG Aiqing, ZHANG Wanhui |
| (Encephalopathy Department, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei 061000, China) |
| Abstract: |
| Objective To explore the clinical efficacy of the modified Chaihu Shugan Formula (CHSGF) combined with acupoint application of Ningjing Patch in treating comorbid sleep disorders and depression after cerebral infarction, and to analyze its effects on neurotransmitters, inflammatory factors, and the hypothalamic-pituitary-adrenal (HPA) axis. Methods A single-blind trial design was conducted among 150 patients with comorbid sleep disorders and depression after cerebral infarction admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province from September 2021 to October 2023. They were divided into three groups using the random number table method, with 50 patients in each group. All three groups received conventional symptomatic treatment. On this basis, the external application group was given acupoint application, the oral administration group received the modified CHSGF orally, and the combination group was given both the modified CHSGF and acupoint application. The course of treatment for all groups was two weeks. The clinical efficacy, adverse reactions, and sleep status, sleep quality, and depression and anxiety states before and after treatment were observed in the three groups. The Chinese medicine (CM) pattern scores and levels of neurotransmitters [brain-derived neurotrophic factor (BDNF), 5-hydroxytryptamine (5-HT), dopamine (DA)], inflammatory factors [high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6], and key factors of the HPA axis [cortisol (CORT), norepinephrine (NE)] were also observed before and after treatment. Results The total effective rate in the combination group was higher than that in the oral administration group and the external application group (P<0.05), and the total effective rate in the oral administration group was higher than that in the external application group (P<0.05). After one and two weeks of treatment, the SRSS scores, PSQI scores, HAMA scores, HAMD scores, and CM pattern scores in the combination group were all lower than those in the oral administration group and the external application group (P<0.05), and the scores in the oral administration group were lower than those in the external application group (P<0.05). After treatment, the levels of BDNF, 5-HT, and DA in the combination group were higher than those in the oral administration group and the external application group (P<0.05), and those levels in the oral administration group were higher than those in the external application group (P<0.05); the levels of hs-CRP, TNF-α, IL-1, and IL-6 in the combination group were lower than those in the oral administration group and the external application group (P<0.05), and those levels in the oral administration group were lower than those in the external application group (P<0.05); the CORT level in the combination group was lower than that in the oral administration group (P<0.05), while the NE level was higher than that in the oral administration group (P<0.05). There was no statistically significant difference in adverse reactions among the three groups (P>0.05). Conclusion The modified CHSGF combined with acupoint application of Ningjing Patch has demonstrated definite efficacy in treating comorbid sleep disorders and depression after cerebral infarction. It can reduce depression and improve sleep status, promote the recovery of neurotransmitters, alleviate inflammatory reactions, inhibit excessive activation of the HPA axis, with a certain level of safety. |
| Key words: cerebral infarction sleep disorders depression modified Chaihu Shugan Formula acupoint application hypothalamic-pituitary-adrenal axis neurotransmitter inflammatory factor |
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