醒神解郁方对卒中后中重度抑郁患者血清Th17/Treg免疫失衡及生活能力干预研究

韩振翔; 祁丽丽; 侯臻臻; 周一心; 刘爱华

doi:10.16766/j.cnki.issn.1674-4152.001771

醒神解郁方对卒中后中重度抑郁患者血清Th17/Treg免疫失衡及生活能力干预研究

doi: 10.16766/j.cnki.issn.1674-4152.001771

1.
上海中医药大学附属第七人民医院神经康复科，上海 200137
2.
上海中医药大学附属岳阳中西医结合医院急诊科, 上海 200437
3.
复旦大学附属华山医院北院中西医结合科，上海 201907

基金项目:

国家中医药管理局“第六批全国老中医药学术经验继承工作”项目国中医药人教发[2017]29号

上海市中医优势病种培育项目、上海中医药大学高峰高原创新团队、上海市中医药领军人才建设项目 ZY3-RCPY-1-1001

上海市浦东新区海派中医流派浦东分基地建设 PDZY-2019-0703

详细信息

通讯作者:
刘爱华，E-mail：huamei1977@163.com

中图分类号: R243 R395.2
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- 被引次数: 0
出版历程
- 收稿日期: 2020-03-28
- 网络出版日期: 2022-02-19

Clinical effect of Xinshen Jieyu Decoction in the imbalance of Th17/Treg and Barthel index in the moderate or severe post-stroke depression patients

1.
Neurorehabilitation Department, the Seventh People's Hospital of Shanghai University of TCM, Shanghai 200137, China

摘要

摘要: 目的观察醒神解郁汤联合舍曲林治疗脑卒中后中重度抑郁症的临床疗效。方法选取2014年1月—2018年1月上海市第七人民医院专科门诊及住院部收治的脑卒中后中重度抑郁患者90例，按随机数字表法分为对照组(45例)和治疗组(45例)。对照组患者给予口服舍曲林50 mg，1次/d；治疗组患者在对照组基础上给予醒神解郁汤，1剂/次，2次/d。所有患者治疗8周，于治疗前、治疗后(2、4、8周)评价汉密尔顿抑郁量表(HAMD)评分、日常生活能力指数(BI)评分，治疗前与治疗8周后进行血清Th17/Treg、BDNF水平检测。结果 2组患者治疗前HAMD评分、BI指数评分、BDNF、Treg、Th17水平等无明显差异；治疗组治疗后各时点汉密尔顿抑郁量表评分改善优于对照组(均P < 0.05)；治疗4周后治疗组日常生活能力评分提高，优于对照组，差异有统计学意义(均P < 0.05)；治疗组治疗后血清BDNF[(27.31±5.20)ng/mL]、Treg水平[(6.52±0.93)%]高于对照组[(23.03±5.62)ng/mL、(4.52±1.51)%]，Th17[(0.30±0.16)%]、Th17/Treg(0.10±0.06)水平低于对照组[(0.41±0.27)%, 0.16±0.07]，差异有统计学意义(均P < 0.05)。结论醒神解郁方联合舍曲林可改善脑卒中后中重度抑郁患者临床症状，提高患者日常生活活动能力，其机制可能是调节血清Th17/Treg-BDNF水平。
- 醒神解郁方 /
- 卒中后抑郁 /
- 免疫失衡
Abstract: Objective To investigate the clinical effect of Xinshen Jieyu Decoction in the moderate or severe post-stroke depression patients. Methods Ninety post-stroke depression patients were included in Seventh People's Hospital of Shanghai University of TCM, which was conducted from January 2014 to January 2018. The patients were randomized to receive Xinshen Jieyu Decoction combined with sertraline vs control sertraline group over 8 weeks. The HAMD was the primary outcome measure. As secondary aims, several biomarkers, such as BDNF, Treg and Th17 were investigated. Results The 2 group did not differ with the baseline severity of depression. Hamilton Depression scale (HAMD) score and Barthel Index in both groups were significantly improved (all P < 0.05). Meanwhile, HAMD score and Bathel Index were significantly more improved in the treatment group than in the control group after 4 weeks (all P < 0.05). The biomarkers, such as BDNF, Treg, Th17 and Treg/Th17 were significant difference before and after treatment (all P < 0.05) and these biomarkers were significantly better than those of the control group (all P < 0.05). BDNF level (27.31±5.20) and Treg level (6.52±0.93) in treatment group after treatment were higher than those in control group (23.03±5.62, 4.52±1.51). Th17 level (0.30±0.16) and Th17/Treg level (0.10±0.06) in treatment group after treatment were higher than those in control group (0.41±0.27, 0.16±0.07). Conclusion Imbalance of Th17/Treg may be a potent pathogenesis of PSD. Xinshen Jieyu Decoction combined with sertraline hydrochloride is more effective and safer than sertraline hydrochloride alone in the PSD treatment.
- Xinshen Jieyu Decoction /
- Post-stroke depression /
- Immunological imbalance

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表 1 2组脑卒中后中重度抑郁患者治疗前后HAMD评分比较(x ±s, 分)

组别	例数	治疗前	治疗后2周	治疗后4周	治疗后8周
治疗组	45	19.75±4.16	12.62±3.23^a	10.00±3.43^a	7.13±3.19^a
对照组	45	18.81±4.67	15.74±2.87^a	12.24±2.81^a	8.56±2.85^a
t值		-1.010	4.830	3.443	2.244
P值		0.315	< 0.001	0.001	0.027
注：与组内治疗前比较，^aP < 0.05。

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表 2 2组脑卒中后中重度抑郁患者治疗前后血清BDNF水平比较(x ±s, ng/mL)

组别	例数	治疗前	治疗后	t值	P值
治疗组	45	21.58±6.38	27.31±5.20	-7.058	< 0.001
对照组	45	20.41±5.72	23.03±5.62	-4.098	< 0.001
t值		0.916	3.748
P值		0.362	< 0.001

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表 3 2组脑卒中后中重度抑郁患者治疗前后Th17、Treg、Th17/Treg水平比较(x ±s)

组别	例数	Th17(%)		Treg(%)		Th17/Treg
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
治疗组	45	0.67±0.30	0.30±0.16^a	4.33±1.55	6.52±0.93^a	0.23±0.11	0.10±0.06^a
对照组	45	0.66±0.08	0.41±0.27^a	4.11±1.65	4.52±1.51	0.25±0.08	0.16±0.07^a
t值		0.176	-2.257	0.658	7.541	-0.727	-4.626
P值		0.861	0.027	0.512	< 0.001	0.469	< 0.001
注：与组内治疗前比较，^aP < 0.05。

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表 4 2组脑卒中后中重度抑郁患者治疗前后BI评分比较(x ±s, 分)

组别	例数	治疗前	治疗2周后	治疗4周后	治疗8周后
对照组	45	36.83±22.28	37.11±23.83	41.11±19.04^a	46.47±19.77^a
治疗组	45	37.44±22.49	42.11±24.20	53.95±19.11^a	62.22±17.65^a
t值		-0.129	-0.987	-3.194	-3.987
P值		0.898	0.326	0.002	< 0.001
注：与组内治疗前比较，^aP < 0.05。

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参考文献(25)

[1]	MITH K. Mental health: a world of depression[J]. Nature, 2014, 515(7526): 181. http://www.onacademic.com/detail/journal_1000039780816610_d177.html
[2]	BAYDYUK M, WU X S, HE L, et al. Brain-derived neurotrophic factor inhibits calcium channel activation, exocytosis, and endocytosis at a central nerve terminal[J]. J Neurosci, 2015, 35(11): 4676-4682. doi: 10.1523/JNEUROSCI.2695-14.2015
[3]	PENG S, LI W, LV L, et al. BDNF as a biomarker in diagnosis and evaluation of treatment for schizophrenia and depression[J]. Discov Med, 2018, 26(143): 127-136. http://www.ncbi.nlm.nih.gov/pubmed/30586536
[4]	李玉雄, 郭子运, 张雄新. 脑卒中后抑郁患者的炎性因子和脑源性神经营养因子水平变化及相关性分析[J]. 解放军医药杂志, 2018, 30(12): 101-104. doi: 10.3969/j.issn.2095-140X.2018.12.026
[5]	LIU X, KENKARE K, LI S, et al. Increased Th17/Treg ratio in poststroke fatigue[J]. Mediators Inflamm, 2015. DOI: 10.1155/2015/931398.
[6]	中华医学会精神病学分会. 中国精神障碍分类与诊断标准第三版(精神障碍分类)[J]. 中华精神科杂志, 2001, 34(3): 59-63. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHMA200103026.htm
[7]	KUCUKDEVECI A A, YAVUZER G, TENNANT A, et al. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey[J]. Scand J Rehabil Med, 2000, 32(2): 87-92. doi: 10.1080/003655000750045604
[8]	HACKETT M L, PICKLES K. Part Ⅰ: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies[J]. Int J Stroke, 2014, 9(8): 1017-1025. doi: 10.1111/ijs.12357
[9]	KOOTKER J A, VAN MIERLO M L, HENDRIKS J C, et al. Risk factors for symptoms of depression and anxiety one year poststroke: a longitudinal study[J]. Arch Phys Med Rehabil, 2016, 97(6): 919-928. doi: 10.1016/j.apmr.2016.01.019
[10]	李雪, 郝铭, 罗有才, 等. 出血性卒中后抑郁患者认知功能与生活质量研究[J]. 陕西医学杂志, 2017, 46(11): 1545-1547. doi: 10.3969/j.issn.1000-7377.2017.11.018
[11]	崔燕, 魏峰, 阎文静, 等. 脑卒中后抑郁发病的影响因素[J]. 山东医药, 2017, 57(9): 89-91. doi: 10.3969/j.issn.1002-266X.2017.09.031
[12]	BEUREL E, LOWELL J A. Th17 cells in depression[J]. Brain Behav Immun, 2018, 69: 28-34. doi: 10.1016/j.bbi.2017.08.001
[13]	GALECKI P, KOWALCZYK M. Interleukin 17 and Treg-a common pathomechanism and a new target of therapy in rheumatic diseases and depression[J]. Reumatologia, 2018, 56(4): 201-202. doi: 10.5114/reum.2018.77969
[14]	DOLATI S, AHMADI M, KHALILI M, et al. Peripheral Th17/Treg imbalance in elderly patients with ischemic stroke[J]. Neurol Sci, 2018, 39(4): 647-654. doi: 10.1007/s10072-018-3250-4
[15]	KUTLUBAEV M A, HACKETT M L. Part Ⅱ: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies[J]. Int J Stroke, 2014, 9(8): 1026-1036. doi: 10.1111/ijs.12356
[16]	BARBI J, PARDOLL D, PAN F. Treg functional stability and its responsiveness to the microenvironment[J]. Immunol Rev, 2014, 259(1): 115-139. doi: 10.1111/imr.12172
[17]	LE JAN S, PLEE J, VALLERAND D, et al. Innate immune cell-produced IL-17 sustains inflammation in bullous pemphigoid[J]. J Invest Dermatol, 2014, 134(12): 2908-2917. doi: 10.1038/jid.2014.263
[18]	许文杰, 蒋瑞冲, 周一心, 等. 活血疏肝法治疗脑卒中后抑郁临床观察[J]. 陕西中医, 2019, 40(10): 1354-1356. doi: 10.3969/j.issn.1000-7369.2019.10.010
[19]	于晓雯, 李国强, 王中琳. 疏肝解郁法治疗卒中后抑郁的系统评价[J]. 中西医结合心脑血管病杂志, 2017, 15(24): 3103-3107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY201724005.htm
[20]	张丹, 张春红, 马会靖, 等. 中医疗法预防脑卒中后抑郁有效性的系统评价[J]. 中国中医急症, 2017, 26(4): 577-580, 628. doi: 10.3969/j.issn.1004-745X.2017.04.004
[21]	周一心, 韩振翔. 醒神解郁汤治疗脑卒中后轻度抑郁30例疗效观察[J]. 新中医, 2015, 47(11): 35-37. https://www.cnki.com.cn/Article/CJFDTOTAL-REND201511019.htm
[22]	DE RYCK A, FRANSEN E, BROUNS R, et al. Psychosocial problems associated with depression at 18 months poststroke[J]. Int J Geriatr Psychiatry, 2014, 29(2): 144-152. doi: 10.1002/gps.3974
[23]	王思博, 王慧彬, 曲慧玲, 等. 卒中后抑郁的影响因素及其对生活质量的影响[J]. 中国医科大学学报, 2017, 46(9): 844-847. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201709017.htm
[24]	范真真, 李敏, 谢倩, 等. 高频重复经颅磁刺激联合高压氧治疗脑卒中后抑郁效果观察[J]. 山东医药, 2019, 59(16): 58-60. doi: 10.3969/j.issn.1002-266X.2019.16.016
[25]	CHAN A, YAN J, CSURHES P, et al. Circulating brain derived neurotrophic factor (BDNF) and frequency of BDNF positive T cells in peripheral blood in human ischemic stroke: effect on outcome[J]. J Neuroimmunol, 2015, 286: 42-47. doi: 10.1016/j.jneuroim.2015.06.013