解郁安神颗粒对脑卒中后抑郁患者的影响及机制研究

发布时间：2018-05-27 21:04

本文选题：脑卒中后抑郁症 + 单因素分析　；参考：《郑州大学》2013年硕士论文

【摘要】：第一部分脑卒中后抑郁症的高危因素目的：分析脑卒中后抑郁症的高危因素。方法：将238例脑卒中患者分为PSD组(110例)和非PSD组(128例),通过单因素分析、多因素Logistic回归分析性别、年龄、性格特点、文化程度、固定职业、收入、居住地、社会支持、并发症、脑卒中类型、病变侧别、病变部位、神经功能和日常生活活动能力对PSD的影响。结果： 1单因素分析结果显示,两组的性别、性格、固定职业、社会支持、并发症、病变侧别、病变部位、神经功能以及日常生活活动能力具有明显的差异(P0.05)。 2多因素Logistic回归分析结果显示,性别、性格、社会支持、病变侧别、病变部位、神经功能以及日常生活活动能力是影响PSD发生的主要危险因素。结论：女性、性格内向、社会支持少、病变在左侧和额叶、神经功能缺损和日常生活活动能力差是促进PSD发生发展的高危因素。第二部分解郁安神颗粒对脑卒中后抑郁患者的影响及机制研究目的：探讨解郁安神颗粒对PSD的影响及可能机制。方法：将80例PSD患者随机分为治疗组(40例)和对照组(40例)。两组患者均予常规脑卒中治疗和氟西汀,治疗组在对照组的基础上予以解郁安神颗粒,连续8周。比较两组的疗效、抑郁程度、神经功能缺损程度、日常生活活动能力以及血清5-HT、NE、TNF-α、IL-1β和BDNF水平。疗效标准于治疗前和治疗第8周末评定疗效。减分率=(治疗前评分-治疗后评分)/治疗前评分×100%。HAMD减分率75%为痊愈,50%为显效,25%为有效,25%为无效。总有效率=(痊愈例数+显效例数+有效例数)/各组样本数×100%。结果： 1治疗组总有效率为97.5%；对照组总有效率为87.5%。两组的总有效率差异具有统计学意义(?=10.660,P0.05)。 2经治疗后,两组的HAMD、SSS量表评分明显降低,且治疗组明显低于对照组(P0.05)；ADL量表评分明显升高,且治疗组明显高于对照组(P0.05)。 3经治疗后,两组的5-HT和NE水平明显升高(P0.05),且治疗组略高于对照组(P0.05)。 4经治疗后,两组的TNF-a和IL-1p水平均明显降低(P0.05),且治疗组明显低于对照组(P0.05) 5经治疗后,两组的BDNF水平明显升高(P0.05),且治疗组略高于对照组(P0.05)。结论：解郁安神颗粒能够有效地治疗PSD,缓解抑郁症状,促进神经功能恢复,提高日常生活活动能力,可能与上调血清5-HT、NE、BDNF水平,下调血清TNF-α和IL-1β水平相关。
[Abstract]:Part I High risk factors of Post-stroke Depression Objective: To analyze the high risk factors of post-stroke depression. Methods: Two hundred and eight patients with stroke were divided into PSD group (n = 110) and non-PSD group (n = 128). By univariate analysis, multivariate Logistic regression analysis, sex, age, personality, education, fixed occupation, income, place of residence, social support, complications. The effects of stroke type, lesion side, lesion location, neurological function and activity of daily living on PSD. Results: 1 the results of univariate analysis showed that there were significant differences in sex, personality, fixed occupation, social support, complications, lesion side, lesion site, nerve function and activity of daily living between the two groups (P 0.05). 2Multivariate Logistic regression analysis showed that sex, personality, social support, pathological side, lesion location, nerve function and daily living ability were the main risk factors affecting the occurrence of PSD. Conclusion: Female, introverted, less social support, lesion in left and frontal lobe, neurological deficit and poor daily living ability are the high risk factors to promote the development of PSD. The second part: effect and mechanism of Jieyu Anshen granule on patients with post-stroke depression Objective: To explore the effect of Jieyu Anshen granule on PSD and its possible mechanism. Methods: 80 patients with PSD were randomly divided into treatment group (n = 40) and control group (n = 40). Two groups of patients were given routine stroke treatment and fluoxetine treatment group on the basis of the control group on the basis of Jieyu Anshen granule for 8 weeks. The therapeutic effect, degree of depression, degree of neurological impairment, activity of daily living (ADL) and serum levels of IL-1 尾 and BDNF were compared between the two groups. Curative effect standard The efficacy was evaluated before treatment and at the end of the 8th week. The score reduction rate before and after treatment was 75%, the recovery rate was 50%, the significant effect was 25%, and the effective rate was 25%. Total effective rate (effective number of cases of recovery, effective number of cases / sample number of each group 脳 100). Results: 1 the total effective rate was 97.5 in the treatment group and 87.5 in the control group. The difference of total effective rate between the two groups was statistically significant (P 0.05). 2After treatment, the scores of HAMD-SSS in the two groups were significantly decreased, and the scores of ADL in the treatment group were significantly lower than those in the control group (P 0.05), and the scores in the treatment group were significantly higher than those in the control group (P 0.05). 3After treatment, the levels of 5-HT and NE in the two groups were significantly higher than those in the control group. 4After treatment, the levels of TNF-a and IL-1p in both groups were significantly lower than those in the control group (P 0.05), and those in the treatment group were significantly lower than those in the control group (P 0.05). 5After treatment, the level of BDNF in the two groups was significantly higher than that in the control group, and the level of BDNF in the treatment group was slightly higher than that in the control group. Conclusion: Jieyu Anshen granule can effectively treat PSD, relieve depression, promote the recovery of nerve function and improve the activity of daily life, which may be related to the up-regulation of serum 5-HTNE-BDNF level and down-regulation of serum TNF- 伪 and IL-1 尾 levels.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.1

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