目的:观察柴胡加龙骨牡蛎汤加减治疗围绝经期抑郁症的临床疗效.方法:将114例围绝经期抑郁症患者按照随机数字表法分为对照组和研究组,每组各57例.对照组给予盐酸文拉法辛缓释胶囊治疗,研究组在对照组治疗的基础上给予柴胡加龙骨牡蛎汤加减.检测两组患者治疗前后激素水平[黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、卵泡刺激素(follicle-stimulating hormone,FSH)]及神经递质水平[去甲肾上腺素(noradrenaline,NE)、5-羟吲哚乙酸(5-hydroxyindole acetic acid,5-HIAA)、肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)、5-羟色胺(5-hydroxytryptamine,5-HT)、肾上腺皮质酮(corticosterone,CORT)、多巴胺(dopamine,DA)],比较两组患者临床疗效、不良反应发生率及治疗前后汉密尔顿抑郁量表(hamilton depression scale,HAMD)评分、匹兹堡睡眠质量指数量表(pittsburgh sleep quality interview,PSQI)、世界卫生组织生存质量测定量表(the world health organization quality of life,WHOQOL-BREF)及更年期综合征自我诊断评定表(Kupper-man)评分变化情况.结果:两组患者治疗后LH、FSH低于本组治疗前,E2高于本组治疗前,且治疗后组间比较,差异均有统计学意义(P＜0.05).两组患者治疗后CORT、ACTH含量低于本组治疗前,5-HIAA、NE、5-HT、DA含量高于本组治疗前,且治疗后组间比较,差异均有统计学意义(P＜0.05).两组患者治疗后PSQI、HAMD、Kupperman评分低于本组治疗前,WHO-QOL-BREF评分高于本组治疗前,且治疗后组间比较,差异均有统计学意义(P＜0.05).研究组有效率为98.25％,高于对照组的89.47％,差异具有统计学意义(P＜0.05).研究组不良反应发生率为5.26％,低于对照组的15.79％,差异具有统计学意义(P＜0.05).结论:柴胡加龙骨牡蛎汤加减治疗围绝经期抑郁症,可调节患者的性激素水平,改善神经递质水平,缓解患者抑郁情绪,提高睡眠质量及生活质量,也可降低不良反应发生率.
Clinical Study on the Treatment of Perimenopausal Depression with Bupleurum Decoction Plus Dragon Bone and Oyster Shell
Objective:To observe the clinical efficacy of Bupleurum Decoction Plus Dragon Bone and Oyster Shell on perimenopausal de-pression,and to explore its mechanism.Methods:A thtal of 114 patients with perimenopausal depression were divided into the control group and the study group according to the random number table method,with 57 cases in each group.The control group was given Ven-lafaxine Hydrochloride Sustained-Release Capsules,while the study group was additionally given Bupleurum Decoction Plus Dragon Bone and Oyster Shell on the basis of the control group.The hormone levels[including luteinizing hormone(LH),estradiol(E2),folli-cle-stimulating hormone(FSH)]and neurotransmitter levels[including noradrenaline(NE),5-hydroxyindole acetic acid(5-HIAA),adrenocorticotrophic hormone(ACTH),5-hydroxytryptamine(5-HT),adrenocorticosterone(CORT),dopamine(DA)]of the two groups were detected before and after treatment.The clinical efficacy,incidence of adverse reactions,and the changes in Hamilton De-pression Scale(HAMD),Pittsburgh Sleep Quality Index(PSQI),The World Health Organization Quality of Life(WHOQOL-BREF)and menopausal syndrome self-diagnosis scale scores before and after treatment were compared between the two groups.Results:After treatment,the LH and FSH levels of the two groups were lower than those before treatment,while the E2 level was higher than that before treatment,and all the differences between the two groups were statistically significant(P＜0.05).The contents of CORT and ACTH in the two groups were lower than those before treatment,while the contents of 5-HIAA,NE,5-HT and DA were higher than those before treatment,and all the differences between the two groups were statistically significant(P＜0.05).The PSQI,HAMD and Kupperman scores of the two groups were lower than those before treatment,while the WHOQOL-BREF score was higher than that before treatment,and all the differences between the two groups were statistically significant(P＜0.05).The effective rate of the study group was 98.25％,which was higher than 89.47％of the control group,and the difference was statistically significant(P＜0.05).The incidence rate of adverse reactions in the study group was 5.26％,which was lower than 15.79％of the control group,and the difference was sta-tistically significant(P＜0.05).Conclusion:Bupleurum Decoction Plus Dragon Bone and Oyster Shell in the treatment of perimenopa-usal depression can regulate the level of sex hormones,improve the level of neurotransmitters,relieve the depression emotions of pa-tients,enhance the quality of sleep and quality of life,and also reduce the incidence of adverse reactions.
perimenopausal depressionBupleurum Decoction Plus Dragon Bone and Oyster ShellVenlafaxineintegrated traditional and Western medicine therapyTreatise on Cold Damage DiseasesZhang Zhongjing
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