目的 探讨天麻钩藤饮加减辅助帕利哌酮缓释片、重复经颅磁刺激(Repeat transcranial magnetic stimulation,rTMS)治疗肝郁痰结证精神分裂症患者的疗效及安全性.方法 选取2021年1月-2022年9月期间重庆市大足区人民医院收治的107例肝郁痰结证精神分裂症患者,采用随机数字表法分为对照组53例和试验组54例.对照组给予帕利哌酮缓释片、rTMS治疗,试验组在对照组基础上给予天麻钩藤饮加减.治疗4周后,观察比较两组患者临床疗效、安全性及治疗前后中医证候积分、阳性与阴性症状量表(Positive and Negative Syndrome,PANSS)评分、神经递质全脑相对功率[5-羟色胺(5-hydroxytryptamine,5-HT)、谷氨酸(Glutamic acid,Glu)、乙酰胆碱(Acetylcholine,Ach)]水平.结果 (1)临床疗效:治疗后试验组总有效率94.44％(51/54)明显高于对照组80.77％(42/52),差异有统计学意义(P＜0.05).(2)中医证候积分:治疗后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P＜0.05);且试验组中医证候积分明显低于对照组,差异有统计学意义(P＜0.05).(3)PANSS评分:治疗后两组患者精神症状PANSS评分均较治疗前降低,差异有统计学意义(P＜0.05);且试验组精神症状PANSS评分明显低于对照组,差异有统计学意义(P＜0.05).(4)神经递质:治疗后两组患者神经递质5-HT、Glu、Ach水平均较治疗前降低,差异有统计学意义(P＜0.05);且试验组神经递质5-HT、Glu、Ach水平均明显低于对照组,差异有统计学意义(P＜0.05).(5)安全性:治疗期间,两组患者均未发生严重或影响治疗不良反应,仅对照组出现1例刺痛感,调整频率后,刺痛感消失.结论 天麻钩藤饮加减辅助帕利哌酮缓释片、rTMS治疗肝郁痰结证精神分裂症效果显著,安全性高,有利于精神症状控制,且可能与调节神经递质表达有关.
Clinical Efficacy and Safety of Tianma Gouteng Decoction in Combination with Pali-peridone Sustained-Release Tablets and rTMS in the Treatment of Schizophrenia
Objective To evaluate the efficacy and safety of modified Tianma Gouteng Decoction(TMGD)com-bined with Paliperidone sustained-release tablets and repetitive transcranial magnetic stimulation(rTMS)for treating pa-tients with schizophrenia characterized by liver depression and phlegm accumulation.Methods A total of 107 schizophre-nia patients diagnosed with liver depression and phlegm accumulation treated at The People's Hospital of Dazu,Chongqing from January 2021 to September 2022 were recruited.They were randomly allocated into a control group(n=53)and an ex-perimental group(n=54)using a random number table method.The control group received Paliperidone sustained-release tablets and rTMS,while the experimental group additionally received modified TMGD.After 4 weeks of treatment,clinical efficacy,safety,changes in traditional Chinese medicine(TCM)syndrome scores,Positive and Negative Syndrome Scale(PANSS)scores,and neurotransmitter levels(5-hydroxytryptamine[5-HT],glutamic acid[Glu],and acetylcholine[Ach])in the whole brain were evaluated between the two groups.Results The total effective rate in the experimental group was 94.44％(51/54),significantly higher than the 80.77％(42/52)in the control group(P＜0.05).TCM syn-drome scores decreased after treatment in both groups(P＜0.05),with the experimental group showing a lower score than the control group(P＜0.05).Both groups exhibited a reduction in PANSS scores after treatment(P＜0.05),and the ex-perimental group demonstrated a more significant decrease than the control group(P＜0.05).The 5-HT,Glu,and Ach were down-regulated in both groups after treatment,and the experimental group had a more pronounced reduction(P＜0.05).No serious adverse reactions occurred during treatment in either group.Only one case of tingling sensation was re-ported in the control group,which resolved after adjusting the frequency.Conclusion TMGD combined with Paliperidone sustained-release tablets and rTMS was found to be markedly effective and safe for treating schizophrenia with liver de-pression and phlegm accumulation.This approach may contribute to better control of psychotic symptoms,potentially through modulation of neurotransmitters.
Modified Tianma Gouteng DecoctionPaliperidone sustained-release tabletsRepetitive transcranial magnetic stimulationSchizophrenia
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