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卒中后焦虑抑郁状态危险因素及降气达郁汤疗效分析

Analysis of risk factors for post-stroke anxiety and depression and the therapeutic effect of Jiangqi Dayu Decoction

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目的 探讨卒中后焦虑抑郁状态危险因素,分析降气达郁汤对卒中后焦虑抑郁的疗效.方法 选取2019年10月至2022年10月武汉市第一医院收治的201例卒中后伴焦虑抑郁状态患者纳入焦虑抑郁组,根据随机数字表法将其分为对照组(n=100,常规西医治疗)与观察组(n=101,常规西医治疗基础上应用降气达郁汤),比较对照组和观察组临床疗效、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、去甲肾上腺素(NE)、脑源性神经营养因子(BDNF)、5-羟色胺(5-HT)以及不良反应.同期选取50例卒中后未伴焦虑抑郁状态患者纳入非焦虑抑郁组,比较非焦虑抑郁组与焦虑抑郁组患者一般资料及实验室指标,采用单因素及多因素logistic回归模型分析卒中后伴焦虑抑郁状态的危险因素.结果 观察组临床疗效总有效率显著高于对照组(95.05%vs 76.00%)(P<0.05).两组治疗后HAMA、HAMD评分均低于治疗前(均P<0.05),血清BDNF、NE、5-HT水平均高于治疗前(均P<0.05);观察组治疗后HAMA、HAMD评分均低于对照组(均P<0.05),血清BDNF、NE、5-HT水平均高于对照组(均P<0.05).两组不良反应发生率比较差异无统计学意义(P>0.05).焦虑抑郁组年龄、女性占比、美国国立卫生研究所脑卒中量表(NIHSS)评分、家庭关怀度<7分占比、合并其他疾病数量>2种占比显著高于非焦虑抑郁组(均P<0.05),受教育年限、家庭人均月收入显著低于非焦虑抑郁组(均P<0.05),两组BMI、吸烟史、饮酒史、白细胞、总胆固醇、糖化血红蛋白、疾病类型、卒中部位差异无统计学意义(均P>0.05).多因素logistic回归模型显示,NIHSS评分高、家庭人均月收入低、女性、家庭关怀度<7分、合并其他疾病数量>2种是卒中后焦虑抑郁状态的危险因素(均P<0.05).结论 NIHSS评分、家庭人均月收入、性别、家庭关怀度、合并其他疾病数量均会影响卒中后焦虑抑郁的发生,降气达郁汤对卒中后伴焦虑抑郁状态患者治疗效果较好,有助于改善焦虑和抑郁症状,上调NE、BDNF、5-HT水平,安全性高,值得推广.
Objective To explore the risk factors for post-stroke anxiety and depression,and analyze the therapeutic effect of Jiangqi Dayu Decoction on on post-stroke anxiety and depression.Methods A total of 201 patients with post-stroke anxiety and depression admitted to the Wuhan First Hospital from October 2019 to October 2022 were selected and included in the anxiety and depression group.They were randomly divided into a control group(n=100,treated with conventional western medicine)and an observation group(n=101,treated with Jiangqi Dayu decoction on the basis of conventional western medicine)using a random number table method.The clinical efficacy,Hamilton Anxiety Scale(HAMA)scores,Hamilton Depression Scale(HAMD)scores,norepinephrine(NE),brain derived neurotrophic factor(BDNF),5-hydroxytryptamine(5-HT),and adverse reactions were compared between the control group and the observation group.During the same period,50 patients without anxiety and depression after stroke were selected and included in the non anxiety and depression group.The general information and laboratory indicators of patients in the non anxiety and depression group were compared with those in the anxiety and depression group.Univariate and multivariate logistic regression models were used to analyze the risk factors for anxiety and depression after stroke.Results The total effective rate of clinical efficacy in the observation group was significantly higher than that in the control group(95.05%vs 76.00%)(P<0.05).After treatment,the HAMA and HAMD scores of both groups were lower than before treatment(all P<0.05),and the serum levels of BDNF,NE,and 5-HT were higher than before treatment(all P<0.05);After treatment,the HAMA and HAMD scores of the observation group were lower than those of the control group(all P<0.05),and the serum levels of BDNF,NE,and 5-HT were higher than those of the control group(all P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).The age,proportion of females,National Institutes of Health Stroke Scale(NIHSS)score,proportion of family care<7,and number of comorbidities>2 were significantly higher in the anxiety and depression group than those in the non anxiety and depression group(all P<0.05).The education level and per capita monthly income of families were significantly lower than those in the non anxiety and depression group(all P<0.05).The body mass index(BMI),smoking history,drinking history,white blood cells,total cholesterol,and glycated hemoglobin of both groups were significantly higher There was no statistically significant difference in disease type and stroke site(all P>0.05).The multivariate logistic regression model showed that high NIHSS score,low per capita monthly income,female gender,family care score<7 points,and the number of comorbidities>2 were risk factors for post-stroke anxiety and depression(all P<0.05).Conclusions NIHSS score,per capita monthly income of families,gender,family care level,and the number of comorbidities can all affect the occurrence of post-stroke anxiety and depression.Jiangqi Dayu decoction has a good therapeutic effect on patients with post-stroke anxiety and depression,helping to improve anxiety and depression symptoms.It upregulates NE,BDNF,and 5-HT levels,has high safety,and is worth promoting.

StrokeDepressionAnxietyJiangqi Dayu Decoction

舒囿淞、李洁、王赛华、何治

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武汉市第一医院康复科,武汉 430010

卒中 抑郁 焦虑 降气达郁汤

国家自然科学基金

82073824

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(2)
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