【摘要】 目的探讨逍遥散加味方联合舍曲林治疗抑郁症的疗效,并探讨其神经免疫内分泌学机制。方法采用酶联免疫吸附法检测中药逍遥散加味方合并舍曲林组、逍遥散加味方组、舍曲林组共三组(每组30例)抑郁症患者治疗前后及正常对照组的血清IL-6、IL-1β、TNF-α的水平并比较;每组在治疗前后分别做地塞米松抑制试验(DST)并检测血浆皮质醇(CORT)和促肾上腺皮质激素(ACTH)的浓度;结合汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行相关分析。结果三组病例组治疗前血清IL-6、IL-1β、TNF-α、CORT、ACTH水平显著高于正常对照组(P<0.05)。三组血清IL-6、IL-1β、TNF-α、CORT、ACTH水平在治疗前后差异均有统计学意义(P<0.05)。逍遥散治疗抑郁症愈显率高,且不良反应小;中西药结合组HAMD评分治疗结束时下降更明显,与其他两组评分比较有显著性差异(P<0.05)。结论血清IL-6、IL-1β、TNF-α、CORT、ACTH水平升高可能是抑郁症的神经免疫内分泌学机制;逍遥散和舍曲林抗抑郁机制类同,均能降低IL-6、IL-1β、TNF-α水平,从而纠正HPA轴的亢进而达到抗抑郁作用。逍遥散对抑郁症疗效与舍曲林相当,两者结合疗效更佳。更多还原

【Abstract】 Objective To observe the clinical effect of combined treatment of Xiaoyao powder and setraline in depression patients,and explore the neuroendocrine and nuroimmune mechanism of Xiaoyao powder in anti-depression. Methods The plasma cortisone(CORT), corticotrophin(ACTH) and serum cytokine level were measured by ELISA in case-control study including traditional Chinese medicine group(treatment by oral Xiaoyao Powder), western medicine group(treatment by oral setraline) and combined group(conbined treatment of Xiaoyao powder and setraline), and the associations between the serum cytokine level, HPA axis and HAMD scores and HAMA scores were explored. Results The levels of serum IL-6, TNF-α, IL-1β, CORT and ACTH of case groups before therapy were significantly higher than those of normal control group(P <0.05). The levels of serum IL-6, TNF-α, IL-1β, CORT and ACTH of three case group after therapy were significantly lower than those before therapy(P <0.05). The markedly effective rate was high in traditional Chinese medicine group with a less reverse effect; After 6 weeks of treatment, the score of HAMD decreased remarkably in the group of combined traditional Chinese medicine with western medicine than that in the else two groups(P <0.05). Conclusions The increases in the levels of serum IL-6,IL-1β, TNF-α, CORT and ACTH may be immunological and neuroendocrine markers of depression; Xiaoyao powder can markedly decrease serum IL-6, IL-1β, TNF-α levels in depression patients and regulate the balance of HPA; Xiaoyao powder has the same therapeutic effect on depression as setraline, and combined treatment of Xiaoyao powder and setraline has a better therapeutic effect.更多还原