【摘要】 目的 探讨柴胡加龙骨牡蛎汤加减治疗肝郁气滞证乳腺癌伴轻中度抑郁患者的临床疗效。方法 选取2021年5月—2023年5月期间唐山市中医医院收治的102例乳腺癌伴轻中度抑郁患者，根据随机数字表法分为对照组和观察组，每组各51例。对照组患者采用西药盐酸氟西汀分散片治疗，观察组在对照组基础上联合中药柴胡加龙骨牡蛎汤加减治疗。治疗4周后，观察比较两组患者临床疗效、安全性，治疗前后中医证候评分、汉密尔顿抑郁量表24项版(Hamilton depression scale 24-item, HAMD-24)评分，血清神经递质和神经营养因子指标[5-羟色胺(5-hydroxytryptamine, 5-HT)、去甲肾上腺素(Norepinephrine, NE)、神经肽Y(Neuropeptide Y,NPY)、多巴胺(Dopamine, DA)、脑源性神经营养因子(Brain-derived neurotrophic factor, BDNF)]、炎症指标[肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、白介素-1β(Interleukin-1β,IL-1β)]、Karnofsky功能状态评分(Karnofsky performance status, KPS)、癌症治疗功能评价系统-乳腺癌特异性模块(Functional assessment ofcancer therap-B,FACT-B)评分。结果 治疗后观察组临床总有效率92.16%(47/51)明显高于对照组80.39%(41/51),差异有统计学意义(χ~2=5.850,P=0.016)。治疗后两组患者中医证候评分均较治疗前降低，差异有统计学意义(P<0.05);且观察组中医证候评分明显低于对照组，差异有统计学意义(P<0.05)。治疗后两组患者HAMD-24评分较治疗前明显降低，差异有统计学意义(P<0.05);且观察组HAMD-24评分明显低于对照组，差异有统计学意义(P<0.05)。治疗后两组患者5-HT、NPY、DA、NE、BDNF指标均较治疗前升高，差异有统计学意义(P<0.05);且观察组5-HT、NPY、DA、NE、BDNF指标均明显高于对照组，差异有统计学意义(P<0.05)。治疗后两组患者TNF-α、IL-6、IL-1β指标均较治疗前降低，差异有统计学意义(P<0.05);且观察组TNF-α、IL-6、IL-1β指标均明显低于对照组，差异有统计学意义(P<0.05)。治疗后两组患者KPS、FACT-B评分均较治疗前升高，差异有统计学意义(P<0.05);且观察组KPS、FACT-B评分高于对照组，差异有统计学意义(P<0.05)。治疗期间，两组患者均未见肝肾功能异常，未发生过敏及其他严重不良反应，用药依从性及安全性均好。结论 柴胡加龙骨牡蛎汤加减方能显著缓解乳腺癌伴抑郁患者的抑郁症状，提高生活质量，并能够调节相关神经递质及神经营养因子水平，抑制炎症反应，疗效确切，安全可靠。更多还原

【Abstract】 Objective To explore the clinical efficacy of modified Chaihu Jia Longgu Muli Decoction in the treatment of breast cancer patients of liver qi stagnation and spleen deficiency syndrome with mild-to-moderate depression.Methods A total of 102 breast cancer patients with mild-to-moderate depression, admitted to Tangshan Hospital of Traditional Chinese Medicine from May 2021 to May 2023,were selected and randomly divided into a control group and an observation group according to a random number table, with 51 patients in each group.The control group was treated with the Western medicine fluoxetine hydrochloride dispersible tablets, while the observation group received the modified Chaihu Jia Longgu Muli Decoction in addition to the treatment used in the control group.After four weeks of treatment, the clinical efficacy, safety, traditional Chinese medicine(TCM)syndrome scores, Hamilton Depression Scale 24-item(HAMD-24)scores, serum neurotransmitters and neurotrophic factors[5-hydroxytryptamine(5-HT),norepinephrine(NE),neuropeptide Y(NPY),dopamine(DA),brain-derived neurotrophic factor(BDNF)],inflammatory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),interleukin-1β(IL-1β)],Karnofsky Performance Status(KPS)scores, and Functional Assessment of Cancer Therapy-Breast(FACT-B)scores were observed and compared between the two groups before and after treatment.Results After treatment, the total clinical effective rate in the observation group was 92.16%(47/51),significantly higher than 80.39%(41/51)in the control group(χ~2=5.850,P=0.016).After treatment, both groups showed a significant decrease in TCM syndrome scores compared to those before treatment(P<0.05),with the observation group showing significantly lower TCM syndrome scores than the control group(P<0.05).After treatment, both groups had significantly lower HAMD-24 scores than those before treatment(P<0.05),with the observation group showing significantly lower HAMD-24 scores than the control group(P<0.05).After treatment, levels of 5-HT,NPY,DA,NE,and BDNF were significantly increased in both groups(P<0.05),with the observation group showing significantly higher levels of these indicators than the control group(P<0.05).After treatment, TNF-α,IL-6,and IL-1β levels were significantly reduced in both groups compared to those before treatment(P<0.05),with the observation group showing significantly lower levels of these inflammatory markers than the control group(P<0.05).After treatment, both groups showed significantly improved KPS and FACT-B scores compared to those before treatment(P<0.05),with the observation group showing higher KPS and FACT-B scores than the control group(P<0.05).During the treatment period, neither group showed liver or kidney dysfunction, allergic reactions, or other serious adverse effects.The medication adherence and safety were good in both groups.Conclusion Modified Chaihu Jia Longgu Muli Decoction can significantly alleviate the depressive symptoms of breast cancer patients, improve quality of life, regulate relevant neurotransmitters and neurotrophic factors, inhibit inflammation, and is both effective and safe.更多还原