【摘要】：目的:觀察清心滋腎湯加味聯(lián)合文拉法辛緩釋片對心腎不交肝郁型圍絕經(jīng)期抑郁癥的臨床療效。方法:臨床收集60例符合診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)的圍絕經(jīng)期抑郁癥患者,隨機(jī)分為2組,各30例,對照組予鹽酸文拉法辛緩釋片,治療組在對照組的基礎(chǔ)上予清心滋腎湯加味。兩者療程均為8周。觀察并比較兩組患者治療前后血清雌二醇(E2)、促卵泡生成素(FSH)水平,血小板5-輕色胺(5-HT)濃度及17項漢密爾頓抑郁量表(HAMD-17)、中醫(yī)證候量表、改良Kupperman評分表評分變化情況。此次研究以HAMD-17抑郁量表作為疾病療效評價,中醫(yī)癥候量表評分作為主要療效指標(biāo),改良Kupperman評分表評分作為次要療效指標(biāo)。結(jié)果:①兩組圍絕經(jīng)期抑郁癥患者治療后三組評分均較用藥前有明顯的降低,差異顯著(P0.05);中藥聯(lián)合抗抑郁藥組與單用抑郁藥組療效比較,前者明顯優(yōu)于后者(P0.05)。②治療后兩組血清E2水平均較治療前明顯升高,治療組較對照組顯著(P0.05);兩組血清FSH水平相比治療前均有所下降,治療組下降更顯著(P0.05)。③治療后兩組患者血小板5-HT濃度均較用藥前明顯增加(P0.05),治療組血小板5-HT濃度增加較對照組明顯,差異有統(tǒng)計學(xué)意義(P0.05)。④治療后,治療組、對照組總有效率分別為93.33%、73.33%,中藥聯(lián)合抗抑郁藥組優(yōu)于單用抗抑郁藥組(P0.05)。⑤中藥聯(lián)合抗抑郁藥、單用抗抑郁藥組不良反應(yīng)發(fā)生率分別為23%、50%,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:清心滋腎湯加味治療心腎不交肝郁型圍絕經(jīng)期抑郁癥臨床有效;對圍絕經(jīng)期抑郁癥患者生殖內(nèi)分泌水平及單胺類神經(jīng)遞質(zhì)含量有一定調(diào)節(jié)作用;清心滋腎湯加味與抗抑郁藥鹽酸文法拉辛緩釋片聯(lián)合應(yīng)用能夠提高其療效且能預(yù)防和減少其不良反應(yīng)的發(fā)生,亦能有效緩解圍絕經(jīng)期相關(guān)不適癥狀。
[Abstract]:Objective: to observe the clinical effect of Qingxin Zishen decoction combined with venlafaxine sustained-release tablet in treating peri-menopausal depression with heart and kidney non-liver-depression. Methods: sixty patients with peri-menopausal depression who met the diagnostic criteria were randomly divided into two groups, 30 patients in each group. The control group was treated with venlafaxine hydrochloride sustained release tablets, and the treatment group was treated with Qingxin Zishen decoction on the basis of the control group. Both courses of treatment were 8 weeks. The changes of serum estradiol (E2), follicle stimulating hormone (FSH), platelet concentration of 5-light tryptamine (5-HT), 17 items of Hamilton Depression scale (HAMD-17), TCM Syndrome scale and modified Kupperman scale were observed and compared before and after treatment. In this study, the HAMD-17 Depression scale was used as the evaluation of the curative effect of the disease, the TCM symptom scale as the main curative effect index, and the modified Kupperman scale as the secondary curative effect index. Results the scores of the three groups in the two groups were significantly lower than those before treatment (P0.05), and the curative effect of the traditional Chinese medicine combined with antidepressant group was higher than that of the single antidepressant group. The serum E2 level in the former group was significantly higher than that in the control group after treatment (P0.05), and the serum FSH level in the treatment group was significantly lower than that in the control group (P0.05). The concentration of platelet 5-HT in the treatment group was significantly higher than that in the control group (P0.05) after treatment (P0.05). The platelet 5-HT concentration in the treatment group was significantly higher than that in the control group (P0.05), and the difference was statistically significant (P0.05) after treatment, the concentration of platelet 5-HT in the treatment group was significantly higher than that in the control group (P0.05). The total effective rates of the control group were 93.33 and 73.33, respectively. The Chinese medicine combined with antidepressant group was better than the single antidepressant group (P0.05). The incidence of adverse reactions in the single antidepressant group was 2350. The difference was statistically significant (P0.05). Conclusion: Qingxinzishen decoction is effective in treating depression in peri-menopausal period of Xinshen non-liver-depression type and has certain regulating effect on reproductive endocrine level and monoamine neurotransmitter content in patients with peri-menopausal depression. The combination of Qingxin Zishen decoction and antidepressant Grammaraxine Hydrochloride sustained release tablets can improve its curative effect, prevent and reduce the occurrence of adverse reactions, and relieve the symptoms related to menopause effectively.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.4

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