宁神补心丸联合“子午流注针法”对脑卒中伴抑郁症患者工作记忆疗效及血清Hcy、NSE的影响

Effect of Ningshen Buxin Pill Combined with "Midnight-noon Ebb-flow Acupuncture" on Working Memory and Serum Hcy and NSE in Patients with Stroke and Depression

关键词:  宁神补心丸  子午流注针法  脑卒中  抑郁

Key words:  Ningshen Buxin pill  Midnight-noon Ebb-flow Acupuncture  stroke  depression

摘要:

目的 探讨宁神补心丸联合"子午流注针法"对脑卒中伴抑郁症患者工作记忆疗效及血清神经元烯醇化酶（neuron enolase，NSE）、同型半胱氨酸（homocysteine，Hcy）的影响。方法 将2019年1月-2020年1月期间收治的84例急性缺血性脑卒中伴抑郁症患者按照随机数字表随机分为中医治疗组和对照组各42例，所有患者均采取常规内科治疗，对照组给予盐酸帕罗西汀口服抗抑郁治疗，中医治疗组在对照组基础上给予宁神补心丸联合"子午流注针法"治疗，比较2组临床疗效及n-back测试结果，血清Hcy、NSE、碱性髓鞘蛋白（myelin basic protein，MBP）、5-羟色胺（5-hydroxytryptamineand，5-HT）、去甲肾上腺素（norepinephrine，NE）水平及生活质量评分。结果 中医治疗组总有效率92.86%高于对照组76.19%（P<0.05）。治疗后2组HAMD-24评分、NIHSS评分、中医证候积分、血清NSE、Hcy、MBP较该组治疗前明显降低（P<0.05），且中医治疗组下降幅度大于对照组（P<0.05）。治疗后2组n-back测试正确率明显提升，反应时间明显下降（P<0.05），且中医治疗组正确率高于对照组，反应时间低于对照组（P<0.05）；治疗后2组5-HT、NE水平以及生理健康、心理健康、环境领域、社会关系和生存质量得分较本组治疗前明显升高（P<0.05），且中医治疗组高于对照组（P<0.05）。结论 宁神补心丸联合"子午流注针法"治疗脑卒中伴抑郁症能够改善神经功能缺损，缓解抑郁情绪，提高功能记忆功能，猜测其作用机制可能与降低Hcy、NSE水平有关。

Abstract:

OBJECTIVE To explore the effect of Ningshen Buxin pill combined with "Midnight-noon Ebb-flow Acupuncture" on working memory and serum neuron enolase(NSE) and homocysteine(Hcy) in patients with stroke and depression. METHODS The 84 patients with acute ischemic stroke and depression from January 2019 to January 2020 were randomly divided into the TCM treatment group and the control group according to the random number table, 42 cases in each group. All patients were treated with routine internal medicine, the control group was treated with paroxetine hydrochloride oral antidepressant, and the treatment group was treated with Ningshen Buxin and "Midnight-noon Ebb-flow Acupuncture" on the basis of the control group. The clinical efficacy, the results of n-back test, the level of Hcy, NSE, myelin basic protein(MBP), 5-hydroxytryptamineand(5-HT) and norepinephrine(NE), the score of life quality were compared in the two groups. RESULTS The total effective rate of the treatment group(92.86%) was higher than that of the control group(76.19%)(P<0.05). After treatment, HAMD-24 score, NIHSS score, TCM syndrome score and serum NSE, Hcy and MBP in the two groups were significantly lower than those before treatment(P<0.05), the decrease of TCM treatment group was larger than that of control group(P<0.05). After treatment, the correct rate of n-back test in the two groups was significantly increased, and the reaction time was significantly decreased(P<0.05), and the correct rate was higher and the reaction time was lower in the TCM treatment group than that in the control group(P<0.05). After treatment, the level of 5-HT, NE and scores of physical health, mental health, environment, social relationship and quality of life in the two groups were significantly higher than those before treatment(P<0.05), and these in TCM treatment group were higher than in the control group. CONCLUSION Ningshen Buxin pill combined with "Midnight-noon Ebb-flow Acupuncture" can improve the neurological deficit, relieve depression and improve the function of memory in stroke patients with depression. The mechanism may be related to the decrease of Hcy and NSE.