柴桂温胆定志汤对脑卒中患者抑郁情绪及认知功能的影响

摘要

目的:观察柴桂温胆定志汤治疗脑卒中后老年患者认知障碍和抑郁情绪的疗效,并探讨其作用机制.方法:选取2015年3月至2017年3月衡水市人民医院收治的诊断为"中风"的老年患者150例,随机分成对照组和观察组,每组75例.2组均予常规治疗,观察组在此基础上加服柴桂温胆定志汤,评估治疗前后2组的术后恢复质量评估量表(PQRS)评分、简易智力状态量表(MMSE)评分、汉密尔顿抑郁量表(HAMD)评分,以及不同时间点脑脊液中PI3K、AKT、pAKT、Bcl、Bax的水平.结果:2组治疗前PQRS评分及MMSE评分,差异无统计学意义(P>0.05),但治疗后3 d和1周的上述评分均比治疗前低,但观察组降低更显著,差异有统计学意义(P<0.05).治疗前,2组的HAMD评分差异无统计学意义(P>0.05),治疗后,2组的HAMD评分均降低,但均为观察组的变化更显著,差异有统计学意义(P<0.05).与治疗前比较,2组治疗后任意时间节点的PI3K、pAKT、bcl水平均下降,差异有统计学意义(P<0.05),而bax水平则升高,差异有统计学意义(P<0.05),但是,各个时间中PI3K/AKT信号通路标志性蛋白浓度的变化趋势,对照组比观察组更明显,差异有统计学意义(P<0.05).治疗后有效率观察组和对照组分别是90.15％,79.89％,差异有统计学意义(P<0.05).结论:柴桂温胆定志汤对老年脑卒中患者认知功能的恢复以及抑郁情绪的舒缓作用显著,其可能与介导PI3K/AKT信号通路的激活有关.%Objective:To observe the curative effect of Chaigui Wendan Dingzhi Decoction on cognitive impairment and depressive mood in elderly patients after stroke , and to explore its mechanism .Methods:From March 2015 to March 2017, 150 elderly pa-tients who were diagnosed as stroke were randomly divided into control group and observation group .PQRS, MMSE and HAMD were measured before and after treatment , and PI3K, AKT, pAKT, Bcl and Bax concentration in cerebrospinal fluid were meas-ured at different time points before and after treatment .Results:1)PQRS score and MMSE score were not comparable before treat-ment (P>0.05), but the scores of the three days and one week after treatment were lower than those before treatment .The obser-vation group was more significant (P<0.05).2)Before treatment, the HAMD score of the two groups was not comparable (P>0.05).After treatment, HAMD scores of two groups were reduced , but the observation group was more significant (P<0.05). The difference was statistically significant (P<0.05).3)Compared with before treatment , the levels of PI3K, pAKT and bcl of two groups at any time point were decreased (P<0.05), while the level of bax was increased (P<0.05).The control group was more significant in changing trend of PI3K/AKT signal pathway marker protein than observation group (P<0.05).4)After treat-ment, the effective rates of the two groups were:observation group 90.15％, control group 79.89％(P<0.05), and the differ-ence was statistically significant .The observation group had better results than the control group .Conclusion:Chaigui Wendan Dingzhi decoction has a significant effect on the recovery of cognitive function and depressive mood in stroke patients after stroke , which may be related to the activation of PI3K /AKT signaling pathway.