补阳还五汤治疗Ⅱ型精神分裂症患者的随机双盲对照研究
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摘要
目的观察补阳还五汤对Ⅱ型精神分裂症患者的疗效。方法将Ⅱ型精神分裂症患者随机分为中药组和西药组,西药组给予阿立哌唑治疗,中药组在阿立哌唑治疗的同时服用补阳还五汤。用阳性和阴性症状量表(PANSS量表)、血清脑源性神经营养因子(BDNF)、威斯康星卡片分类测验(WCST)软件系统在患者入组时、第6周末评估其精神症状和认知功能。结果到达观测点中药组33例,西药组34例。中药组总显效率39.39%,西药组总显效率17.65%,差异有统计学意义(P <0.05)。中药组与西药组第6周末PANSS总分均低于入组时,差异有统计学意义(P <0.01),中药组第6周末PANSS总分低于西药组,差异有统计学意义(P <0.05);中药组第6周末的血清BDNF水平高于入组时,差异有统计学意义(P <0.05);以正常值高限为基线,入组时WCST结果 2组错误应答数、持续应答数、非持续性错误与基线比较差异均有统计学意义(P <0.05),第6周末WCST结果显示西药组持续应答数以及中药组错误应答数、持续应答数均改善,与基线比较差异无统计学意义。结论补阳还五汤能进一步改善Ⅱ型精神分裂症患者的精神症状,升高血清BNDF,减轻患者的认知缺陷,加强疗效,可用于精神分裂症的辅助治疗。
Objective To measure the curative effect of Buyang Huanwu decoction on type II schizophre-nia.MethodsPatients with type Ⅱ schizophrenia were randomly divided into Chinese medicine group and west-ern medicine group. Patients in western medicine group were treated with aripiprazole,and those in Chinese medi-cine group were treated with Buyang Huanwu decoction and aripiprazole. According to PANSS scale,serum brain-derived neurotrophic factor(BDNF),Wisconsin card sorting test(WCST)computer version,the mental symp-toms and cognitive function were detected at baseline and at the end of the 6th week.Results33 cases in Chinesemedicine group and 34 cases in Western medicine group were detected. The total effective rate of Chinese medicinegroup was 39.39%,and that of Western medicine group was 17.65%,the difference was statistically significant(P < 0.05). Significant difference were detected in the total score of PANSS of Western medicine group and Chi-nese medicine group before and after treatment(P < 0.01). At the end of the 6th week,there was significant differ-ence in the total score of PANSS between the two groups(P < 0.05). The serum BDNF of Chinese medicine groupwas significantly different before and after treatment(P < 0.05). Taking the WCST highest normal value as the base-line,there were significant differences in total number of errors(TE)and perseverative responses(PR)and non-perseverative errors(NPE)with the baseline on the two groups(P < 0.05). While at the 6th weekend the WCST re-sults showed that PR in Western medicine group and TE or PR in Chinese medicine group both improved,showingno statistical significance compared with the baseline.ConclusionsBuyang Huanwu decoction can further im-prove the mental symptoms of the patients of type Ⅱ schizophrenia,elevated serum BNDF concentration,reducethe cognitive defects,and finally increase the treatment effect. It can be used for adjuvant treatment of schizophre-nia.
Objective To measure the curative effect of Buyang Huanwu decoction on type II schizophre-nia.MethodsPatients with type Ⅱ schizophrenia were randomly divided into Chinese medicine group and west-ern medicine group. Patients in western medicine group were treated with aripiprazole,and those in Chinese medi-cine group were treated with Buyang Huanwu decoction and aripiprazole. According to PANSS scale,serum brain-derived neurotrophic factor(BDNF),Wisconsin card sorting test(WCST)computer version,the mental symp-toms and cognitive function were detected at baseline and at the end of the 6th week.Results33 cases in Chinesemedicine group and 34 cases in Western medicine group were detected. The total effective rate of Chinese medicinegroup was 39.39%,and that of Western medicine group was 17.65%,the difference was statistically significant(P < 0.05). Significant difference were detected in the total score of PANSS of Western medicine group and Chi-nese medicine group before and after treatment(P < 0.01). At the end of the 6th week,there was significant differ-ence in the total score of PANSS between the two groups(P < 0.05). The serum BDNF of Chinese medicine groupwas significantly different before and after treatment(P < 0.05). Taking the WCST highest normal value as the base-line,there were significant differences in total number of errors(TE)and perseverative responses(PR)and non-perseverative errors(NPE)with the baseline on the two groups(P < 0.05). While at the 6th weekend the WCST re-sults showed that PR in Western medicine group and TE or PR in Chinese medicine group both improved,showingno statistical significance compared with the baseline.ConclusionsBuyang Huanwu decoction can further im-prove the mental symptoms of the patients of type Ⅱ schizophrenia,elevated serum BNDF concentration,reducethe cognitive defects,and finally increase the treatment effect. It can be used for adjuvant treatment of schizophre-nia.
引文
[1]陆林.沈渔邨精神病学[M].6版.北京:人民卫生出版社,2018:28-34,300-323,837-847.
[2]MANCHIA M,PINNA M,CARPINIELLO B.Haloperidol and loss of gray matter in schizophrenia:Reconciling meta-analytical results with molecular pharmacology[J].Psychiatry Research,2016,235:209-210.
[3]GUPTA C N,CALHOUN V D,RACHAKONDA S,et al.Patterns of gray matter abnormalities in schizophrenia based on an international mega-analysis[J].Schizophrenia Bulletin,2015,41(5):1133-1142.
[4]VITA A,PERI L D,DESTE G,et al.Progressive loss of cortical gray matter in schizophrenia:a meta-analysis and meta-regression of longitudinal MRI studies[J].Translational Psychiatry,2012,2(11):e190.
[5]曲铁兵,俞天虹,刘志婷,等.补阳还五汤及其拆方对大鼠脑缺血后神经发生的影响[J].中国中西医结合杂志,2014,34(3):342-347.
[6]龙志江,谢辉,孟琼.不同活血中药配伍对脑缺血大鼠海马BDNF表达的实验研究[J].中医药导报,2016,22(2):20-23.
[7]张明园,何燕玲.最新医院精神科评定量表实用全书[M].北京:人民卫生出版社,2015:100-117.
[8]王宗琴,王高华,胡晓华.基于万方数据库的威斯康星卡片分类测验的文献计量学分析[J].武汉大学学报(医学版),2018,39(2):340-344.
[9]FRANZA F,FASANO V,DE S G,et al.Management of primary negative symptoms in schizophrenia:an one-year observational study[J].Psychiatria Danubina,2015,27(Suppl 1):245-249.
[10]RADISKE A,ROSSATO J I,GONZALEZ M C,et al.BDNFcontrols object recognition memory reconsolidation[J].Neurobiol Learn Mem,2017,142(Pt A):79-84.
[11]FERNANDES B S,STEINER J,BERK M,et al.Peripheral brain-derived neurotrophic factor in schizophrenia and the role of antipsychotics:meta-analysis and implications[J].Molecular Psychiatry,2015,20(9):1108-1119.
[12]KUDLEK M S,MIHALJEVIC-PELES A,SAGUD M,et al.Brain-derived neurotrophic factor serum and plasma levels in the treatment of acute schizophrenia with olanzapine or risperidone:6-week prospective study[J].Nord J Psychiatry,2017,71(7):513-520.
[13]PAN R,CAI J,ZHAN L,et al.Buyang Huanwu decoction facilitates neurorehabilitation through an improvement of synaptic plasticity in cerebral ischemic rats[J].Bmc Complement Altern Med,2017,17(1):173.
[14]贾海骅,赵红霞,连智华,等.精神分裂症中医诊疗概述[J].中国中医基础医学杂志,2015,21(1):25-27.
[15]吴小立,秦峰,王继辉,等.精神分裂症患者血脂代谢异常情况及停用抗精神病药物的影响[J].中华神经医学杂志,2015,14(2):156-161.
[16]LUO L,DENG S,YI J,et al.Buyang huanwu decoction ameliorates poststroke depression via promoting neurotrophic pathway mediated neuroprotection and neurogenesis[J].Evid Based Complement Alternat Med,2017,2017:4072658.
[17]朱丽,李静.不同剂量黄芪配伍的补阳还五汤对缺血性脑卒中患者血液流变学及疗效的影响[J].陕西中医,2014,35(9):1145-1147.
[18]金莉.不同剂量黄芪对糖尿病大鼠认知功能的影响机制研究[D].济南:山东中医药大学,2012:1-50.
[2]MANCHIA M,PINNA M,CARPINIELLO B.Haloperidol and loss of gray matter in schizophrenia:Reconciling meta-analytical results with molecular pharmacology[J].Psychiatry Research,2016,235:209-210.
[3]GUPTA C N,CALHOUN V D,RACHAKONDA S,et al.Patterns of gray matter abnormalities in schizophrenia based on an international mega-analysis[J].Schizophrenia Bulletin,2015,41(5):1133-1142.
[4]VITA A,PERI L D,DESTE G,et al.Progressive loss of cortical gray matter in schizophrenia:a meta-analysis and meta-regression of longitudinal MRI studies[J].Translational Psychiatry,2012,2(11):e190.
[5]曲铁兵,俞天虹,刘志婷,等.补阳还五汤及其拆方对大鼠脑缺血后神经发生的影响[J].中国中西医结合杂志,2014,34(3):342-347.
[6]龙志江,谢辉,孟琼.不同活血中药配伍对脑缺血大鼠海马BDNF表达的实验研究[J].中医药导报,2016,22(2):20-23.
[7]张明园,何燕玲.最新医院精神科评定量表实用全书[M].北京:人民卫生出版社,2015:100-117.
[8]王宗琴,王高华,胡晓华.基于万方数据库的威斯康星卡片分类测验的文献计量学分析[J].武汉大学学报(医学版),2018,39(2):340-344.
[9]FRANZA F,FASANO V,DE S G,et al.Management of primary negative symptoms in schizophrenia:an one-year observational study[J].Psychiatria Danubina,2015,27(Suppl 1):245-249.
[10]RADISKE A,ROSSATO J I,GONZALEZ M C,et al.BDNFcontrols object recognition memory reconsolidation[J].Neurobiol Learn Mem,2017,142(Pt A):79-84.
[11]FERNANDES B S,STEINER J,BERK M,et al.Peripheral brain-derived neurotrophic factor in schizophrenia and the role of antipsychotics:meta-analysis and implications[J].Molecular Psychiatry,2015,20(9):1108-1119.
[12]KUDLEK M S,MIHALJEVIC-PELES A,SAGUD M,et al.Brain-derived neurotrophic factor serum and plasma levels in the treatment of acute schizophrenia with olanzapine or risperidone:6-week prospective study[J].Nord J Psychiatry,2017,71(7):513-520.
[13]PAN R,CAI J,ZHAN L,et al.Buyang Huanwu decoction facilitates neurorehabilitation through an improvement of synaptic plasticity in cerebral ischemic rats[J].Bmc Complement Altern Med,2017,17(1):173.
[14]贾海骅,赵红霞,连智华,等.精神分裂症中医诊疗概述[J].中国中医基础医学杂志,2015,21(1):25-27.
[15]吴小立,秦峰,王继辉,等.精神分裂症患者血脂代谢异常情况及停用抗精神病药物的影响[J].中华神经医学杂志,2015,14(2):156-161.
[16]LUO L,DENG S,YI J,et al.Buyang huanwu decoction ameliorates poststroke depression via promoting neurotrophic pathway mediated neuroprotection and neurogenesis[J].Evid Based Complement Alternat Med,2017,2017:4072658.
[17]朱丽,李静.不同剂量黄芪配伍的补阳还五汤对缺血性脑卒中患者血液流变学及疗效的影响[J].陕西中医,2014,35(9):1145-1147.
[18]金莉.不同剂量黄芪对糖尿病大鼠认知功能的影响机制研究[D].济南:山东中医药大学,2012:1-50.