1.北京中医药大学 北京 100029
2.北京中医药大学东方医院
刘祥,女,在读博士生
# 赵海滨,男,博士,主任医师,教授,博士生导师,主要研究方向:中医药防治心血管疾病,E-mail:haibin999@126.com
纸质出版日期:2023-07-30,
网络出版日期:2023-05-11,
收稿日期:2023-03-03,
移动端阅览
刘祥, 侯季秋, 赵海滨, 等. 双心方对经皮冠脉介入术术后合并抑郁状态心血瘀阻证患者的血清成分影响及相关性分析[J]. 北京中医药大学学报, 2023,46(7):913-923.
LIU Xiang, HOU Jiqiu, ZHAO Haibin, et al. Effect and correlation analysis of
刘祥, 侯季秋, 赵海滨, 等. 双心方对经皮冠脉介入术术后合并抑郁状态心血瘀阻证患者的血清成分影响及相关性分析[J]. 北京中医药大学学报, 2023,46(7):913-923. DOI: 10.3969/j.issn.1006-2157.2023.07.005.
LIU Xiang, HOU Jiqiu, ZHAO Haibin, et al. Effect and correlation analysis of
目的
2
观察双心方对经皮冠脉介入术(PCI)术后合并抑郁状态心血瘀阻证患者血清中超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、5-羟色胺(5-HT)、促肾上腺皮质激素(ACTH)及皮质醇(COR)的影响。
方法
2
选取2021年4—12月就诊于北京中医药大学东方医院病房及门诊符合纳入标准的72例患者,根据随机数字表法分为试验组和对照组,每组36例。对照组予PCI术后的常规西药+安慰剂,试验组予常规西药+双心方,治疗期为4周。采用酶联免疫吸附测定检测试验组和对照组治疗前后的外周血清中hs-CRP、IL-6、5-HT、ACTH及COR的含量,并进行相关性分析。比较患者治疗前后的中医证候量化总分、中医症状单项评分。
结果
2
治疗4周后,2组患者血清中的hs-CRP、IL-6、ACTH及COR含量较治疗前下降(
P
<
0.01),且试验组患者的hs-CRP、IL-6、ACTH及COR含量低于对照组(
P
<
0.01)。治疗4周后,2组患者血清中的5-HT含量较治疗前升高(
P
<
0.01),且试验组患者的5-HT含量高于对照组(
P
<
0.01)。治疗前后,2组患者血清中的5-HT含量与hs-CRP、IL-6含量均呈负相关(
P
<
0.05,
P
<
0.01),hs-CRP、IL-6含量与ACTH、COR含量均呈正相关(
P
<
0.05,
P
<
0.01),5-HT与ACTH、COR含量均呈负相关(
P
<
0.01)。治疗后,2组患者中医证候量化总分和中医症状单项评分均较治疗前降低(
P
<
0.05,
P
<
0.01),试验组患者中医证候量化总分和中医症状单项评分低于对照组(
P
<
0.01)。
结论
2
双心方可能通过下调炎症因子hs-CRP、IL-6而降低炎症反应,进而增加5-HT的含量,降低下丘脑-垂体-肾上腺轴相关因子ACTH及COR含量,发挥双心同治的作用。
Objective
2
To observe the effects of
Shuangxin
Formula on hypersensitive C-reactive protein (hs-CRP)
interleukin-6 (IL-6)
5-hydroxytryptamine (5-HT)
adrenocorticotrophic hormone (ACTH) and cortisol (COR) in patients with depression after percutaneous coronary intervention (PCI) with syndrome of heart blood stasis.
Methods
2
Patients admitted to wards and outpatients of Dongfang Hospital
Beijing University of Chinese Medicine between April 2021 and December 2021 were selected. According to a random number table
72 patients who met the inclusion criteria were divided into the experimental group and the control group
with 36 cases per group. The control group was treated with conventional western medicine after PCI
and placebo. The experimental group was treated with conventional western medicine after PCI and
Shuangxin
Formula. The treatment period for both groups was 4 weeks. The serum levels of hs-CRP
IL-6
5-HT
ACTH
and COR in the experimental group and the control group before and after treatment were determined by enzyme-linked immunosorbent assay
and the correlation was analyzed. The total quantitative score of traditional Chinese medicine syndrome and the single score of traditional Chinese medicine symptoms were compared before and after treatment.
Results
2
After 4 weeks’ treatment
the serum levels of hs-CRP
IL-6
ACTH
and COR in the two groups decreased(
P
<
0.01)
and the levels of hs-CRP
IL-6
ACTH
and COR in the experimental group were lower than in the control group (
P
<
0.01). After 4 weeks’ treatment
the serum level of 5-HT was higher than before treatment in both group (
P
<
0.01)
and the serum level of 5-HT in the experimental group was higher than in the control group (
P
<
0.01). Before and after treatment
the level of 5-HT was negatively correlated with the serum levels of hs-CRP and IL-6 in the two groups (
P
<
0.05
P
<
0.01); the levels of hs-CRP and IL-6 were positively correlated with the levels of ACTH and COR (
P
<
0.05
P
<
0.01); and the level of 5-HT was negatively correlated with the levels of ACTH and COR (
P
<
0.01). After treatment
the total quantitative score of traditional Chinese medicine syndrome and the single score of traditional Chinese medicine symptoms in both groups were lower than those before treatment (
P
<
0.05
P
<
0.01). The total quantitative score of traditional Chinese medicine syndrome and the single score of traditional Chinese medicine symptoms in the experimental group were lower than in the control group (
P
<
0.01).
Conclusion
2
Shuangxin
Formula may reduce the inflammatory response by reducing the levels of the inflammatory factors hs-CRP and IL-6
and then upregulating the excitability of 5-HT
and inhibiting the levels of the HPA axis-related factors ACTH and COR
thus playing the role of spirit-heart treatment.
双心方经皮冠脉介入术抑郁状态炎症心血瘀阻证
Shuangxin Formulapercutaneous coronary interventiondepressioninflammationsyrdrome of heart blood stasis
李秋冶,王凤荣.中西医治疗PCI术后抑郁、焦虑的研究现状[J].中西医结合心脑血管病杂志,2021,19(16):2771-2775.
COCCHIO S, BAlDOVIN T, FURLAN P, et al. Is depression a real risk factor for acute myocardial infarction mortality? A retrospective cohort study[J/OL].BMC Psychiatry, 2019, 19(1): 122 [2023-02-17]. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2113-8.
LAVOIE KL, PAINE NJ, PELLETIER R, et al. Relationship between antidepressant therapy and risk for cardiovascular events in patients with and without cardiovascular disease[J]. Health Psychol, 2018,37(11):989-999.
鄂璐莎.冠心丹参滴丸联合辛伐他汀片治疗冠心病的临床研究[J].中国临床药理学杂志,2018,34(19):2252-2255.
WU ZT, WANG GH, WEI YY, et al. PI3K/AKT/GSK3beta/CRMP-2-mediated neuroplasticity in depression induced by stress[J].Neuroreport,2018,29(15):1256-1263.
TANTI A, BELZUNG C.Open questions in current models of antidepressant action[J].Br J Pharmacol,2010,159(6):1187-1200.
王超,杜泓森,侯季秋,等.慢性情绪应激对急性心肌梗死后骨髓c-kit+干细胞动员的影响[J].中国循环杂志,2018,33(7):709-713.
SUN YZ, WANG ZY, WANG CG, et al. Psycho-cardiology therapeutic effects of Shuangxinfang in rats with depression-behavior post acute myocardial infarction: Focus on protein S100A9 from proteomics [J/OL]. Biomed Pharmacother, 2021, 144: 112303 [2023-02-17]. https://linkinghub.elsevier.com/retrieve/pii/S0753332221010878.
WANG C, HOU JQ, DU HS, et al. Anti-depressive effect of Shuangxinfang on rats with acute myocardial infarction: Promoting bone marrow mesenchymal stem cells mobilization and alleviating inflammatory response[J]. Biomed Pharmacother, 2019, 111:19-30.
中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
中华中医药学会介入心脏病学专家委员会. 经皮冠状动脉介入治疗(PCI)手术前后抑郁和(或)焦虑中医诊疗专家共识[J].中医杂志,2015,56(4):357-360.
中国中西医结合学会神经科专业委员会. 抑郁症中西医结合诊疗专家共识[J].中国中西医结合杂志,2020, 40(2): 141-148.
胸痹心痛的诊断依据、证候分类、疗效评定:中华人民共和国中医药行业标准《中医内科病证诊断疗效标准》(ZY/T001.1—94)[J].辽宁中医药大学学报,2016,18(7):32.
郁病的诊断依据、证候分类、疗效评定:中华人民共和国中医药行业标准《中医内科病证诊断疗效标准》(ZY/T001.1—94)[J].辽宁中医药大学学报,2016,18(11):209.
中国中西医结合学会心血管病专业委员会双心学组.双心疾病中西医结合诊治专家共识[J].中国全科医学,2017,20(14):1659-1662.
刘建平.临床试验样本含量的计算[J].中国中西医结合杂志,2003,23(7):536-538.
张抗,李文元,冯硕,等.临床试验中脱落、退出和失访病例的统计学处理和报告规范[J].中医杂志,2016,5(14):1204-1207.
DING SH, XU SP, CHEN XN, et al. Effects of atorvastatin combined with bivalirudin on coagulation function, cardiac function, and inflammatory factors of percutaneous coronary intervention in elderly patients with acute myocardial infarction[J]. Ann Palliat Med, 2020, 9(4): 1905-1911.
黄文彩,蒋友明,范妤,等. AMI患者血清前白蛋白与炎症因子、血脂的相关性[J].现代医学,2019,47(1):78-80.
武智晓,李杰,王勃.外周血MPO、NLR、hs-CRP对ST段抬高型心肌梗死患者PCI术后主要不良心脏事件的预测价值[J].中国现代医学杂志,2022,32(6):90-96.
CHEN XH, TAN Y, YU SQ, et al. Pinitol Protects Against Ox-Low-Density Lipoprotein-Induced Endothelial Inflammation and Monocytes Attachment[J]. J Cardiovasc Pharmacol, 2022, 79(3): 368-374.
ZEB I, JORGENSEN NW, BLUMENTHAL RS, et al. Association of inflammatory markers and lipoprotein particle subclasses with progression of coronary artery calcium: The multiethnic study of atherosclerosis[J]. Atherosclerosis, 2021, 339: 27-34.
ANTONOPOULOS AS, ANGELOPOULOS A, PAPANIKOLAOU P, et al. Biomarkers of Vascular Inflammation for Cardiovascular Risk Prognostication: A Meta-Analysis[J]. JACC Cardiovasc Imaging, 2022,15(3):460-471.
郑全成,张宇,曾令慧,等.通督治郁针法联合头针疗法治疗卒中后抑郁的疗效及对血清5-HT和BDNF水平影响[J].针灸临床杂志,2021,37(9):25-28.
李润霞,张峥,刘艳清,等.疏肝解郁胶囊联合个性化愉悦元素积极刺激干预对脑卒中后抑郁患者5-HT、NE、DA的影响[J].辽宁中医杂志,2021,48(4):122-126.
JHA MK, QAMAR A, VADUGANATHAN M, et al. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review[J]. J Am Coll Cardiol,2019,73(14):1827-1845.
孙玉婵.解郁通心方治疗稳定型心绞痛合并焦虑的双心疗效观察[D].北京:中国中医科学院,2020.
CARROLL D, GINTY AT, WHITTAKER AC, et al. The behavioural, cognitive, and neural corollaries of blunted cardiovascular and cortisol reactions to acute psychological stress[J]. Neurosci Biobehav Rev, 2017, 77(6): 74-86.
WILEY JW, HIGGINS GA, ATHEY BD. Stress and glucocorticoid receptortranscriptional programming in time and space: Implications for thebrain-gut axis[J]. Neurogastroenterol Motil,2016,28(1):12-25.
ZHOU L, WANG T, YU YW, et al. The etiology of poststroke-depression: a hypothesis involving HPA axis[J/OL]. Biomed Pharmacother,2022,151: 113146 [2023-02-17]. https://linkinghub.elsevier.com/retrieve/pii/S0753332222005352.
GRYGIEL-GÓRNIAK B, LIMPHAIBOOL N, PUSZCZEWICZ M. Cytokine secretion and the risk of depression development in patients with connective tissue diseases[J]. Psychiatry Clin Neurosci, 2019,73(6):302-316.
SARNO E, MOESER AJ, ROBISON AJ.Neuroimmunology of depression[J].Adv Pharmacol,2021,91(4):259-292.
佟彤,刘红旭,李爱勇,等.冠心静胶囊对急性心肌梗死后抑郁模型大鼠血清炎症因子及HPA轴的影响[J].北京中医药,2017,36(12):1068-1071.
STETLER C, Miller GE. Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research[J]. Psychosom Med, 2011,73(2):114-126.
HUI YP, ZHANG QJ, ZHANG L, et al. Activation of prelimbic 5-HT1A receptors produces antidepressant-like effects in a unilateral rat model of Parkinson’s disease[J].Neuroscience, 2014,268(5):265-275.
ZHANG LL, YANG ZY, FAN G, et al. Antidepressant-like Effect of Citrus sinensis (L.) Osbeck Essential Oil and Its Main Component Limonene on Mice[J]. J Agric Food Chem, 2019, 67(50):13817-13828.
曹程.基于脑-肠轴调控的开心散抗抑郁功效物质基础研究[D].南京:南京中医药大学,2019.
PATTERSON ZR, KHAZALL R, MACKAY H, et al. Central ghrelin signaling mediates the metabolic response of C57BL/6 male mice to chronic social defeat stress[J]. Endocrinology, 2013,154(3):1080-1091.
陈力,薛瑞,于能江,等.小补心汤总黄酮对获得性无助小鼠的抗抑郁作用及其对HPA轴功能的影响[J].中国药理学通报,2015,31(6):815-821.
程铭威,靳利利,史振羽,等.疏肝理脾方治疗冠心病经皮冠状动脉介入术术后焦虑抑郁状态疗效研究[J].陕西中医,2022,43(9):1208-1211.
SUN DD, SHEN M, LI JY, et al. Cardioprotective effects of tanshinone ⅡA pretreatment via kinin B2 receptor-Akt-GSK-3β dependent pathway in experimental diabetic cardiomyopathy[J/OL]. Cardiovasc Diabetol, 2011, 10: 4 [2023-02-17]. https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-10-4.
张辛宁,王乐琪,李莎莎,等.丹参从瘀论治抑郁症的潜在靶点及作用机制研究[J].中药新药与临床药理,2021,32(9):1300-1308.
FANG J, LITTLE PJ, XU SW. Atheroprotective Effects and Molecular Targets of Tanshinones Derived from Herbal Medicine Danshen[J]. Med Res Rev, 2018, 38(1):201-228.
张睿,李冰洁,李庆林.酸枣仁皂苷A对脂多糖诱导小胶质细胞活化的影响及神经保护作用[J].中国临床药理学与治疗学,2018,23(2):126-131.
李冰洁.酸枣仁皂苷A对LPS诱导星形胶质细胞C6神经炎症反应机制的研究[D].合肥:安徽中医药大学,2018.
WANG Z, XIAO DR, JI QQ, et al. Jujuboside A attenuates sepsis-induced cardiomyopathy by inhibiting inflammation and regulating autophagy[J/OL]. Eur J Pharmacol, 2023, 947: 175451 [2023-02-17]. https://linkinghub.elsevier.com/retrieve/pii/S0014299922007129.
LEE E, YUN N, JANG YP, et al. Lilium lancifolium Thunb. extract attenuates pulmonary inflammation and air space enlargement in a cigarette smoke-exposed mouse model [J]. J Ethnopharmacol, 2013, 149(1): 148-156.
郭秋平,高英,李卫民.百合有效部位对抑郁症模型大鼠脑内单胺类神经递质的影响[J].中成药,2009,31(11):1669-1672.
郭秋平,高英,李卫民.百合皂苷对抑郁模型大鼠HPA轴的影响[J].中国药理学通报,2010,26(5):699-700.
WANG YF, HUANG M, LU XY, et al. Ziziphi spinosae lily powder suspension in the treatment of depression-like behaviors in rats[J/OL]. BMC Complement Altern Med, 2017, 17(1): 238 [2023-02-17]. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-017-1749-5.
PAO LH, LU SW, SUN GG, et al. Three Chinese herbal medicines promote neuroproliferation in vitro, and reverse the effects of chronic mild stress on behavior, the HPA axis, and proliferation of hippocampal precursor cell in vivo[J]. J Ethnopharmacol, 2012, 144(2): 261-269.
FU SN, WANG JT, HAO CG, et al. Tetramethylpyrazine ameliorates depression by inhibiting TLR4-NLRP3 inflammasome signal pathway in mice[J]. Psychopharmacology(Berl), 2019, 236(7): 2173-2185.
0
浏览量
19
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构