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Article(id=1322922725894923244, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.02.008, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793338956568, onlineDateStr=2026-10-30, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793338956568, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793338956568, creator=13701087609, updateTime=1793338956568, updator=13701087609, issue=Issue{id=1322922680609014711, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='2', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793338945772, creator='13701087609', updateTime=1793340618065, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929694785536732, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929694785536733, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=37, endPage=40, ext={EN=ArticleExt(id=1322922726092055533, articleId=1322922725894923244, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Wenyang Jieyu Decoction（温阳解郁汤）on Serum Inflammatory Factors，Monoamine Transmitters and Intestinal Microflora in Post-stroke Depression Patients, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the effects of Wenyang Jieyu Decoction（温阳解郁汤）on serum inflammatory factors，monoamine neurotransmitter levels and intestinal microbiota in patients with post-stroke depression（PSD）.

Method

Ninety PSD patients admitted to the hospital from January 2020 to March 2023 were selected and divided into control group（45 cases）and observation group（45 cases）by using a random number table method. The control group took Paroxetine Hydrochloride Tablets orally，while the observation group took Wenyang Jieyu Decoction on the basis of control group. The treatment period for two groups was 8 weeks. The therapeutic effects of two groups were compared. The changes in daily living ability，depressive mood，neurological function，inflammatory factors，monoamine neurotransmitters and gut microbiota were compared before and after treatment.

Results

The effective rate of the observation group was higher than that of the control group（P<0.05）. After treatment，the daily activity level（ADL）scores of two groups were higher than those before treatment，while the Hamilton depression scale（HAMD）score and National Institute of Health stroke scale（NIHSS）score were lower than those before treatment（P<0.05）. The ADL score of the observation group was higher than that of the control group after treatment，while the HAMD score and NIHSSscore were lower than those of the control group（P<0.05）. After treatment，the levels of serum tumor necrosis factor-α（TNF-α），hypersensitive C-reactive protein（hs-CRP）and interleukin-6（IL-6）of two groups were lower than those before treatment（P<0.05）. And the levels of the observation group were lower than those of the control group（P<0.05）. After treatment，the levels of serum norepinephrine（NE），5-hydroxytryptamine，（5-HT）and dopamine（DA）of two groups were higher than those before treatment（P<0.05）and the levels of the observation group were higher than those of the control group（P<0.05）. After treatment，the levels of lactobacilli and bifidobacteria of two groups were higher than those before treatment，while the levels of Enterococcus and Escherichia coli were lower than those before treatment（P<0.05）. In the observation group，the levels of lactic acid bacteria and bifidobacteria were higher than those of the control group，while the levels of Enterococcus and Escherichia coli were lower than those of the control group（P<0.05）.

Conclusion

Wenyang Jieyu Decoction has a good therapeutic effect on PSD patients，which can significantly reduce inflammatory reactions，regulate monoamine neurotransmitter levels and improve intestinal microbiota changes.

, authors=Jundong HUANG, Shengwei WU, Qiuling LU, Hui ZHANG, Yilan LI, authorsList=Jundong HUANG, Shengwei WU, Qiuling LU, Hui ZHANG, Yilan LI, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322922727325180920, articleId=1322922725894923244, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=温阳解郁汤对脑卒中后抑郁患者血清炎症因子和单胺类递质水平及肠道菌群的影响, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

探讨温阳解郁汤对脑卒中后抑郁（Post stroke depression，PSD）患者血清炎症因子和单胺类递质水平及肠道菌群的影响。

方法

选择2020年1月—2023年3月收治的PSD患者90例，采用随机数字表法将其分为对照组与观察组各45例。对照组口服盐酸帕罗西汀片，观察组在对照组基础上服用温阳解郁汤。两组治疗周期8周。比较两组治疗疗效；治疗前后日常生活能力、抑郁情绪和神经功能，炎症因子，单胺类神经递质和肠道菌群变化。

结果

观察组PSD患者总有效率高于对照组（P<0.05）。两组治疗后PSD患者日常生活活动能力（Daily Activity Level，ADL）评分高于治疗前，而汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评分和美国国立卫生研究院卒中量表（National institute of health stroke scale，NIHSS）评分低于治疗前（P<0.05）；观察组治疗后PSD患者ADL评分高于对照组，而HAMD评分和NIHSS评分低于对照组（P<0.05）。两组治疗后PSD患者血清肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）、超敏C反应蛋白（Hypersensitive C-reactiveprotein，hs-CRP）和白介素-6（Interleukin-6，IL-6）水平低于治疗前（P<0.05）；观察组治疗后PSD患者血清TNF-α、hs-CRP和IL-6水平低于对照组（P<0.05）。两组治疗后PSD患者血清NE、5-HT和DA水平高于治疗前（P<0.05）；观察组治疗后PSD患者血清去甲肾上腺素（Norepinephrine，NE）、5-羟色胺（5-hydroxytryptamine，5-HT）和多巴胺（Dopamine，DA）水平高于对照组（P<0.05）。两组治疗后PSD患者乳酸杆菌和双歧杆菌高于治疗前，而肠球菌和大肠埃希菌低于治疗前（P<0.05）；观察组治疗后PSD患者乳酸杆菌和双歧杆菌高于对照组，而肠球菌和大肠埃希菌低于对照组（P<0.05）。

结论

温阳解郁汤对PSD患者疗效良好，可显著减轻患者炎症反应，调节单胺类递质水平，及改善肠道菌群变化。

, authors=黄俊东, 吴升伟, 卢秋伶, 章慧, 李一兰, authorsList=黄俊东, 吴升伟, 卢秋伶, 章慧, 李一兰, authorCompany=null, correspAuthors=null, authorNote=

黄俊东（1980-），男，广东广州人，副主任中医师，学士，研究方向：中西医结合治疗精神疾病、中医经方现代应用。

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黄俊东（1980-），男，广东广州人，副主任中医师，学士，研究方向：中西医结合治疗精神疾病、中医经方现代应用。

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黄俊东（1980-），男，广东广州人，副主任中医师，学士，研究方向：中西医结合治疗精神疾病、中医经方现代应用。

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journalName=长春中医药大学学报, refType=null, unstructuredReference=季强泽，张卫，李海燕. 百合知母汤联合脑电仿生电刺激仪治疗脑卒中后抑郁［J］. 长春中医药大学学报，2022，38（9）：998-1001., articleTitle=百合知母汤联合脑电仿生电刺激仪治疗脑卒中后抑郁, refAbstract=null), Reference(id=1322922736284213318, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, doi=null, pmid=null, pmcid=null, year=2022, volume=43, issue=10, pageStart=98, pageEnd=100, url=null, language=null, rfNumber=［24］, rfOrder=23, authorNames=李娜, 柳刚, 李传进, journalName=云南中医中药杂志, refType=null, unstructuredReference=李娜，柳刚，李传进，等. “温督调神”针刺结合森田疗法治疗脑卒中后抑郁经验［J］. 云南中医中药杂志，2022，43（10）：98-100., articleTitle=“温督调神”针刺结合森田疗法治疗脑卒中后抑郁经验, refAbstract=null), Reference(id=1322922736363905095, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, doi=null, pmid=null, pmcid=null, year=2022, volume=22, issue=18, pageStart=3480, pageEnd=3484, url=null, language=null, rfNumber=［25］, rfOrder=24, authorNames=梁子威, 苏嘉宝, 何炎坤, journalName=现代生物医学进展, refType=null, unstructuredReference=梁子威，苏嘉宝，何炎坤，等. 通督调神针法联合丹参川芎嗪注射液对脑卒中后抑郁患者血清神经营养指标和单胺类神经递质的影响［J］. 现代生物医学进展，2022，22（18）：3480-3484., articleTitle=通督调神针法联合丹参川芎嗪注射液对脑卒中后抑郁患者血清神经营养指标和单胺类神经递质的影响, refAbstract=null)], funds=[Fund(id=1322922734124146732, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, awardId=82004226, language=CN, fundingSource=国家自然科学基金青年科学基金项目(82004226), fundOrder=null, country=null), Fund(id=1322922734195449901, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, awardId=2023A03J0855, language=CN, fundingSource=广州市科技局市校（院）联合项目(2023A03J0855), fundOrder=null, country=null), Fund(id=1322922734279335982, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, awardId=510101-0101193, language=CN, fundingSource=广州市中医治未病服务提升工程建设项目(510101-0101193), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322922727547479033, tenantId=1146029695717560320, 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组别例数临床治愈显效有效无效总有效
观察组4515（33.33）15（33.33）10（22.22）5（11.11）40（88.89）
对照组459（20.00）13（28.89）9（20.00）14（31.11）31（68.89）
χ2值-----5.404
P值-----0.020
), ArticleFig(id=1322922731716616227, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=CN, label=表1, caption=

两组脑卒中后抑郁患者疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数临床治愈显效有效无效总有效
观察组4515（33.33）15（33.33）10（22.22）5（11.11）40（88.89）
对照组459（20.00）13（28.89）9（20.00）14（31.11）31（68.89）
χ2值-----5.404
P值-----0.020
), ArticleFig(id=1322922731808890916, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数ADL评分HAMD评分NIHSS评分
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4565.78±7.1685.47±4.64*18.84±3.128.28±1.76*19.54±2.3712.10±2.45*
对照组4567.03±6.5476.25±5.06*18.45±2.2911.32±2.34*20.31±2.4615.65±3.08*
t值-0.8659.0090.6766.9651.5126.051
P值-0.390<0.0010.501<0.0010.134<0.001
), ArticleFig(id=1322922731959885861, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=CN, label=表2, caption=

两组脑卒中后抑郁患者ADL评分、HAMD评分和NIHSS评分比较（±s）

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组别例数ADL评分HAMD评分NIHSS评分
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4565.78±7.1685.47±4.64*18.84±3.128.28±1.76*19.54±2.3712.10±2.45*
对照组4567.03±6.5476.25±5.06*18.45±2.2911.32±2.34*20.31±2.4615.65±3.08*
t值-0.8659.0090.6766.9651.5126.051
P值-0.390<0.0010.501<0.0010.134<0.001
), ArticleFig(id=1322922733625024550, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数TNF-α/（ng/L）hs-CRP/（mg/L）IL-6/（ng/L）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4529.45±4.5117.97±3.42*6.57±1.084.36±0.74*26.32±4.1216.56±3.27*
对照组4528.76±5.4323.12±4.08*6.71±1.145.45±0.92*25.57±3.2420.47±2.93*
t值-0.6566.4890.5986.1930.9605.974
P值-0.514<0.0010.551<0.0010.340<0.001
), ArticleFig(id=1322922733725687847, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=CN, label=表3, caption=

两组脑卒中后抑郁患者炎症因子水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数TNF-α/（ng/L）hs-CRP/（mg/L）IL-6/（ng/L）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4529.45±4.5117.97±3.42*6.57±1.084.36±0.74*26.32±4.1216.56±3.27*
对照组4528.76±5.4323.12±4.08*6.71±1.145.45±0.92*25.57±3.2420.47±2.93*
t值-0.6566.4890.5986.1930.9605.974
P值-0.514<0.0010.551<0.0010.340<0.001
), ArticleFig(id=1322922733796991016, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数NE/（ng/mL）5-HT/（ng/mL）DA/（pg/mL）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4521.32±4.3538.47±5.43*145.62±27.48263.47±37.94*38.48±5.5678.82±7.78*
对照组4520.48±4.6127.97±3.86*147.39±32.41193.52±25.56*39.20±6.7159.95±5.85*
t值-0.88910.5730.27910.2570.55413.004
P值-0.376<0.0010.781<0.0010.581<0.001
), ArticleFig(id=1322922733880877097, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=CN, label=表4, caption=

两组脑卒中后抑郁患者单胺类神经递质水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数NE/（ng/mL）5-HT/（ng/mL）DA/（pg/mL）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4521.32±4.3538.47±5.43*145.62±27.48263.47±37.94*38.48±5.5678.82±7.78*
对照组4520.48±4.6127.97±3.86*147.39±32.41193.52±25.56*39.20±6.7159.95±5.85*
t值-0.88910.5730.27910.2570.55413.004
P值-0.376<0.0010.781<0.0010.581<0.001
), ArticleFig(id=1322922733952180266, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数乳酸杆菌（lg copies/g）双歧杆菌（lg copies/g）肠球菌（lg copies/g）大肠埃希菌（lg copies/g）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
观察组453.12±0.326.58±0.76*6.95±0.639.84±0.82*8.42±0.464.67±0.38*35.42±3.5121.34±4.08*
对照组453.08±0.434.87±0.69*7.12±0.528.45±0.76*8.39±0.576.23±0.45*35.83±4.3428.49±3.76*
t值-0.50111.1751.3968.6490.27517.7680.4938.645
P值-0.618<0.0010.166<0.0010.784<0.0010.623<0.001
), ArticleFig(id=1322922734036066347, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922725894923244, language=CN, label=表5, caption=

两组脑卒中后抑郁患者肠道菌群变化比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数乳酸杆菌（lg copies/g）双歧杆菌（lg copies/g）肠球菌（lg copies/g）大肠埃希菌（lg copies/g）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
观察组453.12±0.326.58±0.76*6.95±0.639.84±0.82*8.42±0.464.67±0.38*35.42±3.5121.34±4.08*
对照组453.08±0.434.87±0.69*7.12±0.528.45±0.76*8.39±0.576.23±0.45*35.83±4.3428.49±3.76*
t值-0.50111.1751.3968.6490.27517.7680.4938.645
P值-0.618<0.0010.166<0.0010.784<0.0010.623<0.001
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温阳解郁汤对脑卒中后抑郁患者血清炎症因子和单胺类递质水平及肠道菌群的影响
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黄俊东 , 吴升伟 , 卢秋伶 , 章慧 , 李一兰
中华中医药学刊 | 国家项目点击 2025,43(2): 37-40
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中华中医药学刊 |国家项目点击 2025 , 43 (2) : 37 -40
温阳解郁汤对脑卒中后抑郁患者血清炎症因子和单胺类递质水平及肠道菌群的影响
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黄俊东, 吴升伟, 卢秋伶, 章慧, 李一兰
作者信息
  • 广州医科大学附属脑科医院，广东 广州 510370
作者简介:

黄俊东（1980-），男，广东广州人，副主任中医师，学士，研究方向：中西医结合治疗精神疾病、中医经方现代应用。

Effect of Wenyang Jieyu Decoction（温阳解郁汤）on Serum Inflammatory Factors，Monoamine Transmitters and Intestinal Microflora in Post-stroke Depression Patients
Jundong HUANG, Shengwei WU, Qiuling LU, Hui ZHANG, Yilan LI
Affiliations
  • Affiliated Brain Hospital of Guangzhou Medical University，Guangzhou 510370，Guangdong，China
出版时间: 2025-02-10 doi: 10.13193/j.issn.1673-7717.2025.02.008
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摘要
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目的

探讨温阳解郁汤对脑卒中后抑郁（Post stroke depression，PSD）患者血清炎症因子和单胺类递质水平及肠道菌群的影响。

方法

选择2020年1月—2023年3月收治的PSD患者90例，采用随机数字表法将其分为对照组与观察组各45例。对照组口服盐酸帕罗西汀片，观察组在对照组基础上服用温阳解郁汤。两组治疗周期8周。比较两组治疗疗效；治疗前后日常生活能力、抑郁情绪和神经功能，炎症因子，单胺类神经递质和肠道菌群变化。

结果

观察组PSD患者总有效率高于对照组（P<0.05）。两组治疗后PSD患者日常生活活动能力（Daily Activity Level，ADL）评分高于治疗前，而汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评分和美国国立卫生研究院卒中量表（National institute of health stroke scale，NIHSS）评分低于治疗前（P<0.05）；观察组治疗后PSD患者ADL评分高于对照组，而HAMD评分和NIHSS评分低于对照组（P<0.05）。两组治疗后PSD患者血清肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）、超敏C反应蛋白（Hypersensitive C-reactiveprotein，hs-CRP）和白介素-6（Interleukin-6，IL-6）水平低于治疗前（P<0.05）；观察组治疗后PSD患者血清TNF-α、hs-CRP和IL-6水平低于对照组（P<0.05）。两组治疗后PSD患者血清NE、5-HT和DA水平高于治疗前（P<0.05）；观察组治疗后PSD患者血清去甲肾上腺素（Norepinephrine，NE）、5-羟色胺（5-hydroxytryptamine，5-HT）和多巴胺（Dopamine，DA）水平高于对照组（P<0.05）。两组治疗后PSD患者乳酸杆菌和双歧杆菌高于治疗前，而肠球菌和大肠埃希菌低于治疗前（P<0.05）；观察组治疗后PSD患者乳酸杆菌和双歧杆菌高于对照组，而肠球菌和大肠埃希菌低于对照组（P<0.05）。

结论

温阳解郁汤对PSD患者疗效良好，可显著减轻患者炎症反应，调节单胺类递质水平，及改善肠道菌群变化。

温阳解郁汤  /  脑卒中  /  抑郁  /  炎症因子  /  单胺类神经递质  /  肠道菌群
Objective

To explore the effects of Wenyang Jieyu Decoction（温阳解郁汤）on serum inflammatory factors，monoamine neurotransmitter levels and intestinal microbiota in patients with post-stroke depression（PSD）.

Method

Ninety PSD patients admitted to the hospital from January 2020 to March 2023 were selected and divided into control group（45 cases）and observation group（45 cases）by using a random number table method. The control group took Paroxetine Hydrochloride Tablets orally，while the observation group took Wenyang Jieyu Decoction on the basis of control group. The treatment period for two groups was 8 weeks. The therapeutic effects of two groups were compared. The changes in daily living ability，depressive mood，neurological function，inflammatory factors，monoamine neurotransmitters and gut microbiota were compared before and after treatment.

Results

The effective rate of the observation group was higher than that of the control group（P<0.05）. After treatment，the daily activity level（ADL）scores of two groups were higher than those before treatment，while the Hamilton depression scale（HAMD）score and National Institute of Health stroke scale（NIHSS）score were lower than those before treatment（P<0.05）. The ADL score of the observation group was higher than that of the control group after treatment，while the HAMD score and NIHSSscore were lower than those of the control group（P<0.05）. After treatment，the levels of serum tumor necrosis factor-α（TNF-α），hypersensitive C-reactive protein（hs-CRP）and interleukin-6（IL-6）of two groups were lower than those before treatment（P<0.05）. And the levels of the observation group were lower than those of the control group（P<0.05）. After treatment，the levels of serum norepinephrine（NE），5-hydroxytryptamine，（5-HT）and dopamine（DA）of two groups were higher than those before treatment（P<0.05）and the levels of the observation group were higher than those of the control group（P<0.05）. After treatment，the levels of lactobacilli and bifidobacteria of two groups were higher than those before treatment，while the levels of Enterococcus and Escherichia coli were lower than those before treatment（P<0.05）. In the observation group，the levels of lactic acid bacteria and bifidobacteria were higher than those of the control group，while the levels of Enterococcus and Escherichia coli were lower than those of the control group（P<0.05）.

Conclusion

Wenyang Jieyu Decoction has a good therapeutic effect on PSD patients，which can significantly reduce inflammatory reactions，regulate monoamine neurotransmitter levels and improve intestinal microbiota changes.

Wenyang Jieyu Decoction（温阳解郁汤）  /  stroke  /  depression  /  Inflammatory factors  /  monoamine neurotransmitters  /  intestinal microbiota
黄俊东, 吴升伟, 卢秋伶, 章慧, 李一兰. 温阳解郁汤对脑卒中后抑郁患者血清炎症因子和单胺类递质水平及肠道菌群的影响. 中华中医药学刊, 2025 , 43 (2) : 37 -40 . DOI: 10.13193/j.issn.1673-7717.2025.02.008
Jundong HUANG, Shengwei WU, Qiuling LU, Hui ZHANG, Yilan LI. Effect of Wenyang Jieyu Decoction（温阳解郁汤）on Serum Inflammatory Factors，Monoamine Transmitters and Intestinal Microflora in Post-stroke Depression Patients[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (2) : 37 -40 . DOI: 10.13193/j.issn.1673-7717.2025.02.008
正文
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脑卒中是常见的一种脑血管疾病，具有发病急、病情较重等特点，严重影响患者身心健康[1]。脑卒中常伴抑郁情绪，据表明脑卒中后抑郁（Post stroke depression，PSD）发病率占脑卒中的20%～50%[2]。PSD临床表现主要为兴趣减退、易怒、情绪低落，随着病情的进展，会出现社会功能和认知功能障碍，严重影响患者神经功能恢复，从而延长治疗时间，导致患者生活质量下降[3-4]。目前，关于PSD治疗主要在原发病治疗基础上结合抗抑郁药物治疗，但通常治疗效果并不十分理想，且不良反应较多[5]。中医学认为PSD属“郁证”范畴，是在中风病后情志不畅所致的抑郁症状。研究证实，中医药可有效改善PSD患者症状，取得良好临床疗效，加之其治疗机制多特点，备受关注[6]。基于此，本研究选择我院于2020年1月-2023年3月收治的PSD患者90例，旨在探讨温阳解郁汤对PSD患者血清炎症因子和单胺类递质水平及肠道菌群的影响。现报道如下。
1　资料与方法
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1.1　一般资料
选择我院于2020年1月—2023年3月收治的PSD患者90例，采用随机数字表法将其分为对照组与观察组各45例。对照组中，男25例，女20例；年龄47～73岁，平均（58.89±5.51）岁；体质量指数16～28 kg/m2，平均（22.04±2.31）kg/m2；病程1～5个月，平均（2.93±0.74）个月。观察组中，男26例，女19例；年龄45～74岁，平均（59.42±6.72）岁；体质量指数15～27 kg/m2，平均（21.87±2.25）kg/m2；病程1～6个月，平均（3.01±0.68）个月。两组一般资料比较差异无统计学意义（P>0.05）。本研究经本医院医学伦理委员会审核通过。
1.2　纳入标准
（1）依据《中国各类主要脑血管病诊断要点2019》[7]、《中国神经障碍分类与诊断标准》[8]和《中医内科病证诊断疗效标准》[9]相关诊断标准；（2）经颅脑CT、MRI证实为脑卒中；（3）均为首次确诊，且患者病情稳定；（4）签署知情同意书。
1.3　排除标准
（1）合并严重血液系统疾病、精神系统疾病、呼吸系统疾病及心脑血管系统疾病者；（2）合并其他精神类疾病者；（3）恶性肿瘤者；（4）存在认知功能障碍及沟通交流障碍者；（5）入组前1个月服用抗医药药物者；（6）过敏体质者。
1.4　治疗方法
两组患者入院均给予基础治疗，包括营养支持、抗血小板聚集、降低颅内压、维持水电解质平衡及心理疏导等。对照组：口服盐酸帕罗西汀片（浙江华海药业股份有限公司；规格：20 mg×7片×2板/盒；国药准字H20031106）1片/次，1次/d；观察组：在对照组基础上服用温阳解郁汤，处方如下：附子15 g，桂枝6 g，生姜6 g，炙甘草6 g，大枣6枚，乌梅6 g，诸药水煎，取汁450 mL，1剂/d，分早、中、晚3次服用。两组治疗周期均为8周。
1.5　疗效标准
依据疗效指数评价疗效。（治疗前积分-治疗后积分）/治疗前积分×100%＝疗效指数。（1）临床治愈：治疗后，疗效指数≥95%；（2）显效：治疗后，95% >疗效指数≥70%；（3）有效：治疗后，70% >疗效指数≥30%；（4）无效：治疗后疗效指数<30%。总有效率＝临床治愈率+显效率+有效率。
1.6　观察指标
（1）观察两组治疗前后PSD患者日常生活能力、抑郁情绪和神经功能变化，采用日常生活活动能力（Daily activity level，ADL）量表评价患者日常生活能力，评分最高100分，最低0分，评分越高日常生活活动能力越好；采用汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评价患者抑郁情绪，以评分<8分没有抑郁，以评分8～24分表示轻中度抑郁，以评分>24分表示重度抑郁；采用美国国立卫生研究院卒中量表（National institute of health stroke scale，NIHSS）评价患者神经功能，评分最高42分，最低0分，评分越高神经功能缺损越严重。（2）观察两组治疗前后PSD患者炎症因子变化，采集患者清晨空腹肘静脉血3 mL，离心10 min，半径10 cm，转速2500 r/min，收集血清，运用ELISA法测定肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）、超敏C反应蛋白（Hypersensitive C -reactiveprotein，hs-CRP）和白介素-6（Interleukin-6，IL-6）。（3）观察两组治疗前后PSD患者单胺类神经递质水平变化，采集患者清晨空腹肘静脉血3 mL，离心10 min，半径10 cm，转速2500 r/min，收集血清，运用ELISA法测定去甲肾上腺素（Norepinephrine，NE）、5-羟色胺（5-hydroxytryptamine，5-HT）和多巴胺（Dopamine，DA）水平。（4）观察两组治疗前后PSD患者肠道菌群变化，采集患者新鲜粪便5 g，加入10 mL的磷酸盐缓冲盐，充分混合均匀，以半径10 cm，转速8000 r/min，离心12 min，取上清液，再半径10 cm，转速8000 r/min，离心8 min，通过DNA提取试剂盒提取DNA，并行乳酸杆菌、双歧杆菌、肠球菌和大肠埃希菌PCR反应，计算肠道菌群数量，以lg copies/g表示。
1.7　统计学处理
运用SPSS 26.0软件分析。计数资料以百分率表示，采用χ2检验；计量资料以（）表示，采用t检验。P<0.05为差异有统计学意义。
2　结果
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2.1　患者疗效比较
观察组PSD患者总有效率高于对照组（P<0.05）。见表1。
2.2　ADL评分、HAMD评分和NIHSS评分比较
两组治疗后PSD患者ADL评分高于治疗前，而HAMD评分和NIHSS评分低于治疗前（P<0.05）；观察组治疗后PSD患者ADL评分高于对照组，而HAMD评分和NIHSS评分低于对照组（P<0.05）。见表2。
2.3　炎症因子水平比较
两组治疗后PSD患者血清TNF-α、hs-CRP和IL-6水平低于治疗前（P<0.05）；观察组治疗后PSD患者血清TNF-α、hs-CRP和IL-6水平低于对照组（P<0.05）。见表3。
2.4　单胺类神经递质水平比较
两组治疗后PSD患者血清NE、5-HT和DA水平高于治疗前（P<0.05）；观察组治疗后PSD患者血清NE、5-HT和DA水平高于对照组（P<0.05）。见表4。
2.5　肠道菌群变化比较
两组治疗后PSD患者乳酸杆菌和双歧杆菌高于治疗前，而肠球菌和大肠埃希菌低于治疗前（P<0.05）；观察组治疗后PSD患者乳酸杆菌和双歧杆菌高于对照组，而肠球菌和大肠埃希菌低于对照组（P<0.05）。见表5。
3　讨论
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脑卒中的肢体功能、神经功能等发病中受不同程度损伤，病情稳定后，由于康复时间较长，容易发生PSD[10-11]。PSD是常见的脑卒中后的精神障碍中的一种情感障碍并发症，患者出现思维功能减退、活动能力下降、情绪低落及淡漠等情感障碍[12-13]。现阶段，针对PSD患者主要是按照患者实际情况进行针对性综合治疗方法，但由于受个体差异的影响，导致临床疗效并不稳定[14]。
祖国医学认为PSD属“郁证”范畴，中医学的“郁”最早见于《黄帝内经》，郁证离乱涵盖了“因病致郁”和“因郁致病”两个方面。《景岳全书·郁证》曰：“凡五气之郁则诸病皆有，此因病而郁也。”《内经》云：“阳气者，精则养神”，《易经》指出：“阳主动”之说，而郁证诸多表现为“少动”或者“不动”，可见“阳气”在郁证发病中发挥关键作用。同时，中医理论认为PSD多因脑卒中后情志不畅，造成肝失疏泄，气机郁结，引发抑郁情绪[15-17]。因此，应以温阳解郁为治疗法则。温阳解郁汤由郑钦安《医法圆通》之补坎益离丹化裁而来，方中“附子辛热，能补坎中真阳，真阳为君火之种，补真火即是补君火也”，同时上助心阳、中温脾阳；桂枝、生姜辛通心阳，疏肝气，温肝阳，补肝用；炙甘草、大枣甘缓其中，合辛甘化阳、酸甘化阴之意，同时“甘草补中有引火归根之妙”，生姜、大枣温中焦，助脾阳，乌梅统领阳药入肝，温补肝阳，使肝中阳气得以升发，又可敛肝气、养肝血以柔肝，正合肝“体阴而用阳”的生理特性。诸药合用，复肾阳、补肝阳、暖心阳、运脾阳，收纳微阳于肾，伏虚火于中，切合抑郁症之病机。现代药理研究表明，温阳解郁汤具有多种生理活性，如抗血小板聚集、改善微循环、缓解记忆功能障碍、抗炎、调节免疫力、抗抑郁、镇静催眠、保护脑内神经元及提高抗氧化能力等。本研究表明，观察组PSD患者总有效率高于对照组，由此可见温阳解郁汤可提高疗效；观察组治疗后PSD患者ADL评分高于对照组而HAMD评分和NIHSS评分低于对照组，由此可见温阳解郁汤可提高日常生活能力、减轻抑郁情绪及改善神经功能。
炎症因子与PSD发生、发展密切相关。炎症反应在脑损伤的生理病理过程中发挥关键作用，是抑郁症和脑卒中共同的病理基础，炎症因子异常分泌会导致脑卒中和抑郁情绪明显加重[18]。TNF-α和IL-6主要由炎症状态下活化的巨噬细胞产生，能够介导炎症级联反应；hs-CRP是急性炎症反应的关键标志物之一[19]。本研究表明，观察组治疗后PSD患者血清TNF-α、hs-CRP和IL-6水平低于对照组，由此可见温阳解郁汤可降低血清TNF-α、hs-CRP和IL-6水平而减轻炎症反应。
NE、5-HT和DA是重要的单胺类神经递质，这些物质能够将兴奋性通过神经元轴突传至丘脑和基底节，再至额叶皮层，从而参与情感调节；NE、5-HT和DA神经通过遭到破坏，则会造成其水平下降而致使抑郁[5，20]。其中NE是儿茶酚胺的一种，其水平变化与机体情绪活动相关，当NE水平下降时，则会诱发认知功能、注意力等损伤，从而导致患者抑郁情况加重。5-HT是重要的一种中枢神经系统神经递质，当其水平减少容易发生抑郁症。本研究表明，观察组治疗后PSD患者血清NE、5-HT和DA水平高于对照组，由此可见温阳解郁汤可提高患者NE、5-HT和DA水平，调节单胺类神经递质水平，而提高疗效。
肠道菌群变化与PSD发生、发展密切相关。随着宏基因组学的不断发展，越来越关注从脑肠轴的角度对肠道微生物与各种神经系统疾病的关系，肠道微生物能够通过代谢系统调节通路、免疫调节通路、内分泌调节通路、神经内-分泌调节通路对神经系统功能进行调节，从而影响人体情绪和行为表现[21-23]。PSD可通过神经免疫系统导致肠道菌群紊乱，从而引起肠道影响，并且影响色氨酸代谢产物的合成，破坏5-HT信号传导，进一步导致PSD加重[24-25]。本研究表明，观察组治疗后PSD患者乳酸杆菌和双歧杆菌高于对照组，而肠球菌和大肠埃希菌低于对照组，由此可见温阳解郁汤可通过增加乳酸杆菌和双歧杆菌数量及降低肠球菌和大肠埃希菌数量，而调节患者肠道菌群水平。
综上所述，温阳解郁汤对PSD患者疗效良好，可显著减轻患者炎症反应，调节单胺类递质水平，改善肠道菌群变化。
基金
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  • 国家自然科学基金青年科学基金项目(82004226)
  • 广州市科技局市校（院）联合项目(2023A03J0855)
  • 广州市中医治未病服务提升工程建设项目(510101-0101193)
文献
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参考文献 引证文献
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doi: 10.13193/j.issn.1673-7717.2025.02.008
  • 首发时间：2026-10-30
  • 出版时间：2025-02-10
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国家自然科学基金青年科学基金项目(82004226)
广州市科技局市校（院）联合项目(2023A03J0855)
广州市中医治未病服务提升工程建设项目(510101-0101193)
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    广州医科大学附属脑科医院，广东 广州 510370
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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