摘要目的 观察不同证型抑郁症在应用5-羟色胺再摄取抑制剂类(SSRI)抗抑郁药基础七联合中药汤剂治疗抑郁症的临床疗效.方法 肝郁气滞型70例、肝郁脾虚型 60例、心脾两虚型50例抑郁症患者,在各证型内应用随机数字表法分为两组,即肝郁气滞研究组34例和对照组36例、肝郁脾虚研究组30例和对照组30例、心脾两虚研究组24例和对照组26例;研究组在SSRI的基础上联合不同的中医汤剂,对照组仅给予SSRI抗抑郁药,应用海米尔吨抑郁评定量表(HAMD)、海米尔吨焦虑评定量表(HAMA)、临床总体印象(CGI)在治疗前、治疗后1周末、2周末、4周末、6周末分别进行评定,比较两组间的症状变化、有效率、痊愈率.结果 ①抑郁量表评分:肝郁气滞研究组和对照组、肝郁脾虚研究组和对照组在治疗后4周末[肝郁气滞研究组:(9.01±3.45)、对照组(13.02±4.54);肝郁脾虚研究组(10.22±3.23)、对照组(14.12±3.87)]、6周末[肝郁气滞研究组:(6.02±2.20)、对照组(10.22±2.10);肝郁脾虚研究组(7.25+2.20)、对照组(10.68±3.45)]抑郁量表评分逐渐降低,差异均有统计学意义(P<0.05);且从第1周末开始焦虑症状改善:心脾两虚研究组和对照组的HAMD、HAMA均未见明显变化;②肝郁气滞研究组、肝郁脾虚研究组的有效率(分别为70.6%、66.6%)分别高于各自的对照组(47.2%、40.0%),组间比较差异有统计学意义;心脾两虚研究组和对照组的有效率(分别为58.3%、50.0%)比较,差异无统计学意义(P>0.05);③三个证型的研究组和对照组之间痊愈率比较,差异均无统计学意义(肝郁气滞型分别为41.1%、30.6%,χ2=0.859,P>0.05;肝郁脾虚型分别为40.0%、33.3%,χ2=0.287,P>0.05:心脾两虚型分别为33.3%、26.9%,χ2=0.244,P>0.05).结论 肝郁气滞、肝郁脾虚型SSRI联合中药汤剂可提高抑郁症抗抑郁药物的疗效,改善焦虑.

abstractsObjective To observe the effect of SSRI combined with TCM on the treatment of depression of different TCM types. Methods 70 depressive patients of stagnation of liver qi (SLQ) were randomly recruited into a study (34 cases) and a control group (36 cases); 60 depressive patients of spleen deficiency and liver qi stagnation (SDLQS) were randomly recruited into a study (30 cases) and a control group (30 cases); and SO depressive patients of deficiency of both heart and liver (DBHL) were randomly recruited into a study (24 cases) and a control group (26 cases). Patients in the study group were treated with SSRI and TCM; with the control group was only treated with SSRI. All patients were assessed with HAMD, HAMA and CGI before treatment and after treatment at 1st weekend, 2nd weekend, 4th weekend and 6th weekend. Differences of effective rate and full remission rate were contrasted. Results ①Scores of depression scale decreased in both the study group and the control group of patients with SLQ and SDLQS at the 4th [SLQ study group: (9.01±3.45), control group (13.02±4.54); SDLQS study group (10.22±3.23)、 control group (14.12±3.87)] and 6th [SLQ study group (6.02±2.20), control group (10.22±2.10); SDLQS study group (7.25±2.20) control group (10.68 ± 3.45)] weekend, showing statistical differences; anxiety state has been improved since the 1st weekend; no obvious changes of HAMD and HAMA showed in both the study group and the control group of patients with DBHL; ②Therapeutic effects in the study group were higher than the control group of both patients with SLQ and SDLQS, showing statistical significance; while no difference can be seen between the two group of patients with DBHL; ③ No differences of full remission rate between the study group and the control group of 3 TCM types were found(SLQ:41.1%v30.6%,χ2=0.859,P>0.05; SDLQS:40.0%v33.3, χ2=0.287,P>0.05; DBHL: 33.3%v26.9%,χ2=0.244,P>0.05). ④Significant differences of HAMD and HMDA between the study and the control group of 3 TCM types were found before and after treatment Conclusion SSRI integrated with TCM may promote effective rate and decrease anxiety in patients with SLQ and SDLQS.