| Ischemic stroke is caused by insufficient or obstructed blood supply in the brain,which results in ischemia and anoxia of the brain tissue,local necrosis or softening of the brain tissue,and the corresponding signs and nervous system symptoms.Ischemia Post-stroke expression IPSD is a common and important complication of ischemic stroke.This is due to persistent depression after stroke and reduced interest as a core symptom of mood disorder.In clinical practice,clinicians often pay less attention to the emotion of patients with ischemic stroke,resulting in a low diagnostic rate of IPSD.The occurrence of depression after ischemic stroke significantly affects the prognosis and outcome of stroke patients.And the nervous system repair ability is poor,so the nerve function defect of IPSD patients is not good,affecting their quality of life,resulting in prolonged hospital stay,increased medical costs,to families.Society carries a heavy burden.Cognitive impairment and affective disorder after stroke are often accompanied,and interact with each other,so more and more people pay more attention to them.The results showed that the antidepressant response to depression after ischemic stroke was relatively poor,and the risk of recurrence and reburning was increased.Compared with non-vascular depression,the depressive dysfunction after ischemic stroke is more serious and the prognosis is worse.And 25%of patients with IPSD develop vascular dementia.Optimal treatment of ischemic post-stroke depression is particularly important.In recent years,it has been shown that butylphthalide protects neurons and nerve repair by reconstructing microcirculation of ischemic area,protecting mitochondrial function,scavenging free radicals,reducing inflammatory response,and improving cognitive function,but so far,butylphthalide has less clinical research on vascular depression.Sertraline is a novel selective serotonin reuptake inhibitors SSRIs-like antidepressants with relatively few side effects.Sertraline has been widely used in the treatment of IPSD,and has achieved a good curative effect.Objective:According to Butylphthalide Soft Capsules combined with sertraline in the treatment of depression after ischemic stroke?IPSD?to observe the adverse reaction and improve the compliance of patients with depressive symptoms in the combination of the NIHSS score,HAMD scale,clinical effect and mechanism of combination treatment of depression after ischemic stroke.The levels of VEGF,hs–CRP,IL–1?in serum were detected before and after treatment,and the correlation between VEGF,hs–CRP,IL–1?and degree of IPSD was observed?Methods:From February 2016 to December 2017,40 patients with first-episode ischemic stroke in Department of Neurology,affiliated Hospital of Hebei University,were selected as non-depressive group?n=40?.There were 16 females and 24 males aged 36 to 71years.The average age was 60.2 years old,80 patients with IPSD were selected as depression group,and were randomly divided into butyphthalide treatment group?15 female,25 male,age 35-72 years?.The average age was 61.7 years old)and the control group 40 cases?female18,male 22,age 37-69 years,mean 63.3 years old?,Diagnosis of ischemic stroke meets the standards of the 4thNational Conference on Cerebrovascular Disease,supported by cranial CT or MRI;The diagnosis of IPSD was based on ICD-10?ICD-10?and Hamilton Depression Scale according to Hamilton Depression scale?-17?.The HAMD score of all patients was?8.There was no significant difference in age and gender basis between the two groups?P>0.05?.All patients were given basic treatment of ischemic stroke:antiplatelet aggregation,statin lipid stable plaque,blood circulation,control of blood pressure and blood glucose,limb rehabilitation and psychotherapy for 8 weeks.The control group was treated with sertraline:50 mg/day once a day.?After 1 week of oral administration,it could be adjusted to 100-150mg according to the patient's condition and tolerance.?The butyphthalide treatment group took butyphthalide soft capsule 0.2g/L for 3/d on an empty stomach on the basis of the treatment of the control group.HAMD scale and National Institute of Health Stroke Scale scale were used to assess the degree of neurological deficits before and after 4W treatment and 8W treatment.The levels of VEGF,hs–CRP and IL–1?in the patients were measured,and the effect of treatment was compared between the two groups.Results:1.NIHSS score After 4 weeks of treatment,the NIHSS scores of the three groups were significantly different from those before treatment?P<0.05?.The comparison between the butyphthalide group and the non-depressive group was significantly lower than that of the control group?P<0.05?,and the NIHSS scores of the butyphthalide group and the non-depressive group were significantly lower than those of the control group?P<0.05?.But there was no significant difference between the former two groups?P<0.05?.After 8 weeks of treatment,there were significant differences in the NIHSS scores of the three groups compared with those before treatment and 4 weeks after treatment?P<0.05?,and the differences between the butyphthalide group and the control group were statistically significant?P<0.05?.The NIHSS score of butyphthalide group was slightly lower than that of non-depressive group,but there was no significant difference between non-depressive group and control group?P<0.01?.2.HAMD score After 4 weeks of treatment,the HAMD scores of the two groups were lower than those before treatment?P<0.05?,and the HAMD scores of the butyphthalide group were significantly lower than those of the control group?P<0.05?.The difference was statistically significant?P<0.05?.After 8 weeks of treatment,the HAMD scores of the two groups were significantly lower than those before treatment and 4 weeks after treatment,and there was a significant difference between the two groups.The HAMD score of butyphthalide treatment group was significantly lower than that of control group?P<0.01?,and the difference was statistically significant?P<0.01?.3.VEGFAfter 8 weeks of treatment,the serum VEGF level in butyphthalide group was significantly higher than that before treatment?P<0.05?,but the serum VEGF level in non-depressive group and control group was higher than that in control group.But there was no statistical difference between the two groups:butyphthalide group was significantly higher than that of non-depressive group and control group,but there was no significant difference between non-depressive group and control group?P<0.01?.4.hs-CRP?IL-1?Before treatment,the serum levels of hs-CR and IL-1?in depression group were significantly higher than those in non-depression group?P<0.05?.Intragroup comparison:the serum levels of hs-CR and IL-1?in the three groups were significantly lower than those before treatment?P<0.05?,while the serum levels of hs-CRP and IL-1?in the butyphthalide group and non-depressive group were significantly lower than those in the control group?P<0.05?.There was no significant difference between Dante phthalide group and non-depression group?P<0.01?.5.Three groups of patients were followed up,all patients had no obvious adverse reactions.Conclusion:1.Butylphthalide has a good therapeutic effect in adjuvant treatment of depression after ischemic stroke.One of its mechanisms may be to promote the secretion of vascular endothelial growth factor?VEGF?,promote angiogenesis,and thus protect neurovascular units.Another mechanism may be to correct the imbalance of inflammatory cytokine network,protect the nerve and blood vessels in ischemic area,and improve the symptoms of the patients.2.There was a positive correlation between NIHSS score and HAMD score and the severity of IPSD.Both of them were negatively correlated with serum VEGF content and positively correlated with serum hs-CRP?IL-1?content.3.Butyphthalide combined with sertraline can improve neurologic function as well as depression.It can effectively improve the quality of life of patients with IPSD.4.Before and after treatment,the general indicators were not significantly abnormal,indicating that butyphthalide combined with sertraline clinical application of safety is worthy of affirmation. |
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