| Stroke is a common disease in neurology.Despite its stable incidence and reduced mortality over the past two decades,stroke survivors,stroke-related disability and stroke-related deaths are increasing year by year.PSD is a disease characterized by neuropsychiatry in the clinic because it adversely affects rehabilitation and quality of life,interferes with rehabilitation,and is an important burden for the caregiver.Even more worrisome is that stroke is a chronic,serious cause of adult disability that requires long-term recovery.Despite the progress in prevention and treatment,it is still a serious problem for patients and families,and a huge burden on public finances.PSD is a maj or predictor of poor prognosis after stroke because it is associated with disability,sleep disorders,poor rehabilitation,cognitive impairment,etc.And cognitive impairment leads to avoidance of socialization and isolation,as well as increased mortality.Although the pathogenesis of PSD has not been fully elucidated,we have found that neuroimmunological mechanisms play a maj or role.Studies have found that inducible nitric oxide synthase(iNOS)is closely related to acute or chronic stress or depression caused by acute and chronic inflammatory reactions.Experimental studies have found that the level of macrophage inflammatory protein-l?(MIP-l?)in patients with depression is significantly increased,and the level of anti-depressant drugs decreases after treatment,suggesting that MIP-la may be involved in the pathogenesis of depression.At present,there are many studies on the correlation between serum IL-1?,IL-6 and TNF-a levels and post-stroke depression,and there are few studies on iNOS and MIP-la in patients with PSD.At present,selective serotonin reuptake inhibitor(SSRI)is the main therapeutic drug for PSD in clinical practice,whose effect is significant,but the application is limited due to insufficient understanding of PSD and some side effects.Flupentixol and Melitracen Tablets is a new type of antidepressant that produces good antidepressant effects and is effective in treating depression or anxiety.At the same time,Shugan Granule has the effect of soothing liver and relieving depression.It has been shown that Shugan Granule also has a certain effect on the treatment of PSD.Therefore,we selected PSD patients to detect the correlation between serum iNOS and MIP-la levels and PSD by detecting serum iNOS and MIP-la levels in patients with PSD.The effects of Shugan Granules on serum iNOS and MIP-la levels were observed,and the role of neuroimmunology in the mechanism of PSD was further revealed,which provided clues and evidence for the early detection and treatment of PSDObjectives:By measuring the changed level of PSD group's iNOS and MIP-la before and after treatment,analyzed the correlation between these two factors and post-cerebral infarction depression,to reveal the inflammatory cytokines related to neuroimmunity in the post-cerebral infarction depression course,providing indicators for clinical diagnosis and prediction.At the same time,through the observation of the efficacy of Shugan Granule in the treatment of post-cerebral infarction depression,it provides a new idea for the treatment of post-cerebral infarction depression and other depressionMethod:80 patients of cerebral infarction in the basal ganglia who were hospitalized for the first time from October 2017 to January 2019 in the Affiliated Hospital of Hebei University were enrolled in the PSD group and randomly divided into the treatment group and the control group.Forty patients with concurrent cerebral infarction were enrolled in the non-PSD group;The normal group was selected health checkup people from the outpatient clinic of our hospital for the same period of time.The control group of the PSD group was given oral Flupentixol and Melitracen Tablets on the basis of conventional treatment:10.5 mg orally at morning and noon;The treatment group was supplemented with Shugan granules on the basis of the control group:1 bag 3/day orally.The iNOS and MIP-la levels of PSD group were measured before and 4 weeks after treatment.Evaluated the HAMD scores of the treatment group and the control group before treatment and 4 weeks after treatment to evaluate the therapeutic effect of the drugResults:1.The levels of INOS and MIP-la in the non-PSD group,the normal group and the PSD group before treatment:Compared with the normal group and the non-PSD group,the levels of serum iNOS and MIP-la in the PSD group were significantly higher than those in the other two groups;non-PSD Compared with the normal group,serum iNOS and MIP-la levels were higher,but not statistically significant2.The levels of iNOS in the PSD-treated group and the control group before and after treatment:The levels of iNOS in the PSD-treated group and the control group were not significantly different before treatment.The level of iNOS in the PSD-treated group decreased after treatment,and the difference was statistically significant.The iNOS level in the control group decreased after treatment,and the difference was statistically significant.Compared with the control group,the iNOS level was lower in the latter treatment group,and the difference was statistically significant(P<0.05).3.The levels of MIP-la in the PSD-treated group and the control group before and after treatment:The levels of MIP-la in the PSD-treated group and the control group were not significantly different before treatment.The level of MIP-la in the PSD-treated group decreased after treatment,and the difference was statistically significant.The MIP-la level in the control group decreased after treatment,and the difference was statistically significant.Compared with the control group,the MIP-la level was lower in the latter treatment group,and the difference was statistically significant(P<0.05).4.Correlation between depression degree and iNOS in patients with PSD:The HAMD score of patients in PSD group was positively correlated with iNOS(r=0.262),indicating that the more severe the depression,the higher the serum iNOS level.5.Correlation between depression degree and MIP-la in patients with PSD:The HAMD score of patients in PSD group was positively correlated with MIP-la(r=0.262),indicating that the more severe the depression,the higher the sermm iNOS level.6.Comparison of HAMD scores before and after treatment in PSD treatment group and control group:The HAMD scores of the PSD-treated group and the control group did not differ significantly before treatment;the HAMD scores of the PSD-treated group decreased significantly after treatment,and the difference was statistically significant;the HAMD score of the control group decreased after treatment,and the difference was not statistically significant;Compared with the control group,the treatment group had a lower HAMD score,and the difference was statistically significant(P<0.05).Conclusion:In summary,the concentration of iNOS and MIP-la in the seum of patients with PSD is high,and participates in the pathogenesis of PSD,which has guiding significance for predicting post-cerebral infarction depression.At the same time,the HAMD score of patients with Shugan granule combined with Flupentixol and Melitracen Tablets treatment decreased,and the depression mood improved significantly,suggesting that the combination of Chinese and Western medicine has a significant effect on improving patients' depressive symptoms.The sample can be further expanded for research and provide theoretical basis for clinical application. |
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