目的 探討齊拉西酮聯(lián)合度洛西汀治療老年腦卒中后抑郁的臨床療效及對(duì)患者相關(guān)神經(jīng)遞質(zhì)水平的影響。方法 回顧性選取2019年1月-2020年1月于德州市第二人民醫(yī)院接受治療的100例老年腦卒中后抑郁患者為研究對(duì)象，按治療方法不同將患者分為對(duì)照組和試驗(yàn)組，每組各50例，對(duì)照組患者單純給予鹽酸度洛西汀腸溶片口服治療，每次20 mg，每天2次（早晨、中午各服用1次）。試驗(yàn)組在對(duì)照組給藥基礎(chǔ)上聯(lián)用小劑量的鹽酸齊拉西酮片，每天10~20 mg，兩組患者均治療8周。治療后通過漢密爾頓抑郁量表（HAMD）減分率對(duì)療效進(jìn)行評(píng)價(jià)；分別于治療前及治療8周后對(duì)兩組患者進(jìn)行各項(xiàng)指標(biāo)評(píng)估：采用HAMD評(píng)估抑郁癥狀，采用美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）評(píng)價(jià)神經(jīng)功能缺損程度，采用蒙特利爾認(rèn)知評(píng)估量表（MoCA）評(píng)定認(rèn)知功能，采用卡氏功能狀態(tài)量表（KPS）評(píng)定生活質(zhì)量；分別于治療前及治療8周后使用放射免疫計(jì)數(shù)儀檢測(cè)患者血漿中5-羥色胺（5-HT）、內(nèi)皮素（ET）水平。治療8周后測(cè)定副反應(yīng)量表（TESS）評(píng)分?；颊叱鲈汉笠噪娫掚S訪的方式進(jìn)行1年隨訪，記錄兩組患者的復(fù)發(fā)情況。結(jié)果 治療后試驗(yàn)組臨床治療總有效率為92.0%，顯著高于對(duì)照組的80.0%（P<0.05）；兩組患者治療前HAMD、NIHSS、MoCA及KPS評(píng)分比較無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），兩組治療8周后HAMD、NIHSS評(píng)分均顯著低于本組治療前（P<0.05），MoCA、KPS評(píng)分均顯著高于本組治療前（P<0.05），且試驗(yàn)組治療8周后HAMD、NIHSS評(píng)分顯著低于對(duì)照組（P<0.05），MoCA、KPS評(píng)分顯著高于對(duì)照組（P<0.05）。兩組患者治療前5-HT、ET水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），兩組治療8周后5-HT、ET水平高于本組治療前，且試驗(yàn)組治療8周后5-HT、ET水平顯著高于對(duì)照組（P<0.05）；兩組患者的TESS評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P> 0.05）；1年隨訪發(fā)現(xiàn)試驗(yàn)組有4例患者復(fù)發(fā)，復(fù)發(fā)率為8.33%（4/48），對(duì)照組有5例患者復(fù)發(fā)，復(fù)發(fā)率為10.20%（5/49），兩組復(fù)發(fā)率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 齊拉西酮聯(lián)合度洛西汀治療老年腦卒中后抑郁可有效提升治療效果，提升患者血中神經(jīng)遞質(zhì)5-HT、ET的水平，改善抑郁癥狀，降低神經(jīng)功能缺損程度，改善認(rèn)知功能障礙以及提升生活質(zhì)量，且不會(huì)增加不良反應(yīng)的發(fā)生，也不增加復(fù)發(fā)率。

Objective To investigate the clinical efficacy of ziprasidone combined with duloxetine in the treatment of post-stroke depression and its effect on the level of related neurotransmitters. Methods A total of 100 elderly patients with post-stroke depression treated in Dezhou Second People's Hospital from January 2019 to January 2020 were selected retrospectively. According to different treatment methods, the patients were divided into control group and experimental group, with 50 cases in each group. The patients in the control group were simply treated with Duloxetine Hydrochloride Enteric Coated Tablets, 20 mg each time, twice a day (once in the morning and once at noon). On the basis of administration in the control group, the patients in the experimental group were treated with low-dose Ziprasidone Hydrochloride Tablets, 10-20 mg·d^-1. Both groups were treated for eight weeks. After treatment, the curative effect was evaluated by the score reduction rate of Hamilton Depression Scale (HAMD). Before and eight weeks after treatment, the two groups were evaluated:HAMD was used to evaluate the symptoms of depression, NIHSS was used to evaluate the degree of neurological deficit, MoCA was used to evaluate the cognitive function, and KPS was used to evaluate the quality of life. The plasma levels of 5-hydroxytryptamine (5-HT) and endothelin (ET) were measured by radioimmunoassay before treatment and eight weeks after treatment. After eight weeks of treatment, the scores of Treatment Emergent Symptom Scale (TESS) were measured. The patients were followed up by telephone for one year after discharge, and the recurrence of the two groups was recorded. Results After treatment, the total effective rate of clinical treatment in the experimental group was 92.0%, significantly higher than 80.0% in the control group (P < 0.05). There was no significant difference in the scores of HAMD, NIHSS, MoCA and KPS between the two groups before treatment (P > 0.05). After eight weeks of treatment, the scores of HAMD and NIHSS in the two groups were significantly lower than those before treatment (P < 0.05), the scores of MoCA and KPS were significantly higher than those before treatment (P < 0.05), and the scores of HAMD and NIHSS in the experimental group were significantly lower than those in the control group (P < 0.05), the scores of MoCA and KPS were significantly higher than that in the control group (P < 0.05). There was no significant difference in the levels of 5-HT and ET between the two groups before treatment (P > 0.05). The levels of 5-HT and ET in the two groups after eight weeks of treatment were higher than those before treatment, and the levels of 5-HT and ET in the experimental group were significantly higher than those in the control group after eight weeks of treatment (P < 0.05). There was no significant difference in TESS score between the two groups (P > 0.05). One year follow-up showed that four patients in the experimental group had recurrence, the recurrence rate was 8.33% (4/48), and five patients in the control group had recurrence, the recurrence rate was 10.20% (5/49). There was no significant difference in the recurrence rate between the two groups (P > 0.05). Conclusion Ziprasidone combined with duloxetine in the treatment of post-stroke depression can effectively improve the treatment effect, improve the levels of neurotransmitters 5-HT and ET in patients' blood, improve depressive symptoms, reduce the degree of neurological deficit, improve cognitive impairment and improve the quality of life, and will not increase the incidence of adverse reactions and the recurrence rate.

R971

山東省自然科學(xué)基金資助項(xiàng)目（ZR2019MEE088）