柴胡疏肝散合文拉法辛对抑郁症血清T淋巴细胞亚群及NK细胞的影响
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摘要
背景：抑郁症患者存在下丘脑-垂体-肾上腺轴(Hypothalamic-pituitary-adrenal Axis,HPA)的慢性长期兴奋,导致免疫功能紊乱。抗抑郁药可以纠正患者的免疫功能紊乱。对17项柴胡疏肝散治疗抑郁症的Meta分析显示,柴胡疏肝散与抗抑郁药物的痊愈率和有效率相当；但是否通过纠正患者的免疫功能紊乱而发挥作用仍不清楚。
目的：观察柴胡疏肝散对抑郁症患者血清T淋巴细胞亚群及NK细胞的影响。
方法：将41例符合DSM-Ⅳ抑郁症诊断标准的患者,随机分成研究组与对照组；其中研究组(20例)用柴胡疏肝散合并文拉法辛治疗,对照组(21例)用文拉法辛治疗。其中两组各有1例退出,最后进入统计的共39例。采用流式细胞仪测定两组治疗前、治疗4周后外周血T淋巴细胞亚群细胞浓度,以及自然杀伤细胞(NK细胞)表达的百分率。所有分类变量数据用χ2检验,数值变量组间采用t检验；应用Spearman相关性分析方法对HAMD与T淋巴细胞亚群、NK细胞进行相关性分析。
结果：
1.与对照组相比,研究组治疗后总T淋巴细胞(CD3+)、辅助T淋巴细胞(CD4+)、自然杀伤细胞(NK细胞)表达百分率的减分值有统计学意义(P<0.05～0.01)
2与治疗前比较,研究组、对照组经4周的治疗,CD3+、CD4+、抑制性T淋巴细胞(CD8+)明显下降,差异有统计学意义(P<0.05)。
3.相关性分析显示,抑郁症患者血清CD8+与HAMD评分呈负相关(P<0.05)。
4.研究组4周后副反应发生率比对照组少。
结论：柴胡疏肝散能改善抑郁症患者免疫功能,降低其副反应。
Backgrounds
Chronic long-term activation of the HPA axis is associated with depression,which induces the immune system dysfunction. Antidepressants can help correct the immune dysfunction in patients.A meta-analysis which combined17reseaches which treated depression by chaihu shugansan showed that the rates of remission and response between chaihu shugansan and antidepressants are equal,but it remains unclear wheather it plays a role by correcting immune dysfunction in patients.
Objective
To explore the effect of chaihu shugansan on T-lymphocytes subgroup and natural killer cell (NK cell) in patients with depression.
Method
41Patients diagnosed with Liver Qi Stagnation Syndrome depression who met the diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition(DSM-IV) were randomly assigned to treatment group or control group.The treatment group(20patients) were treated by chaihu shugansan combined with venlafaxine, and control group(21patients) were treated by venlafaxine alone. There was one dropout in each group and altogether data of39 patients were analised by SPSS.Serum levels of T-lymphocytes subgroups and express percent of NK cell between the two groups were compared before treatment and four weeks after treatment respectively in both treatment and control groups. Statistical software SPSS11.5was used to analyze Data.Conduct chi-square tests for all the categorical variables, independent samples t-tests for numerical variables between two groups and Spearman's correlation analysis for between the scales of the HAMD and the T lymphocyte subgroup, NK cells.
ResultS
1. There were statistically significant differences between the research group and the control group in the reduction scores of the frequencies of expressions of T cell (maker:CD3+), helper T cell(phenotypic marker:CD4+) and NK cell after the therapy.(P<0.05～0.01)
2. The serum levels of T cell (maker:CD3+), helper T cell(phenotypic marker: CD4+) and CD8+T cell declined significantly after treatment in both trial and control group (P<0.05).
3. In addition, The serum level of CD8+was negatively associated with HAMD score of patients with depression (P<0.05).
4. Furthermore, Incidence of side effects were lower in the trial group than in the control group.
CONCLUSION
Chaihu shugansan can improve immune function of patients with depression and decrease the side effects of antidepressants.
目的：观察柴胡疏肝散对抑郁症患者血清T淋巴细胞亚群及NK细胞的影响。
方法：将41例符合DSM-Ⅳ抑郁症诊断标准的患者,随机分成研究组与对照组；其中研究组(20例)用柴胡疏肝散合并文拉法辛治疗,对照组(21例)用文拉法辛治疗。其中两组各有1例退出,最后进入统计的共39例。采用流式细胞仪测定两组治疗前、治疗4周后外周血T淋巴细胞亚群细胞浓度,以及自然杀伤细胞(NK细胞)表达的百分率。所有分类变量数据用χ2检验,数值变量组间采用t检验；应用Spearman相关性分析方法对HAMD与T淋巴细胞亚群、NK细胞进行相关性分析。
结果：
1.与对照组相比,研究组治疗后总T淋巴细胞(CD3+)、辅助T淋巴细胞(CD4+)、自然杀伤细胞(NK细胞)表达百分率的减分值有统计学意义(P<0.05～0.01)
2与治疗前比较,研究组、对照组经4周的治疗,CD3+、CD4+、抑制性T淋巴细胞(CD8+)明显下降,差异有统计学意义(P<0.05)。
3.相关性分析显示,抑郁症患者血清CD8+与HAMD评分呈负相关(P<0.05)。
4.研究组4周后副反应发生率比对照组少。
结论：柴胡疏肝散能改善抑郁症患者免疫功能,降低其副反应。
Backgrounds
Chronic long-term activation of the HPA axis is associated with depression,which induces the immune system dysfunction. Antidepressants can help correct the immune dysfunction in patients.A meta-analysis which combined17reseaches which treated depression by chaihu shugansan showed that the rates of remission and response between chaihu shugansan and antidepressants are equal,but it remains unclear wheather it plays a role by correcting immune dysfunction in patients.
Objective
To explore the effect of chaihu shugansan on T-lymphocytes subgroup and natural killer cell (NK cell) in patients with depression.
Method
41Patients diagnosed with Liver Qi Stagnation Syndrome depression who met the diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition(DSM-IV) were randomly assigned to treatment group or control group.The treatment group(20patients) were treated by chaihu shugansan combined with venlafaxine, and control group(21patients) were treated by venlafaxine alone. There was one dropout in each group and altogether data of39 patients were analised by SPSS.Serum levels of T-lymphocytes subgroups and express percent of NK cell between the two groups were compared before treatment and four weeks after treatment respectively in both treatment and control groups. Statistical software SPSS11.5was used to analyze Data.Conduct chi-square tests for all the categorical variables, independent samples t-tests for numerical variables between two groups and Spearman's correlation analysis for between the scales of the HAMD and the T lymphocyte subgroup, NK cells.
ResultS
1. There were statistically significant differences between the research group and the control group in the reduction scores of the frequencies of expressions of T cell (maker:CD3+), helper T cell(phenotypic marker:CD4+) and NK cell after the therapy.(P<0.05～0.01)
2. The serum levels of T cell (maker:CD3+), helper T cell(phenotypic marker: CD4+) and CD8+T cell declined significantly after treatment in both trial and control group (P<0.05).
3. In addition, The serum level of CD8+was negatively associated with HAMD score of patients with depression (P<0.05).
4. Furthermore, Incidence of side effects were lower in the trial group than in the control group.
CONCLUSION
Chaihu shugansan can improve immune function of patients with depression and decrease the side effects of antidepressants.
引文
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3.Fazzino F,Urbina M,Cedeno N,et al.Fluoxetine treatment to rats modifies serotonin transporter and cAMP in lymphocytes,CD4+ and CD8+ subpopulations and interleukins 2 and 4. International immunopharmacology,2009,9:463-467.
4.Shen Y D, Lu P L, Wei L L, et al. Fluoxetine treatment for major depression decreases the plasma levels of cytokines. Afr. J. Biotechnol,2010,9:7346-7351.
5.陈品,洪丽,赵燕民.抑郁症患者外周血T淋巴细胞亚群变化.河南医科大学学报,2000,35：548-549.
6.Pav6n L, Sandoval-Lopez G, Hernandez M, et al. Th2 cytokine response in Major Depressive Disorder patients before treatment.J Neuroimmunol, 2006,172:156-165.
7.Ravindran AV, Griffiths J, Merali Z, et al. Circulating lymphocyte subsets in major depression and dysthymia with typical or atypical features. Psychosom Med.,1998, 60:283-289.
8.Gonzalez A, Fazzino F, Castillo M, et al. Serotonin,5-HT1A serotonin receptors and proliferation of lymphocytes in major depression patients. Neuroimmunomodulation,2007,14:8-15.
9.Basterzi AD, Yazici K, Buturak V, et al. Effects of venlafaxine and fluoxetine on lymphocyte subsets in patients with major depressive disorder:a flow cytometric analysis. Prog Neuropsychopharmacol Biol Psychiatry,2010,34:70-75.
10.Dunn AJ, Swiergiel AH, Beaurepaire RD. Cytokines as mediators of dep ression: What can we learn from animal studies?. Neuroscience &Biobehavioral Reviews, 2005,29:891-909.
11.Lichtenstein GR. Infliximab imp roves quality of life in patients with Crohn's disease. Inflamm Bowel Dis,2002,8:237-243.
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18.American Psychiatry Association Diagnostic and Statistical Manual of Mental Disorders.4th Ed.Washington DC:American Psychiatry Association,1994.
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23.汤艳清,谢光荣,李艳苓,等.抑郁症患者血中T细胞亚群数量及相关因素的研究.中国临床心理学杂志,2004,12：279-283.
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21.杨坤,张中兴,王长虹,等.抑郁症患者帕罗西汀治疗前后血清细胞因子C-反应蛋白和锌水平变化的研究.中国行为医学科学,2005,14：792-794.
2.杨坤,张中兴,王长虹,等.抑郁症患者帕罗西汀治疗前后血清细胞因子C-反应蛋白和锌水平变化的研究.中国行为医学科学,2005,14：792-794.
3.Fazzino F,Urbina M,Cedeno N,et al.Fluoxetine treatment to rats modifies serotonin transporter and cAMP in lymphocytes,CD4+ and CD8+ subpopulations and interleukins 2 and 4. International immunopharmacology,2009,9:463-467.
4.Shen Y D, Lu P L, Wei L L, et al. Fluoxetine treatment for major depression decreases the plasma levels of cytokines. Afr. J. Biotechnol,2010,9:7346-7351.
5.陈品,洪丽,赵燕民.抑郁症患者外周血T淋巴细胞亚群变化.河南医科大学学报,2000,35：548-549.
6.Pav6n L, Sandoval-Lopez G, Hernandez M, et al. Th2 cytokine response in Major Depressive Disorder patients before treatment.J Neuroimmunol, 2006,172:156-165.
7.Ravindran AV, Griffiths J, Merali Z, et al. Circulating lymphocyte subsets in major depression and dysthymia with typical or atypical features. Psychosom Med.,1998, 60:283-289.
8.Gonzalez A, Fazzino F, Castillo M, et al. Serotonin,5-HT1A serotonin receptors and proliferation of lymphocytes in major depression patients. Neuroimmunomodulation,2007,14:8-15.
9.Basterzi AD, Yazici K, Buturak V, et al. Effects of venlafaxine and fluoxetine on lymphocyte subsets in patients with major depressive disorder:a flow cytometric analysis. Prog Neuropsychopharmacol Biol Psychiatry,2010,34:70-75.
10.Dunn AJ, Swiergiel AH, Beaurepaire RD. Cytokines as mediators of dep ression: What can we learn from animal studies?. Neuroscience &Biobehavioral Reviews, 2005,29:891-909.
11.Lichtenstein GR. Infliximab imp roves quality of life in patients with Crohn's disease. Inflamm Bowel Dis,2002,8:237-243.
12.陈泽奇,胡随瑜,张海男,等.抑郁症常见证候标准的研究.中医杂志,2005,46：47-49.
13.尤建良.四逆散临床经验数则.中国中医基础医学杂志,2007,13：465-475.
14.陈煜辉,周莺.柴胡疏肝散抗抑郁作用的药理学实验研究.江西中医学院学报,2004,16：59-60.
15.佟凯航,赵建军.柴胡疏肝散加减治疗抑郁症38例.吉林中医药,2007,27：23-24.
16.金卫东,邢葆平,王鹤秋,等.柴胡疏肝散治疗抑郁症对照研究临床疗效的Meta分析.中华中医药学刊,2009,27：1397-1399.
17.贺新民,张益康.柴胡疏肝散加味联合百忧解治疗中风后抑郁症36例疗效观察.新中医,2007,39：22-23.
18.American Psychiatry Association Diagnostic and Statistical Manual of Mental Disorders.4th Ed.Washington DC:American Psychiatry Association,1994.
19.Anisman H, Merali Z. Cytokines, stress, and depressive illness. Brain Behav Immun, 2002,16:513-524.
20.Schiepers O, Wichers M, Maes M. Cytokines and major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry,2005,29:201-217.
21.郭苏皖,肖红,傅强.抑郁症与神经症白细胞介素比较研究.临床精神医学杂志,2001，11：274-275.
22.Fazzino F, Obregonf, Morles M, et al.Transporter in Lymphocytes of Patients with Major Depression Treated with Venlafaxine Plus Psychotherapy, Advances in Experimental Medicine and Biology,2009,643 Part Ⅱ:217-224.
23.汤艳清,谢光荣,李艳苓,等.抑郁症患者血中T细胞亚群数量及相关因素的研究.中国临床心理学杂志,2004,12：279-283.
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