Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

摘要

BACKGROUND: Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine (TCM); meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression (PSD). OBJECTIVE: To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation. DESIGN: Contrast observation. SETTING: Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group. PARTICIPANTS: A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years. METHODS: ① All the enrolled subjects were diagnosed for syndrome differentiation by senior TCM physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis, kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale (NDS; 45 points in total; the higher the scores were, the severer the deficit was), Fugl-Meyer assessment, (FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was), modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of daily life (ADL) was], symptom checklist-90 (SCL-90; including total scores, positive scores, mean and average scores of positive items), Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA, the higher the scores were, the severer the degree was). ② Patients were divided into one symptom type, two symptom types and ≥ 3 symptom types; meanwhile, they were also divided into deficiency symptom, excess symptom and deficiency-excess symptom. Scores among various groups were compared simultaneously. MAIN OUTCOME MEASURES: Comparison of nervous function and mental psychology of PSD patients with various symptoms. RESULTS: ① Differences of various symptoms: Among 177 patients, there were 43 subjects in the types of sputum-stasis stagnation, 64 in qi stagnation and blood stasis, 21 in kidney-essence deficiency, 33 in deficiency of the spleen and stomach, and 16 in phlegm-fire disturbing the heart. In the comparison of the scores of nervous function and psychological tests among different syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency were obviously lower than those of the total samples and PSD patients of deficiency of the spleen and stomach and phlegm-fire disturbing the heart, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items in the former three groups were allobviously higher than those in the latter three groups (P 0.05). CONCLUSION: The damages of nervous function and mental psychology are more serious in PSD patients with the syndrome types of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency, as well as those with several (three or more) syndrome types, and the conditions may be improved by the treatment based on TCM syndrome differentiation.