目的 探究安脑丸联合丙戊酸钠对老年躁狂抑郁症的临床效果及对患者糖原合成酶激酶3（GSK3）活性、炎症状态、认知功能的影响。方法 前瞻性选取焦作市第四人民医院2018年2月-2020年9月收治的老年躁狂抑郁症患者92例作为研究对象，按照随机数字表法分为对照组和试验组，每组各46例。对照组服用丙戊酸钠缓释片治疗，初始剂量为每次500 mg，每天1次；1周内可根据患者病情、耐受情况增加至每天1 000~1 500 mg。试验组在对照组基础上加用安脑丸，初始剂量为每次6 g，每天2次；2周后调整药物剂量为每次3 g，每天1次。两组药物均为口服，均持续治疗8周。比较两组治疗总有效率，分别于治疗前及治疗8周后采用贝克-拉范森躁狂量表（BRMS）及汉密尔顿抑郁量表（HAMD）评价两组患者的躁狂症状和抑郁症状，检测两组患者外周血单个核细胞（PBMC）中GSK3相关蛋白及血清炎症因子肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）、白细胞介素-10（IL-10）等水平，采用元认知问卷（MCQ-30）评分评估患者认知功能，观察并记录两组患者不良反应发生情况。结果 治疗8周后，试验组总有效率为93.48%，显著高于对照组的78.26%（P<0.05）。治疗8周后两组BRMS、HAMD评分较治疗前下降（P<0.05），试验组低于对照组（P<0.05）；治疗8周后两组PBMC中pSer21-GSK3α、pSer9-GSK3β、total-GSK3α、total-GSK3β、血清IL-10水平较治疗前升高（P<0.05），试验组高于对照组，血清TNF-α、IL-1水平低于治疗前（P<0.05），试验组低于对照组（P<0.05）；治疗8周后两组MCQ-30量表认知自信、自我认知意识、积极信念、控制思维的倾向、失控和危机感评分较治疗前升高（P<0.05），试验组高于对照组（P<0.05）；试验组不良反应发生率与对照组比较无明显差异（P>0.05）。结论 安脑丸联合丙戊酸钠治疗老年躁狂抑郁症能显著提高疗效，减轻患者躁狂与抑郁程度，还可下调GSK3活性、炎症因子表达水平，改善认知能力，且不增加药物不良反应。

Objective To explore the clinical effect of Annao Pill combined with sodium valproate in the treatment of senile manic depression and its effect on glycogen synthase kinase 3 (GSK3) activity, inflammatory state and cognitive function. Methods A total of 92 elderly patients with manic depression treated in Jiaozuo Fourth People's Hospital from February 2018 to September 2020 were prospectively selected as the research objects. They were randomly divided into control group and experimental group, with 46 cases in each group. Patients in the control group were treated with Sodium Valproate Sustained-Release Tablets, with an initial dose of 500 mg once a day, within one week, it can be increased to 1 000—1 500 mg per day according to the patient's condition and tolerance. On the basis of the control group, patients in the experimental group were added with Annao Pill, with an initial dose of six g each time, twice a day, after two weeks, the dosage was adjusted to three g each time, one time a day. Both groups were treatedorally for eight weeks. The total effective rates of the two groups were compared. The manic symptoms and depressive symptoms of the two groups were evaluated by Bech-Rafaelsen Mania Rating Scale (BRMS) and Hamilton Depression Scale (HAMD) before and eight weeks after treatment. The levels of the GSK3 related protein in peripheral blood mononuclear cells (PBMC) and serum inflammatory factor tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-10 (IL-10) were detected. Cognitive function were evaluated by Metacognitive questionnaire (MCQ-30), and the adverse reactions of the two groups were observed and recorded. Results After eight weeks of treatment, the total effective rate in the experimental group was 93.48%, which was significantly higher than 78.26% in the control group (P < 0.05). After eight weeks of treatment, the scores of BRMS and HAMD in the two groups decreased compared with those before treatment (P < 0.05), and the scores in the experimental group were lower than those in the control group (P < 0.05). The levels of pSer21-GSK3α, pSer9-GSK3β, total-GSK3α, total-GSK3β in PBMC and serum IL-10 of the two groups after eight weeks of treatment were higher than those before treatment (P < 0.05), and the levels in the experimental group were higher than those in the control group (P < 0.05). The level of serum TNF-α and IL-1 of the two groups after eight weeks of treatment were lower than that those before treatment (P < 0.05), and the levels in the experimental group were lower than those in the control group (P < 0.05). After eight weeks of treatment, the scores of MCQ-30 scale cognitive selfconfidence, self-awareness, positive belief, tendency to control thinking, out of control and sense of crisis in the two groups were higher than those before treatment (P < 0.05), and those in the experimental group were higher than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the experimental group and the control group (P>0.05). Conclusion The combination of Annao Pill and sodium valproate in the treatment of senile manic depression can significantly improve the curative effect, reduce the degree of mania and depression, reduce the activity of GSK3 and the expression level of inflammatory factors, improve cognitive ability, and do not increase adverse drug reactions.

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