目的 探讨齐拉西酮联合度洛西汀治疗老年脑卒中后抑郁的临床疗效及对患者相关神经递质水平的影响。方法 回顾性选取2019年1月-2020年1月于德州市第二人民医院接受治疗的100例老年脑卒中后抑郁患者为研究对象，按治疗方法不同将患者分为对照组和试验组，每组各50例，对照组患者单纯给予盐酸度洛西汀肠溶片口服治疗，每次20 mg，每天2次（早晨、中午各服用1次）。试验组在对照组给药基础上联用小剂量的盐酸齐拉西酮片，每天10~20 mg，两组患者均治疗8周。治疗后通过汉密尔顿抑郁量表（HAMD）减分率对疗效进行评价；分别于治疗前及治疗8周后对两组患者进行各项指标评估：采用HAMD评估抑郁症状，采用美国国立卫生研究院卒中量表（NIHSS）评价神经功能缺损程度，采用蒙特利尔认知评估量表（MoCA）评定认知功能，采用卡氏功能状态量表（KPS）评定生活质量；分别于治疗前及治疗8周后使用放射免疫计数仪检测患者血浆中5-羟色胺（5-HT）、内皮素（ET）水平。治疗8周后测定副反应量表（TESS）评分。患者出院后以电话随访的方式进行1年随访，记录两组患者的复发情况。结果 治疗后试验组临床治疗总有效率为92.0%，显著高于对照组的80.0%（P<0.05）；两组患者治疗前HAMD、NIHSS、MoCA及KPS评分比较无统计学意义（P>0.05），两组治疗8周后HAMD、NIHSS评分均显著低于本组治疗前（P<0.05），MoCA、KPS评分均显著高于本组治疗前（P<0.05），且试验组治疗8周后HAMD、NIHSS评分显著低于对照组（P<0.05），MoCA、KPS评分显著高于对照组（P<0.05）。两组患者治疗前5-HT、ET水平比较差异无统计学意义（P>0.05），两组治疗8周后5-HT、ET水平高于本组治疗前，且试验组治疗8周后5-HT、ET水平显著高于对照组（P<0.05）；两组患者的TESS评分比较差异无统计学意义（P> 0.05）；1年随访发现试验组有4例患者复发，复发率为8.33%（4/48），对照组有5例患者复发，复发率为10.20%（5/49），两组复发率比较差异无统计学意义（P>0.05）。结论 齐拉西酮联合度洛西汀治疗老年脑卒中后抑郁可有效提升治疗效果，提升患者血中神经递质5-HT、ET的水平，改善抑郁症状，降低神经功能缺损程度，改善认知功能障碍以及提升生活质量，且不会增加不良反应的发生，也不增加复发率。

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

山东省自然科学基金资助项目（ZR2019MEE088）