【目的】分析柴连虑平颗粒 （由柴胡、黄连、白芍、当归、丹参、佛手、酸枣仁等中药组成） 治疗卒中后焦虑症的疗效 及对血清神经递质、氧化应激的影响。 【方法】将104例卒中后焦虑症肝气郁结、心火亢盛型患者随机分为观察组和对照组， 每组各52例。对照组给予帕罗西汀等常规西医治疗，观察组在对照组的基础上给予柴连虑平颗粒治疗，疗程为8周。观察 2组患者治疗前后医院焦虑抑郁量表 （HADS） 评分、汉密尔顿焦虑量表 （HAMA） 评分、血清神经递质指标[脑源性神经营养因 子 （BDNF） 、多巴胺 （DA） 、5-羟色胺 （5-HT） 、去甲肾上腺素 （NE） ]及氧化应激指标[丙二醛 （MDA） 、超氧化物歧化酶 （SOD） 、 谷胱甘肽过氧化物酶 （GSH-Px） ]的变化情况，比较2组患者的临床疗效和不良反应总发生率。 【结果】（1） 疗效方面，治疗8周 后，观察组的总有效率为94.23% （49/52） ，对照组为76.92% （40/52） ，组间比较 （χ2 检验） ，观察组的疗效明显优于对照组 （P＜ 0.05） 。 （2） 焦虑程度方面，治疗后，2组患者的HADS评分和HAMA评分均较治疗前降低 （P＜0.05） ，且观察组对HADS评分和 HAMA评分的降低幅度均明显优于对照组 （P＜0.01） 。 （3） 神经递质指标方面，治疗后，2组患者血清BDNF水平均较治疗前升 高 （P＜0.05） ，血清DA、5-HT、NE水平均较治疗前降低 （P＜0.05） ，且观察组对血清BDNF水平的升高幅度及对血清DA、 5-HT、NE水平的降低幅度均明显优于对照组 （P＜0.01） 。 （4） 氧化应激指标方面，治疗后，2组患者血清MDA水平均较治疗 前降低 （P＜0.05） ，血清SOD、GSH-Px水平均较治疗前升高 （P＜0.05） ，且观察组对血清MDA水平的降低幅度及对血清 SOD、GSH-Px水平的升高幅度均明显优于对照组 （P＜0.05或P＜0.01） 。 （5） 不良反应方面，观察组的不良反应总发生率为 5.77% （3/52） ，对照组为9.62% （5/52） ，组间比较，差异无统计学意义 （P＞0.05） 。 【结论】在常规西医治疗基础上联合柴连虑 平颗粒治疗卒中后焦虑症肝气郁结、心火亢盛型患者疗效确切，可有效缓解患者焦虑症状，减轻神经功能受损程度及应激 反应水平，且不良反应少，安全性高。

Objective To investigate the clinical efficacy of Chailian Lvping Granules （mainly composed of Bupleuri Radix， Coptidis Rhizoma， Paeoniae Radix Alba， Angelicae Sinensis Radix， Salviae Miltiorrhizae Radix et Rhizoma，Citri Sarcodactylis Fructus，and Ziziphi Spinosae Semen） in treating post-stroke anxiety and to observe their effect on serum neurotransmitters and oxidative stress. Methods A total of 104 patients with post- stroke anxiety of liver-qi stagnation and heart-fire exuberance type were randomly divided into an observation group and a control group，52 cases in each group. The control group was treated with conventional western medicine of Paroxetine，and the observation group was treated with Chailian Lvping Granules on the basis of treatment for the control group. The course of treatment lasted for eight weeks. The two groups were observed in the changes of Hospital Anxiety and Depression Scale （HADS） score，Hamilton Anxiety Scale （HAMA） score，serum neurotransmitter parameters of brain-derived neurotrophic factor （BDNF） ，dopamine （DA） ，5-hydroxytryptamine （5-HT） and norepinephrine（NE）， and oxidative stress indicators of malondialdehyde （MDA）， superoxide dismutase（SOD）， and glutathione peroxidase（GSH-Px） before and after treatment. Moreover， the clinical efficacy and total incidence of adverse reactions were compared between the two groups. Results （1） After eight weeks of treatment，the total effective rate of the observation group was 94.23% （49/52） ，and that of the control group was 76.92% （40/52） . The intergroup comparison （tested by chi-square test） showed that the curative effect of the observation group was significantly superior to that of the control group （P＜0.05） . （2） After treatment，the HADS score and HAMA score for the axienty degree in the two groups were decreased compared with those before treatment （P＜0.05） ，and the decrease of HADS score and HAMA score in the observation group was significantly superior to that in the control group （P＜0.01） . （3） After treatment，the serum level of neurotransmitter BDNF in the two groups was increased while the serum levels of DA，5-HT and NE were decreased compared with those before treatment （P＜0.05） . The increase of serum BDNF level and the decrease of serum DA，5-HT and NE levels in the observation group were significantly superior to those in the control group （P＜0.01） . （4）After treatment，the serum level of oxidative stress indicator MDA in the two groups was decreased while the serum levels of SOD and GSH-Px were increased compared with those before treatment （P＜0.05） . The decrease of serum MDA level and the increase of serum SOD and GSH-Px levels in the observation group were significantly superior to those in the control group （P＜0.05 or P＜0.01） . （5） The total incidence of adverse reactions in the observation group was 5.77% （3/52），and that in the control group was 9.62%（5/52） . There was no significant difference between the two groups （P＞0.05） . Conclusion On the basis of conventional western medicine treatment， Chailian Lvping Granules exert certain effect in the treatment of patients with post-stroke anxiety of liver-qi stagnation and heart-fire exuberance type. The combined therapy is effective and safe on alleviating the anxiety symptoms of patients，decreasing the degree of neurological impairment and stress response level，and has few adverse reactions.

R277.7

国家自然科学基金资助项目 （编号：81904193）