【目的】 观察基于肠道菌-神经递质-脑轴（简称脑肠轴）理论运用补益心脾法治疗产后抑郁心脾两虚证患者的临床疗效， 探讨其对患者抑郁、焦虑情绪的改善作用。【方法】 将 2021年 6月至 2023年 7月在中国人民解放军联勤保障部队第九〇八医 院就诊的 136 例产后抑郁心脾两虚证患者按随机数字表法随机分为常规治疗组（对照组）和补益心脾组（观察组），每组 各 68 例。对照组给予常规抗抑郁药物治疗，观察组在对照组的基础上联合补益心脾法（参芪解郁方）治疗，2 组均连续治 疗 6 周。观察2组患者治疗前后中医证候主症积分、汉密尔顿抑郁量表（HAMD）评分、广泛性焦虑自评量表（GAD-7）评分和 血清神经递质 5-羟色胺（5-HT）、多巴胺（DA）、去甲肾上腺素（NE）及肠道菌群代谢产物短链脂肪酸（SCFAs）、谷氨酸 （GLU）、γ-氨基丁酸（GABA）水平的变化情况，并评价 2组患者的临床疗效和用药安全性。【结果】（1）疗效方面，治疗 6周 后，观察组的总有效率为 89.71%（61/68），对照组为 73.53%（50/68），组间比较（χ2检验），观察组的疗效明显优于对照组 （P < 0.05）。（2）中医证候积分方面，治疗后，2组患者的情志不畅、思维困顿、食欲减退、腹胀便溏等各项主症积分均较治 疗前降低（P < 0.05），且观察组的降低幅度均明显优于对照组（P < 0.01）。（3）抑郁、焦虑情绪方面，治疗后，2 组患者的 HAMD评分和GAD-7评分均较治疗前降低（P < 0.05），且观察组的降低幅度均明显优于对照组（P < 0.01）。（4）神经递质方面， 治疗后，2组患者的血清5-HT、DA、NE水平均较治疗前升高（P < 0.05），且观察组的升高幅度均明显优于对照组（P < 0.01）。 （5）肠道菌群代谢产物方面，治疗后，2组患者的血清 SCFAs、GLU、GABA水平均较治疗前提高（P < 0.05），且观察组的提 高幅度均明显优于对照组（P < 0.01）。（6）安全性方面，观察组的不良反应发生率为 8.82%（6/68），对照组为 5.88%（4/68）， 组间比较，差异无统计学意义（P > 0.05）。【结论】 基于脑肠轴理论使用补益心脾法治疗产后抑郁心脾两虚证患者疗效显著， 可通过改善患者神经递质失衡及肠道菌群代谢来减轻抑郁、焦虑情绪，且具有较高的安全性。

Objective To observe the clinical efficacy of therapy of tonifying heart and spleen for the treatment of patients with postpartum depression of heart and spleen deficiency syndrome based on the theory of intestinal floraneurotransmitter-brain axis（shortened as brain-intestine axis），and to explore its effect on the improvement of patients􀆳 depression and anxiety. Methods A total of 136 patients with postpartum depression of heart and spleen deficiency syndrome who admitted to The 908th Hospital of the Joint Logistics Support Force of the People􀆳s Liberation Army of China from June 2021 to July 2023 were randomly divided into the conventional treatment group（control group）and the tonifying heart-spleen group（observation group）according to the random number table method，with 68 cases in each group. The control group was treated with conventional antidepressant drugs， and the observation group was treated with therapy of tonifying heart and spleen by utilization of Shen Qi Jieyu Prescription Granules）on the basis of treatment for the control group. Both groups were treated for six continuous weeks. Before and after the treatment，the two groups were observed in the changes of main symptom scores of traditional Chinese medicine（TCM）syndrome，Hamilton Depression Scale（HAMD）scores，7-Item Generalized Anxiety Disorder Scale（GAD-7）scores， and the levels of serum neurotransmitters of 5-hydroxytryptamine（5-HT），dopamine （DA）， norepinephrine（NE）， as well as microflora metabolites such as short-chain fatty acids （SCFAs）， glutamic acid（GLU），gamma-aminobutyric acid（GABA）. Moreover，the clinical efficacy and safety of the two groups of patients were evaluated. Results （1） After six weeks of treatment， the total effective rate of the observation group was 89.71%（61/68）and that of the control group was 73.53%（50/68），and the intergroup comparison（tested by chi-square test）showed that the efficacy of the observation group was significantly superior to that of the control group（P < 0.05）.（2）After treatment，the scores of TCM syndrome main symptoms such as emotional upset， slow thinking， poor appetite， abdominal distension and loose stools in the two groups were decreased compared with those before treatment（P < 0.05）， and the decrease in the observation group was significantly superior to that in the control group（P < 0.01）.（3）After treatment，the HAMD scores and GAD-7 scores in the two groups of patients were all decreased compared with those before treatment（P < 0.05），and the decrease in the observation group was significantly superior to that in the control group（P < 0.01）.（4）After treatment， the serum levels of neurotransmitters 5-HT， DA， and NE in the two groups of patients were all increased compared with those before treatment（P < 0.05）， and the increase in the observation group was significantly superior to that in the control group（P < 0.01）.（5）After treatment，the serum levels of microflora metabolites SCFAs，GLU and GABA in the two groups of patients were all increased compared with those before treatment（P < 0.05），and the increase in the observation group was significantly superior to that in the control group（P < 0.01）.（6）The incidence of adverse reactions in the observation group was 8.82%（6/68）and that in the control group was 5.88%（4/68），and the intergroup comparison showed that the difference was not statistically significant（P > 0.05）. Conclusion The application of therapy of tonifying heart and spleen for the treatment of patients with postpartum depression of heart and spleen deficiency syndrome based on brain-intestine axis exerts certain efficacy and safety through correcting the imbalance of neurotransmitters and regulating the microflora metabolites of the patients，thus to alleviate depression and anxiety.

R277.7

江西省中医药管理局科技计划项目（编号：2022B089）