【目的】 探究加味柴胡桂枝汤联合氟哌噻吨美利曲辛对脑卒中伴抑郁-焦虑患者负性心理、睡眠及血清组蛋白去乙酰化 酶3（HDAC3）、Bcl-2相互作用蛋白1（Beclin-1）的影响。【方法】 选取2023年1月至2025年1月平顶山市第二人民医院收治的 126例肝气郁结型脑卒中伴抑郁-焦虑患者为研究对象，采用随机数字表法将患者随机分为常规组和试验组，每组各63例。 2组患者均给予脑血管病常规治疗，常规组加用氟哌噻吨美利曲辛治疗，试验组在常规组基础上联合加味柴胡桂枝汤治疗， 2组疗程均为6周。观察2组患者治疗前后神经功能美国国立卫生研究院卒中量表（NIHSS）评分，汉密尔顿抑郁量表（HAMD） 评分、汉密尔顿焦虑量表（HAMA）评分、匹兹堡睡眠质量指数量表（PSQI）评分及血清HDAC3、Beclin-1水平的变化情况，并 评价2组治疗方案的安全性。【结果】（1）脱落情况方面，研究过程中，常规组脱落5例，试验组脱落4例，最终常规组58例、 试验组 59 例完成全部疗程的治疗。（2）神经功能方面，治疗 6 周后，2 组患者的神经功能 NIHSS 评分均较治疗前降低（P＜ 0.05），且试验组的降低幅度明显优于常规组（P＜0.01）。（3）抑郁、焦虑状态方面，治疗6周后，2组患者的HAMD、HAMA评 分均较治疗前降低（P＜0.05），且试验组的降低幅度均明显优于常规组（P＜0.01）。（4）睡眠质量方面，治疗 6周后，2组患者 的PSQI评分均较治疗前降低（P＜0.05），且试验组的降低幅度明显优于常规组（P＜0.01）。（5）血清学相关指标方面，治疗6周 后，2 组患者血清 HDAC3 水平均较治疗前降低（P＜0.05），血清 Beclin-1 水平均较治疗前升高（P＜0.05），且试验组对血清 HDAC3水平的降低幅度及对血清Beclin-1水平的升高幅度均明显优于常规组（P＜0.01）。（6）安全性方面，治疗期间，试验组 的不良反应发生率为6.78%（4/59），常规组为13.79%（8/58），组间比较，差异无统计学意义（P＞0.05）。【结论】 加味柴胡桂枝 汤联合氟哌噻吨美利曲辛能够有效改善肝气郁结型脑卒中伴抑郁-焦虑患者血清HDAC3、Beclin-1水平，减轻神经功能缺损 程度和负性心理，提高患者睡眠质量，且不增加不良反应，具有较高的安全性。

Objective To investigate the effects of Modified Chaihu Guizhi Decoction combined with flupentixol and melitracen on negative psychological state，sleep，and serum levels of histone deacetylase 3（HDAC3） and Bcl-2 interacting protein 1（Beclin-1） in stroke patients with depression-anxiety. Methods A total of 126 stroke patients with depression-anxiety of liver qi stagnation syndrome admitted to Pingdingshan Second People’s Hospital from January 2023 to January 2025 were selected as the studying subjects. Patients were randomly divided into a conventional group and an trial group using a random number table，with 63 patients in each group. Both groups received conventional treatment for cerebrovascular disease. The conventional group additionally received Flupentixol and Melitracen，while the trial group received Modified Chaihu Guizhi Decoction in combination with Flupentixol and Melitracen. The treatment course for both groups was 6 weeks. Changes in neurological function assessed by the National Institutes of Health Stroke Scale （NIHSS） score， Hamilton Depression Rating Scale （HAMD） score，Hamilton Anxiety Rating Scale （HAMA） score，Pittsburgh Sleep Quality Index （PSQI） score， and serum levels of HDAC3 and Beclin-1 were observed before and after treatment. The safety of the two treatment regimens was also evaluated. Results （1） There were 5 cases dropped out from the conventional group and 4 from the trial group during the study，resulting in 58 cases in the conventional group and 59 cases in the trial group completing the full treatment course.（2） In terms of neurological function，after 6 weeks of treatment，the NIHSS scores decreased in both groups compared to those before treatment （P＜0.05），and the reduction was significantly greater in the trial group than in the conventional group （P＜0.01）.（3） Regarding depression and anxiety states， after 6 weeks，the HAMD and HAMA scores decreased in both groups compared to those before treatment （P＜ 0.05），and the reductions were significantly greater in the trial group than in the conventional group （P＜0.01）. （4） Regarding sleep quality，after 6 weeks，the PSQI scores decreased in both groups compared to those before treatment （P＜0.05），and the reduction was significantly greater in the trial group than in the conventional group （P＜0.01）.（5）Regarding serological indicators，after 6 weeks，serum HDAC3 levels decreased in both groups compared to those before treatment （P＜0.05），while serum Beclin-1 levels increased （P＜0.05）；the reduction in serum HDAC3 and the increase in serum Beclin-1 were both significantly greater in the trial group than in the conventional group （P＜0.01）.（6） Regarding safety， the incidence of adverse reactions during treatment was 6.78% （4/59） in the trial group and 13.79% （8/58） in the conventional group， with no statistically significant difference between the groups （P＞0.05）. Conclusion Modified Chaihu Guizhi Decoction combined with Flupentixol and Melitracen can effectively improve serum levels of HDAC3 and Beclin-1，reduce the degree of neurological deficit and negative psychological state，and enhance sleep quality in stroke patients with depressionanxiety of liver qi stagnation syndrome， without increasing adverse reactions， demonstrating a favorable safety profile.

R277.7

国家重点研发计划项目（编号：2022YFC2502400）