围绝经期抑郁症发病机制及中医药防治研究进展

Pathogenesis of Perimenopausal Depression and Prevention and Treatment by Traditional Chinese Medicine： A Review

摘要:

围绝经期抑郁症（PMD）是女性在进入绝经期前后易发生的一种精神障碍类疾病，因其高发病率、低普及率、低诊断率、反复发作等特点，已经成为对围绝经期女性健康造成重大威胁的重要公共卫生问题。PMD发病机制复杂，主要涉及下丘脑-垂体-卵巢（HPO）轴老化导致的生殖激素异常波动、炎症及级联反应、氧化应激等方面。目前针对PMD的治疗尚无特异性的药理干预措施，而中医药作为祖国医学的瑰宝，融汇数千年传统中医经验与智慧，在防治PMD方面具有整体调节、多靶向、不良反应小等优势。近年来中药活性成分、中药提取物、复方通过多组分、多方向干预PMD的相关研究越来越多，且取得了一定进展。大量研究表明，中医药防治PMD的潜在机制包括抗炎、抗氧化、调节单胺神经递质等，主要涉及NOD样热蛋白结构域相关蛋白3（NLRP3）炎性小体、核因子E₂相关因子2（Nrf2）/血红素加氧酶-1（HO-1）、脑源性神经营养因子（BDNF）/酪氨酸激酶受体B（TrkB）等信号通路的调控。该文通过整理总结中医药治疗PMD的临床及基础研究，明析其致病机制和治疗靶向，以期为中医药治疗PMD提供基础理论支持和新的策略及借鉴。

Abstract:

PPerimenopausal depression （PMD） is a mental disorder that occurs in women before and after menopause. It has become a major public health problem posing a threat to the health of perimenopausal women due to its high incidence， low prevalence， low diagnostic rate， and recurrent episodes. The pathogenesis of PMD is complex and mainly involves the aging of the hypothalamic-pituitary-ovarian （HPO） axis， which leads to abnormal fluctuations in reproductive hormones， inflammation and cascade reactions， and oxidative stress. Currently， there are no specific pharmacological interventions for PMD. Traditional Chinese medicine （TCM）， as a treasure of motherland medicine， integrates thousands of years of TCM experience and wisdom and has the advantages of holistic regulation， low toxicity， and mild adverse reactions in the prevention and treatment of PMD. In recent years， more and more studies have been conducted on the active ingredients， extracts， and compound formulas of TCM for treating PMD via multi-components and multi-directions， achieving fruitful results. A large number of studies have shown that TCM treats PMD by reducing inflammation， inhibiting oxidation， and modulating monoamine neurotransmitter levels， which mainly involve NOD-like receptor thermal protein domain-associated protein 3 （NLRP3） inflammasome， nuclear factor E₂-related factor 2 （Nrf2）/hemeoxygenase-1 （HO-1）， brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TrkB） and other signaling pathways. This article reviews the clinical and basic studies about TCM treatment of PMD to analyzes the pathogenesis of PMD and the therapeutic targets of TCM， aiming to provide basic theoretical support and new approaches for the TCM treatment of PMD.