不同抗抑郁药物对抑郁症患者的疗效及对糖脂类代谢的影响
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摘要
目的探讨不同抗抑郁药物对抑郁症患者的疗效及其对糖脂类代谢的影响。方法将我院收治的240例抑郁症患者随机分为三组,分别采用舍曲林、西酞普兰、米氮平治疗,分别为77例、80例、83例。比较三组患者治疗前后汉密尔顿抑郁量表(HAMD)评分、血糖水平及血脂水平的差异。结果治疗4周后、治疗8周后三组患者HAMD评分较治疗前显著下降(P<0.05),米氮平组患者HAMD评分低于同期西酞普兰组、舍曲林组(P<0.05);治疗4周后、治疗8周后西酞普兰组和舍曲林组患者HAMD评分,组间比较无明显差异(P>0.05);治疗4周后、治疗8周后米氮平组、西酞普兰组患者空腹血糖(FPG)、餐后2h血糖(2h PG)、胆固醇(TC)、甘油三酯(TG)水平显著升高,也高于同期舍曲林组(P<0.05);治疗4周后、治疗8周后米氮平组、西酞普兰组患者间2hPG、FPG、TC、TG水平无明显差异(P>0.05);治疗4周后、治疗8周后舍曲林组患者2hPG、FPG、TC、TG水平较治疗前无明显差异(P>0.05)。结论舍曲林、西酞普兰、米氮平对抑郁症患者临床效果佳;米氮平、西酞普兰较舍曲林对抑郁症糖脂代谢影响较大;舍曲林对抑郁症糖脂代谢影响较小,值得临床选择。
Objective To explore the efficacy of different antidepressants in the glycolipid metabolism for patients with depression. Methods 240 patients with depression were randomly assigned to three groups,with 80 patients in each group. Patients took the Sertraline,Citalopram or Mirtazapine,respectively. The HAMD(Hamilton Depression Scale)points,blood glucose level and blood lipid levels were counted. Results After 4 w and 8 w of treatment,the HAMD points for three groups were significantly lower than before(P<0.05);the HAMD points in the Mirtazapine group were lower than Citalopram group and Sertraline group(P<0.05);after 4 w and 8 w of treatment,the HAMD points in the Citalopram group and Sertraline group were not significantly different(P>0.05);after 4 w and 8 w of treatment,the index of 2 hPG(2 hour plasma glucose),FPG(fasting plasma glucose),TC(total cholesterol)and TG(triglyceride)in the Mirtazapine group and Citalopram group were significantly higher than Sertraline group(P<0.05);after 4 w and 8 w of treatment,the index of 2 hPG,FPG,TC and TG in the Mirtazapine group and Citalopram group were not significantly different(P>0.05);before treatment and after 4 w,8 w of treatment,the index of 2 hPG,FPG,TC and TG in the Sertraline group were not significantly different(P>0.05). Conclusion Sertraline,Citalopram and Mirtazapine were all shown efficacy in treating patients with depression. However,Mirtazapine and Citalopram produce a larger effect in the glycolipid metabolism while Sertraline has minimal impact on the glycolipid metabolism. It shall be recommended in clinical practice.
Objective To explore the efficacy of different antidepressants in the glycolipid metabolism for patients with depression. Methods 240 patients with depression were randomly assigned to three groups,with 80 patients in each group. Patients took the Sertraline,Citalopram or Mirtazapine,respectively. The HAMD(Hamilton Depression Scale)points,blood glucose level and blood lipid levels were counted. Results After 4 w and 8 w of treatment,the HAMD points for three groups were significantly lower than before(P<0.05);the HAMD points in the Mirtazapine group were lower than Citalopram group and Sertraline group(P<0.05);after 4 w and 8 w of treatment,the HAMD points in the Citalopram group and Sertraline group were not significantly different(P>0.05);after 4 w and 8 w of treatment,the index of 2 hPG(2 hour plasma glucose),FPG(fasting plasma glucose),TC(total cholesterol)and TG(triglyceride)in the Mirtazapine group and Citalopram group were significantly higher than Sertraline group(P<0.05);after 4 w and 8 w of treatment,the index of 2 hPG,FPG,TC and TG in the Mirtazapine group and Citalopram group were not significantly different(P>0.05);before treatment and after 4 w,8 w of treatment,the index of 2 hPG,FPG,TC and TG in the Sertraline group were not significantly different(P>0.05). Conclusion Sertraline,Citalopram and Mirtazapine were all shown efficacy in treating patients with depression. However,Mirtazapine and Citalopram produce a larger effect in the glycolipid metabolism while Sertraline has minimal impact on the glycolipid metabolism. It shall be recommended in clinical practice.
引文
1.肖刚,陆德青,吴小未.艾司西酞普兰合用奥氮平治疗更年期难治性抑郁症的随机对照研究[J].中国临床医生杂志,2016,44(06):28-30.
2.潘苗,张三强,吕路线,等.不同抗抑郁药物干预对首发老年抑郁症患者半年结局的影响[J].中国老年学杂志,2016,36(11):2640-2643.
3.曾永涛,段敏.文拉法辛与舍曲林治疗首发抑郁症对照研究[J].中国健康心理学杂志,2016,24(08):1128-1132.
4.王静.三种抗抑郁症药物治疗伴躯体疼痛症状的抑郁症患者的对比研究[J].中国实用医药,2016,11(27):8-10.
5.中华医学会精神科分会.中国精神障碍分类与诊断标准(第三版)[M].山东:山东科学技术出版社,2001:87-89.
6.陆德青,肖刚,姜宝顺.艾司西酞普兰与西酞普兰治疗女性老年抑郁症伴焦虑患者的随机对照研究[J].中国健康心理学杂志,2014,22(05):656-658.
7.田静彬,王宝梅,李雨,等.柴胡甘麦汤对老年女性抑郁症患者催乳素及糖脂代谢影响的临床研究[J].中医学报,2014,29(06):898-900.
8.王燕.奥氮平联合艾司西酞普兰治疗难治性抑郁症患者糖脂代谢及睡眠质量的效果[J].医疗装备,2017,30(18):113-114.
9.彭四新,褚庆文.二甲双胍对米氮平所致体质量增加抑郁症患者肝脏脂肪含量及糖脂代谢的影响[J].南昌大学学报(医学版),2017,57(04):54-56,79.
10.张喜燕,杜亚松,龚云,等.舍曲林治疗首发青少年抑郁症认知功能的研究[J].世界临床药物,2013,34(01):31-35.
11.刘高峰,杜亚丽.奥氮平联合艾司西酞普兰对难治性抑郁症患者糖脂代谢及睡眠质量的影响[J].现代诊断与治疗,2017,28(17):3216-3217.
12.辛霁霏.舍曲林与帕罗西汀治疗抑郁症首次发病患者认知功能的效果分析[J].吉林医学,2013,34(01):72-73.
13.彭四新,褚庆文.二甲双胍对米氮平所致体质量增加抑郁症患者肝脏脂肪含量及糖脂代谢的影响[J].南昌大学学报(医学版),2017,57(4):54-56.
14.钟智勇,陶炯,王相兰,等.抗抑郁药物联合短期无抽搐电休克治疗对抑郁症疗效及认知功能的影响[J].中国临床药理学与治疗学,2017,22(2):179-183.
15.赵静,郭慧荣,连楠.抗抑郁药物联合心理治疗在抑郁症临床治疗中的效果分析[J].黑龙江医学,2017,41(2):111-112.
2.潘苗,张三强,吕路线,等.不同抗抑郁药物干预对首发老年抑郁症患者半年结局的影响[J].中国老年学杂志,2016,36(11):2640-2643.
3.曾永涛,段敏.文拉法辛与舍曲林治疗首发抑郁症对照研究[J].中国健康心理学杂志,2016,24(08):1128-1132.
4.王静.三种抗抑郁症药物治疗伴躯体疼痛症状的抑郁症患者的对比研究[J].中国实用医药,2016,11(27):8-10.
5.中华医学会精神科分会.中国精神障碍分类与诊断标准(第三版)[M].山东:山东科学技术出版社,2001:87-89.
6.陆德青,肖刚,姜宝顺.艾司西酞普兰与西酞普兰治疗女性老年抑郁症伴焦虑患者的随机对照研究[J].中国健康心理学杂志,2014,22(05):656-658.
7.田静彬,王宝梅,李雨,等.柴胡甘麦汤对老年女性抑郁症患者催乳素及糖脂代谢影响的临床研究[J].中医学报,2014,29(06):898-900.
8.王燕.奥氮平联合艾司西酞普兰治疗难治性抑郁症患者糖脂代谢及睡眠质量的效果[J].医疗装备,2017,30(18):113-114.
9.彭四新,褚庆文.二甲双胍对米氮平所致体质量增加抑郁症患者肝脏脂肪含量及糖脂代谢的影响[J].南昌大学学报(医学版),2017,57(04):54-56,79.
10.张喜燕,杜亚松,龚云,等.舍曲林治疗首发青少年抑郁症认知功能的研究[J].世界临床药物,2013,34(01):31-35.
11.刘高峰,杜亚丽.奥氮平联合艾司西酞普兰对难治性抑郁症患者糖脂代谢及睡眠质量的影响[J].现代诊断与治疗,2017,28(17):3216-3217.
12.辛霁霏.舍曲林与帕罗西汀治疗抑郁症首次发病患者认知功能的效果分析[J].吉林医学,2013,34(01):72-73.
13.彭四新,褚庆文.二甲双胍对米氮平所致体质量增加抑郁症患者肝脏脂肪含量及糖脂代谢的影响[J].南昌大学学报(医学版),2017,57(4):54-56.
14.钟智勇,陶炯,王相兰,等.抗抑郁药物联合短期无抽搐电休克治疗对抑郁症疗效及认知功能的影响[J].中国临床药理学与治疗学,2017,22(2):179-183.
15.赵静,郭慧荣,连楠.抗抑郁药物联合心理治疗在抑郁症临床治疗中的效果分析[J].黑龙江医学,2017,41(2):111-112.