度洛西汀和西酞普兰对抑郁症患者电刺激痛觉诱发电位P250的影响  

Effects of duloxetine and citalopram on electrical pain-related evoked potentials P250 in depression

作　　者：徐乐平[1] 纪菊英[1] 宋梓祥[1] 祝育青 孙剑[1] 王焕林[1] 

机构地区：[1]解放军第一○二医院精神科,常州213003

出　　处：《中华精神科杂志》2011年第3期159-162,共4页Chinese Journal of Psychiatry

摘　　要：目的 探讨不同药理机制的抗抑郁对抑郁症患者电刺激痛觉诱发电位P250的影响.方法 将60例不伴疼痛的抑郁症患者采用随机数字表法随机分为度洛西汀组（30例,口服度洛西汀60 mg/d）和西酞普兰组（30例,口服西酞普兰20～40 mg/d）治疗,并于治疗前、治疗第2周末测定电刺激痛觉诱发电位P250,与对照组（30名,正常健康人）进行比较;对度洛西汀组和西酞普兰组P250下降率与17项汉密尔顿抑郁量表（HAMD17）评分的相关性进行分析.结果 （1）度洛西汀组和西酞普兰组治疗前P250波幅分别为（36.4±6.8）、（35.2±6.5）μV,均高于对照组[（28.0±5.5）μV],差异有统计学意义（P均=0.000）;3组P250潜伏期的差异无统计学意义（P=0.732）.（2）度洛西汀组和西酞普兰组治疗第2周末P250波幅分别下降为（31.4±5.7）、（34.0±5.9）μV,均高于对照组,差异有统计学意义（P=0.020,P=0.000）;2组治疗前后P250波幅的差异均有统计学意义（P=0.000,P=0.022）,P250潜伏期的差异均无统计学意义（P=0.667,P=0.408）.（3）度洛西汀组治疗第2周末P250波幅的下降值为（5.0±3.4）μV,下降率为（13±10）%,均高于西酞普兰组[（1.2±2.8）μV,（3±8）%],差异有统计学意义（P=0.000,P=0.000）.（4）度洛西汀组和西酞普兰组治疗第2周末P250波幅下降率与HAMD17总分减分率无显著相关性（P=0.318,P=0.287）,与焦虑/躯体化因子减分率呈正相关（分别r=0.370、P=0.034,r=0.417、P=0.009）.结论 抗抑郁药对P250波幅有下调作用,并可独立于抗抑郁效应;度洛西汀的作用强于西酞普兰.Objective To explore effects of antidepressants with distinct pharmacological property on electrical pain-related evoked potentials P250 in depression. Methods Sixty cases pain-free depressive inpatients were randomly divided into two groups, treated with duloxetine （60 mg/d, n = 30） or citalopram （20-40 mg/d, n = 30） respectively for 2 weeks. Pain-related evoked potentials P250 was measured before and after treatment, which was contrasted with healthy controls （n=30）. Results The amplitudes of P250 were significandy higher in either duloxetine or citalopram group at baseline compared with controls [（36. 4 ±6.8）, （35.2±6.5）μV vs. （28.0±5.5） μV , P = 0.000, P=0.000], and decreased significantly at the end of study [（31. 4 ± 5. 7） , （34. 0 ± 5. 9） μV, P =0. 000, P =0. 022 respectively]. Either the absolutely decreased value [（5.0 ±3. 4） μV vs. （1. 2 ±2. 8） μV, P =0.000] or the decreased ratio [（13±10）% vs.（3±8）%,P = 0. 000] of P250 amplitudes were significant higher in duloxetine group than citalopram group.The reduction of P250 amplitudes was not significantly related with the change of HAMD17 total score （P = 0. 318, P = 0. 287） , which was statistically positively correlate with the reduction rate of anxiety/somatization factor in either duloxetine group or citalopram group （r = 0. 370, P = 0. 034; r = 0. 417 , P =0. 009 respectively）. Conclusion Duloxetine and citalopram possibly have down-regulating effects on P250 amplitude independent of antidepressant effects, with duloxetine being more effective than citalopram.

关 键 词：西酞普兰 诱发电位 疼痛 抑郁 度洛西汀 

分 类 号：R749.4[医药卫生—神经病学与精神病学]