度洛西汀对抑郁症患者认知功能与神经内分泌的影响  

Effect of duloxetine on cognitive function and neuroendocrine in patients with depression

作　　者：贾艳滨[1] 徐贵云[2] 李淑仪[1] 欧阳惠怡 党亚梅[2] 

机构地区：[1]暨南大学附属第一医院精神科,广东广州510632 [2]广州市精神病医院情感障碍科,广东广州510370

出　　处：《中国新药与临床杂志》2011年第12期928-932,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：广州市卫生局科技攻关计划(2007Z3-E0611)

摘　　要：目的评估度洛西汀治疗抑郁症患者12 wk后,对认知功能及神经内分泌的影响。方法 27例成年抑郁患者(男性10例,女性17例),进行度洛西汀治疗,剂量60～120 mg,治疗12 wk。分别于基线和度洛西汀治疗12 wk后检测血清促甲状腺素(TSH)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、游离甲状腺素(FT4)、促肾上腺皮质激素(ACTH)和血清皮质醇水平。同时进行认知功能检查:威斯康星卡片分类测验(WCST)、连线测验(TMT)、词语流畅性测验(VFT)、中国修订韦克斯勒成人智力量表(WAIS-RC)的数字广度及数字符号、汉诺塔(TOH)测验,并在治疗前及药物治疗后wk 1、2、4、8、12采用汉密尔顿抑郁量表17项(HAMD-17)因子分、总分进行疗效评定。结果度洛西汀治疗12 wk与治疗前认知功能比较,WAIS-RC的数字广度(14.35±3.21)及数字符号(49.50±15.36)较治疗前(13.50±3.15,46.50±14.91)评分显著增高(P<0.05),WCST、TMT、VFT及TOH测验数值比较未见显著差异(P>0.05)。内分泌检查FT4较治疗前显著下降[(11.89±4.02)pmol·L^(-1)vs.(13.59±4.55)pmol·L^(-1),P<0.05];FT3、TT3、TT4、TSH、ACTH及皮质醇与治疗前比较未见显著差异(P>0.05)。相关分析研究发现治疗前后HAMD-17总分的减分率与治疗前后FT3(相关系数为-0.420,P=0.036)和TT4(相关系数为-0.513,P=0.029)的改变呈负相关,与其他内分泌指标不存在相关性。治疗前后HAMD-17总分的减分率与治疗前后完成TOH测试总时间呈正相关(相关系数为0.44.1,P=0.027),与其他神经认知功能指标不存在相关性。度洛西汀治疗的总有效率为78%(21/27),痊愈率56%(15/27)。结论度洛西汀用药12 wk能有效治疗抑郁症患者,改善注意记忆等认知功能,与影响下丘脑-垂体-甲状腺轴功能有关。AIM To explore the curative effect and safety of modified electroconvulsive therapy（MECT） combined with duloxetine in treatment of depressive disorder patients with attempted suicide.METHODS A total of 86 patients with suicide-attempted depression were randomly divided into research group（n = 44,MECT combined with duloxetine 20 or 30 mg,bid,po） and control group（n =42,single duloxetine 20 or 30 mg, bid,po） in the 6-week study.The clinical efficacy were assessed by Hamilton Depression Scale 17-item（HAMD- 17） and Clinical Global Impression-Severity of Illness（CGI-S）,and the side effects were assessed by Treatment Emergent Symptom Scale（TESS） before treatment and at the end of the week 1,2,4,6 after the administration.RESULTS There were 41 patients in research group and 40 patients in control group completed the 6 weeks study.HAMD-17 scores of the two groups at the end of the week 1,2,4 or 6 after treatment had statistically significant differences from that of before the treatment in both the two groups（P0.01）,and the severity of illness had significant improvement in the two groups after the treatment（P0.05,P0.01）. There were significant differences between the two groups in HAMD-17 scores and CGI-S scores at any visit time. （P0.05）.In the research group,17 patients were cured,24 patients were effective,0 patients were invalid;in the control group,8 patients were cured,28 patients were effective,4 patients were invalid,with significant difference in curative effect between the two groups.TESS scores had no difference between the two groups with no statistically significant difference in the adverse reaction rate between the two groups（P0.05）.CONCLUSION MECT combined duloxetine is more effective than single duloxetine in treantment of suicide-attempted depression,and the safety is comparable.

关 键 词：度洛西汀 抑郁症 认知 下丘脑-垂体系统 

分 类 号：R749[医药卫生—神经病学与精神病学]