米氮平与阿米替林治疗脑卒中后抑郁临床对照研究  

A clinical control study of mirtazapine vs.amitriptyline in post-stroke depression

作　　者：吕应春[1] 王振英[1] 宋景贵[1] 王长虹[1] 

机构地区：[1]河南省精神病医院,河南新乡453002

出　　处：《中国民康医学》2012年第5期536-538,共3页Medical Journal of Chinese People’s Health

基　　金：2011河南省科技发展项目(编号112102310211)

摘　　要：目的:探讨米氮平与阿米替林治疗脑卒中后抑郁的临床疗效和安全性。方法:将64例脑卒中后抑郁患者随机分为研究组(米氮平组)32例,对照组(阿米替林组)32例。于治疗前和治疗第1、2、4、6周末采用汉密顿抑郁量表和不良反应量表评定临床疗效和不良反应,并于治疗第1周末和第6周末对主要抑郁症状进行检测。结果:治疗前两组汉密顿抑郁量表评分差异无显著性(P>0.05);治疗各时段两组评分均较治疗前显著下降(P<0.05或0.01);治疗1周末和2周末研究组汉密顿抑郁量表评分较对照组下降显著(P<0.05),总分减分率较对照组显著升高(P<0.05);治疗6周末除对照组自责、自杀念头症状检出率与治疗前差异无显著性外(P>0.05),两组其他抑郁症状检出率均显著低于治疗前(P<0.01);治疗后研究组不良反应发生率21.9%,对照组为46.9%(x2=4.43,P<0.05)。结论:米氮平治疗卒中后抑郁疗效与阿米替林相当,但米氮平起效明显快于阿米替林,不良反应较阿米替林少而轻,对改善卒中后抑郁的核心症状优于阿米替林。Objective：To explore the efficacy and safety of mirtazapine and amitriptyline in post - stroke depression （ PSD ）. Methods ： Sixty - four PSD patients were randomly divided into two groups of 32 ones each, research group was treated with mirtazapine and control group with amitriptyline. Efficacies were assessed with the Hamilton Depression Scale （HAMD） and adverse reactions with the Treatment Emergent Symptom Scale（TESS） before treatment and at the end of the 1 st, 2nd, 4th and 6th week of treatment, main depressive symptoms detected at the end of the I st and 6th week. Results： There was no significant difference in the HAMD score be- tween two groups before treatment, compared with pretreatment the HAMD scores of each periods of both groups lowered more signifi- cantly （ P 〈 0.05 or 0.01 ） , those did more significantly in the research than in the control group at the end of the 1 st and 2nd week （ P 〈 0.05） , and the score - reducing rate of total score heightened more significantly in the research than in the control group （P 〈 0. 05） ; the detection rates of self- reproach and suicidal thought at the end of the 6th week had no significant difference from pretreatment in the control group（ P 〈 0.05） , those of other depressive symptoms of both groups were significantly lower compared with pretreatment（P 〈0.01 ） ; the incidence of adverse reactions was respectively 21.9% in the research and 46.9% in the control group （x^2 = 4.43, P 〈 0.05 ）. Conclusions ： Mirtazapine has an efficacy equivalent to amitriptyline in the treatment of poststroke depression, but the former takes effect more rapidly, has fewer adverse reactions and advantage in improving core symptoms.

关 键 词：米氮平 阿米替林 脑卒中后抑郁 核心症状 汉密顿抑郁量表 

分 类 号：R749.13[医药卫生—神经病学与精神病学]