帕罗西汀提高绝经后焦虑/抑郁患者的雌激素水平和认知功能  

Paroxetine increases estrogen and cognition in postmenopausal anxiety-depression patients

作　　者：谢双燕 周伯荣[1] 胡佳佳[1] 关海涛[1] 邓燕华[1] 

机构地区：[1]广州医科大学附属第三医院神经内科,510150

出　　处：《中国神经免疫学和神经病学杂志》2015年第1期30-33,共4页Chinese Journal of Neuroimmunology and Neurology

基　　金：广东省科技计划资助项目(编号2011B060300027)

摘　　要：目的探讨抗抑郁剂帕罗西汀对绝经后焦虑/抑郁患者雌激素水平和认知功能的影响。方法收集绝经后焦虑抑郁患者82例,随机分为帕罗西汀抗抑郁治疗组(以下简称治疗组)44例,对照组38例,采用放射免疫法测定患者治疗前后的性激素〔包括雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)〕水平;同时评价情绪和认知相关的汉密顿焦虑量表(Hamilton anxiety rating scale,HAM-A)、汉密顿抑郁量表(Hamilton depression rating scale,HAM-D)和蒙特利尔认知评定量表(Chinese version of the Montreal cognitive assessment,MoCACV)评分。结果治疗组治疗后E2水平与治疗前相比明显上升〔(57.24±14.65)pg/mL比(48.45±10.25)pg/mL,P<0.05〕,与对照组治疗后〔(37.54±7.61)pg/mL〕相比E2水平也明显升高(P<0.05);治疗组FSH从治疗前的(50.56±16.78)mIU/mL下降到治疗后的(28.90±11.34)mIU/mL(P<0.05),治疗组治疗后与对照组治疗后〔(47.71±10.05)mIU/mL〕比较差异也有统计学意义;治疗组LH从治疗前的(24.18±6.25)mIU/mL下降到治疗后的(18.43±4.55)mIU/mL(P<0.05),治疗组治疗后与对照组治疗后〔(25.83±10.19)mIU/mL〕比较也有统计学差异。治疗组治疗前后HAM-A和HAM-D量表评分明显下降,而MoCA-CV量表评分明显上升(P<0.05)。治疗组治疗前后E2水平分别与治疗前后HAM-A和HAM-D评分呈负相关(HAM-A:r治疗前=-0.27,r治疗后=-0.24;HAM-D:r治疗前=-0.65,r治疗后=-0.37),与治疗前MoCA-CV呈正相关(r=0.52,r=0.47)。结论帕罗西汀可提高和改善绝经后女性雌激素水平与认知功能,提示雌激素可能是帕罗西汀改善情绪及认知功能的作用机制之一。Objective To investigate the effect of paroxetine on sex hormone levels and cognitive function in post-menopausal anxiety/depression patients.Methods Eighty-two post-menopausal patients who were diagnosed as anxiety/depression disorder and were not receiving hormone replacement therapy participated in aprospective,6-month,open-label naturalistic study.Patients were divided into an antidepressant treatment group（44cases）and a non-antidepressant treatment（control）group（38cases）.We collected demographic data,sex hormone levels,psychological cognitive rating scale scores.Results Paroxetine significantly increased serum E2from（48.45±10.25）pg/mL to（57.24±14.65）pg/mL,while FSH declined from（50.56±16.78）mIU/mL to（28.90±11.34）mIU/mL（P〈0.05）,LH also decreased from（24.18±6.25）mIU/mL to（18.43±4.55）mIU/mL（P〈0.05）.Moreover,there were significant differences in E2,FSH,LH when comparing antidepressant group and control group after treatment.Meanwhile,HAM-A and HAM-D scores were decreased and MoCA-CV score was raised by paroxetine（P〈0.05）.We also found a negative association between E2 and scores of HAM-A and HAM-D at pre and post-treatment of paroxetine（HAM-A：r=-0.27,r=-0.24;HAM-D：r=-0.65,r=-0.37）,while a positive correlation between E2 and MoCA-CV scores at pretreatment of Paroxetine（r = 0.52,r = 0.47）.Conclusions Paroxetine improves cognitive function in postmenopausal anxiety-depression patients,possibly by increasing endogenous estrogen discharge and delaying degeneration of the gonads.

关 键 词：帕罗西汀 雌激素类 焦虑 抑郁 认知功能 

分 类 号：R749.72[医药卫生—神经病学与精神病学]