草酸艾司西酞普兰联合左甲状腺素钠治疗亚临床甲状腺功能减退伴焦虑抑郁30例  

Effects of escitalopram oxalate and levothyroxine sodium treatment on patients of subclinical hypothyroidism combined with anxiety and depression:an analysis of 30 cases

作　　者：于梦尧 鲁春[2] 冯李明[1] 王新文 YU Mengyao;LU Chun;FENG Limin;WANG Xinwen(Department of Endocrinology,Donghai People’s Hospital,Lianyungang,Jiangsu 222300,China;Department of Psychiatry,Donghai People’s Hospital,Lianyungang,Jiangsu 222300,China)

机构地区：[1]东海县人民医院内分泌科,江苏连云港222300 [2]东海县人民医院精神科,江苏连云港222300

出　　处：《安徽医药》2020年第8期1655-1658,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的观察草酸艾司西酞普兰联合左甲状腺素钠治疗亚临床甲状腺功能减退伴焦虑抑郁的效果。方法选取2015年1月至2018年7月东海县人民医院亚临床甲状腺功能减退伴焦虑抑郁病人90例,采用随机数字表法分为西酞普兰组、左甲状腺素钠组和联合组,每组30例。分别予以草酸艾司西酞普兰、左甲状腺素钠和草酸艾司西酞普兰+左甲状腺素钠联合治疗。8周后,观察三组治疗前后游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平和汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)评分的变化。结果治疗后与治疗前相比,西酞普兰组TSH[(7.70±1.09)μIU/mL比(7.77±1.03)μIU/mL]、FT3[(4.28±0.73)pmol/L比(4.30±0.58)pmol/L]、FT4[(9.72±1.03)pmol/L比(9.98±1.09)pmol/L]无变化(P>0.05),TSH左甲状腺素钠组[(4.39±0.76)μIU/mL比(7.69±1.01)μIU/mL]和联合组[(4.30±0.51)μIU/mL比(7.78±0.98)μIU/mL]下降,FT3左甲状腺素钠组[(5.85±0.81)pmol/L比(4.34±0.67)pmol/L]和联合组[(5.63±0.54)pmol/L比(4.27±0.63)pmol/L]升高、FT4左甲状腺素钠组[(13.22±1.56)pmol/L比(10.22±1.30)pmol/L]和联合组[(12.69±1.31)pmol/L比(9.89±1.12)pmol/L]升高(P<0.05)。治疗后HAMA和HAMD评分与治疗前相比,西酞普兰组[(12.60±1.35)分比(21.90±2.56)分]、[(12.57±1.61)分比(22.16±1.72)分],左甲状腺素钠组[(14.50±1.54)分比(21.30±2.39)分]、[(13.90±2.64)分比(22.93±1.85)分]和联合组[(8.36±1.73)分比(20.43±3.08)分]、[(8.26±1.63)分比(21.96±1.62)分]下降(P<0.05)。与西酞普兰组、左甲状腺素钠组相比,联合组HAMA和HAMD评分下降(P<0.05)。结论草酸艾司西酞普兰或左甲状腺素钠均可以缓解亚临床甲状腺功能减退伴焦虑抑郁病人的焦虑抑郁症状,联合用药疗效优于单药治疗。Objective To observe the efficacy of escitalopram oxalate and levothyroxine sodium on the treatment of patients withsubclinical hypothyroidism combined with anxiety and depression.Methods Ninety patients of subclinical hypothyroidism com-bined with anxiety and depression,who were treated in Donghai People’s Hospital from January 2015 to July 2018,were chosenand randomly assigned into escitalopram group(n=30),levothyroxine group(n=30)and combined group(n=30).The patientswere treated with escitalopram oxalate,levothyroxine sodium,and escitalopram oxalate plus levothyroxine sodium,respectively.After8 weeks,thyroid stimulating hormone(TSH),free triiodothyronine(FT3),and free tetraiodothyronine(FT4)levels before and afterthe treatment were tested and Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were usedto evaluate the emotional status.Results In comparison with pretreatment,the TSH[(7.70±1.09)μIU/m L vs.(7.77±1.03)μIU/m L],FT3[(4.28±0.73)pmol/L vs.(4.30±0.58)pmol/L],FT4 levels[(9.72±1.03)pmol/L vs.(9.98±1.09)pmol/L]of escitalopramgroup were unchanged after treatment(P>0.05).TSH levels were decreased in levothyroxine group [(4.39±0.76)μIU/m L vs.(7.69±1.01)μIU/m L]and combined group[(4.30±0.51)μIU/m L vs.(7.78±0.98)μIU/m L](P<0.05)and FT3 levels were in-creased in levothyroxine group[(5.85±0.81)pmol/L vs.(4.34±0.67)pmol/L]and combined group[(5.63±0.54)pmol/L vs.(4.27±0.63)pmol/L](P<0.05).FT4 levels were increased in levothyroxine group[(13.22±1.56)pmol/L vs.(10.22±1.30)pmol/L]andcombined group[(12.69±1.31)pmol/L vs.(9.89±1.12)pmol/L](P<0.05).In comparison with pretreatment,the HAMA and HAMDscores were decreased in escitalopram group[(12.60±1.35)vs.(21.90±2.56)],[(12.57±1.61)vs.(22.16±1.72)],levothyroxinegroup[(14.50±1.54)vs.(21.30±2.39)],[(13.90±2.64)vs.(22.93±1.85)]and combined group[(8.36±1.73)vs.(20.43±3.08)],[(8.26±1.63)vs.(21.96±1.62)]after treatment(P<0.05).In comparison with escitalopram group and levothyroxine group,theHAMA and HAMD scores w

关 键 词：甲状腺功能减退/药物疗法 西酞普兰 左甲状腺素钠 焦虑 抑郁 

分 类 号：R581.2[医药卫生—内分泌]