氯胺酮对焦虑型和非焦虑型双相障碍的抗抑郁疗效比较  

Comparison of antidepressant efficiency of ketamine on anxious and non-anxious bipolar disorder

作　　者：王成瑜 周燕玲[1] 刘伟健 郑伟 詹妍妮[3,6] 蓝晓凤 宁玉萍 Wang Chengyu;Zhou Yanling;Liu Weijian;Zheng Wei;Zhan Yanni;Lan Xiaofeng;Ning Yuping(Department of Early Intervention,the Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital),Guangzhou 510370,China;Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders,Guangzhou 510370,China;Institute of Psychiatry&Psychology,the Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital),Guangzhou 510370,China;Peking University Sixth Hospital,Peking University,Beijing 100191,China;Department of Physical Therapy,the Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital),Guangzhou 510370,China;Department of Psychiatry,Mental Health Center of Shantou University,Shantou 515065,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]广州医科大学附属脑科医院(广州市惠爱医院)早期干预科,510370 [2]广东省精神疾病转化医学工程技术研究中心,广州510370 [3]广州医科大学附属脑科医院(广州市惠爱医院)精神心理研究所,510370 [4]北京大学第六医院,100191 [5]广州医科大学附属脑科医院(广州市惠爱医院)物理治疗科,510370 [6]汕头大学精神卫生中心精神科,515065 [7]南方医科大学第一临床医学院,广州510515

出　　处：《神经疾病与精神卫生》2021年第8期546-551,共6页Journal of Neuroscience and Mental Health

基　　金：广州市科技计划项目(202102020557);国家重点研发计划专项(2016YFC0906302)。

摘　　要：目的探讨焦虑型和非焦虑型双相抑郁患者重复氯胺酮抗抑郁治疗反应的差异.方法本研究是基于2016年7月至2018年8月在广州医科大学附属脑科医院进行的一项单臂开放标签临床试验的事后研究,纳入32例焦虑型(n=23)和非焦虑型(n=9)双相抑郁患者.焦虑型双相抑郁被定义为符合DSM-5双相障碍目前为重性抑郁发作的诊断且汉密尔顿抑郁评定量表焦虑-躯体化因子分≥7分.在维持心境稳定剂、抗抑郁药和(或)苯二氮?类镇静催眠药稳定使用的情况下,两组均接受6次重复亚麻醉剂量(0.5 mg/kg)氯胺酮静脉注射治疗,在治疗前、首次治疗后4 h、每次治疗后24 h和末次治疗后2周采用蒙哥马利-阿斯伯格抑郁评定量表(MADRS)评估患者的抑郁症状.结果焦虑型和非焦虑型双相抑郁患者经重复亚麻醉剂量氯胺酮治疗的有效率(末次治疗后24 h,5/8比14/19;末次治疗后2周,4/7比11/17)和缓解率(末次治疗后24 h:4/8比9/19;末次治疗后2周:4/7比6/17)差异无统计学意义(P>0.05).线性混合模型显示,控制基线MADRS评分后随访时间对MADRS评分具有显著效应(F=20.558,P<0.001),经治疗MADRS评分逐渐降低,焦虑亚型对MADRS评分无显著效应(F=0.309,P=0.582),焦虑亚型和随访时间无显著交互作用(F=0.215,P=0.988).结论焦虑型和非焦虑型双相抑郁患者在接受亚麻醉剂量氯胺酮治疗后抑郁症状均有显著改善,氯胺酮对焦虑型和非焦虑型双相抑郁患者的抑郁症状的改善同样有效.Objective To explore the difference in antidepressant response to repeated ketamine treatment between anxious and non-anxious bipolar depression.Methods This study is based on a singlearm open-label clinical trial conducted at the Affiliated of Brain Hospital Guangzhou Medical University from July 2016 to August 2018.A total of 32 patients with bipolar depression of anxious subtype(n=23)and nonanxious subtype(n=9)were enrolled.Anxious bipolar depression was defined as DSM-5 bipolar depression plus a Hamilton Depression Rating Scale Anxiety-Somatization Factor score of greater than or equal to 7.They received 6 repeated sub-anesthetic doses of intravenous ketamine(0.5 mg/kg),while maintaining the stable dosages of mood stabilizers,antidepressants and/or benzodiazepine sedative hypnotics.The depressive symptoms were assessed with Montgomery-Åsberg Depression Rating Scale(MADRS)at baseline,4 hours after the first infusion,24 hours after each infusion,and 2 weeks after the whole treatment.Results There was no significant difference in response and remission rates between anxious and non-anxious bipolar depression at 24 hours(response,5/8 vs 14/19;remission,4/8 vs 9/19)or 2 weeks after the last ketamine infusion(response,4/7 vs 11/17;remission,4/7 vs 6/17)(P>0.05).The linear mixed model revealed a significant effect of that the follow-up time on the MADRS score after controlling for baseline depressive symptom(F=20.558,P<0.001).After treatment,MADRS score decreased gradually,and anxious subtypes had no significant effect on MADRS score(F=0.309,P=0.582).There was no significant interaction effect of anxious subtype by follow-up time on MADRS score(F=0.215,P=0.988).Conclusions The depressive symptoms of both patients with anxious and non-anxious bipolar depression significantly improved after receiving ketamine,and ketamine worked just as well for anxious as non-anxious patients.

关 键 词：氯胺酮 双相障碍 焦虑亚型 抗抑郁疗效 

分 类 号：R749.4[医药卫生—神经病学与精神病学]