度洛西汀治疗伴不同程度焦虑症状的抑郁症临床疗效比较

Comparison of clinical efficacy of duloxetine in the treatment of depression patients with different degrees of anxiety symptoms

目的研究伴不同程度焦虑症状的抑郁症患者实施度洛西汀治疗的临床疗效。方法选择温州市第七人民医院精神科收治的100例抑郁症患者,根据汉密尔顿焦虑量表(HAMA)评分分组,可能焦虑组36例(HAMA<14分),明显焦虑组64例(HAMA≥14分),均实施度洛西汀治疗,疗程共8周。记录2组自杀风险、复发及不良反应发生情况,比较2组临床疗效、HAMA评分、汉密尔顿抑郁量表(HAMD)评分。结果明显焦虑组自杀风险、复发率(61%、30%)均高于可能焦虑组(28%、14%)(χ^(2)=18.452,P=0.001;χ^(2)=5.176,P=0.037);明显焦虑组入院时及治疗后1、2、4、8周HAMD和HAMA评分[(26±6)、(21±6)、(16±7)、(11±6)、(8±5)和(20.4±5.0)、(18.9±4.8)、(15.0±4.9)、(12.6±4.4)、(10.0±4.3)分]均高于可能焦虑组[(21±4)、(16±4)、(12±5)、(9±4)、(6±4)和(10.2±2.4)、(9.3±2.7)、(8.1±2.6)、(7.3±2.3)、(6.4±2.7)分](t=6.348,P=0.001;t=5.176,P=0.001;t=4.982,P=0.001;t=5.749,P=0.001;t=3.157,P=0.011和t=7.153,P=0.001;t=6.827,P=0.001;t=5.694,P=0.001;t=4.186,P=0.002;t=4.742,P=0.001);明显焦虑组治疗2周末早期起效率、治疗4和8周末有效率、临床治愈率均低于可能焦虑组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论度洛西汀治疗伴不同程度焦虑症状抑郁症患者,伴轻度焦虑症状的患者疗效更佳,对于焦虑症状明显的抑郁症患者来说,自杀风险更高,病情更加严重,在抗抑郁药治疗过程中,疗效更差,起效更慢,复发率更高,临床应加强重视。

Objective To explore the clinical efficacy of duloxetine in the treatment of depression patients with different degrees of anxiety symptoms.Methods A total of 100 patients with depression in the department of psychiatry of the Seventh People′s Hospital of Wenzhou were selected.They were divided into a possible anxiety group of 36 cases(HAMA<14 points)and a significant anxiety group of 64 cases(HAMA≥14 points)according to the Hamilton Anxiety Scale(HAMA).Both groups were treated with duloxetine for a total of 8 weeks.The suicide risk,recurrence rate,and adverse reactions of the two groups were recorded,and their clinical efficacy,HAMA score,and Hamilton Depression Scale(HAMD)score were compared.Results The obvious anxiety group showed early efficacy after 2 weeks of treatment,and the effective rate and clinical cure rate after 4 and 8 weeks of treat-ment were significantly lower than those of the possible anxiety group(P<0.05);There was no statistically signifi-cant difference in the incidence of adverse reactions between the two groups(P>0.05).The suicide risk and recur-rence rate(61%,30%)of the obvious anxiety group were significantly higher than those of the possible anxiety group(28%,14%)(χ^(2)=18.452,P=0.001;χ^(2)=5.176,P=0.037).The HAMD and HAMA scores[(26±6),(21±6),(16±7),(11±6),(8±5)and(20.4±5.0),(18.9±4.8),(15.0±4.9),(12.6±4.4),(10.0±4.3)]of the obvious anxiety group were significantly higher than those of the possible anxiety group[(21±4),(16±4),(12±5),(9±4),(6±4)and(10.2±2.4),(9.3±2.7),(8.1±2.6)(7.3±2.3),(6.4±2.7)](t=6.348,P=0.001;t=5.176,P=0.001;t=4.982,P=0.001;t=5.749,P=0.001;t=3.157,P=0.011;and t=7.153,P=0.001;t=6.827,P=0.001;t=5.694,P=0.001;t=4.186,P=0.002;t=4.742,P=0.001)at admission and 1,2,4,and 8 weeks after treatment.The obvious anxiety group had early onset of treatment after 2 weeks,effective rates after 4 and 8 weeks,and clinical cure rates significantly lower than the possible anxiety group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Duloxetine is more effective in the treatment of depression patients with different degrees of anxiety symptoms.The therapeutic effect is better for patients with mild anxiety symptoms.For depression patients with obvious anxiety symptoms,the risk of suicide is higher,the condition is more severe,and in the process of antidepressant treatment,the efficacy is worse,the onset is slower,and the re-currence rate is higher.Therefore,clinical attention should be strengthened.