重性抑郁障碍急性期患者不同治疗方案临床疗效

Evaluation of clinical efficacy about different ways treating major depressive disorder

目的探讨选择性五羟色胺再摄取抑制剂(SSRI)类抗抑郁药物、心理治疗和改善脑功能药物治疗联用对重性抑郁障碍急性期患者的临床疗效。方法收集2008年1月至2011年8月山西医科大学第一医院及山西省武警总队医院就诊的住院抑郁障碍患者400例。采用随机、对照、开放性设计,将400例重性抑郁障碍患者,全部患者均符合美国精神障碍诊断与统计手册(第4版)诊断标准及经人格障碍定式临床会谈量表(SCID)分为4组,每组100例:A组给予SSRI抗抑郁药;B组给予SSRIs抗抑郁药+心理治疗;C组给予SSRI抗抑郁药+改善脑功能药物;D组给予SSRI抗抑郁药+心理治疗+改善脑功能药物,急性期随访8周,采用汉密尔顿抑郁量表-17项(HAMD-17)评估临床疗效,共收集有效数据340例。以SPSS13.0软件包对数据进行重复测量方差分析。结果应用重复测量方差分析及析因分析进行分析显示:340例患者中,D组2、4、6、8周末HAMD-17减分率比A、B、C组高;C组与A组在2、4周末HAMD-17减分率无统计学差异,6、8周末B、C组HAMD-17减分率较A组高;各治疗组随治疗时间的延长减分率增加(F=1618.2,P<0.01),且时间与分组有交互作用(F=7.15,P<0.01);SSRIs是否联用改善脑功能药物HAMD-17减分率在2、4、6、8周差异有统计学意义(F=30.70,F=63.75,F=20.47,F=22.09,P均<0.01),SSRIs是否联用心理治疗在2、4周差异无统计学意义(F=0.23,F=0.27,P均<0.05),6、8周差异有统计学意义(F=25.20,F=36.05,P均<0.01);两因素除4周外无交互效应。结论重性抑郁障碍急性期联合治疗短期临床疗效更快、更明显,且治疗有协同作用。

Objective To explore the clinical efficacy of antidepressant pharmacotherapy( SSRI class),psychological treatment and improving brain function drugs in patients with acuting depressive disorders. Methods Four-hundred cases with serious acuting depressive disorder who were conformed by the diagnostic and statistical manual of mental disorders Ⅳ and structured clinical interview for DSM-Ⅳ were divided into the following four groups in a random,controlled and open experimental design: group A: SSRI,group B: SSRI + psychological treatment,group C: SSRI + improving brain function drugs,group D: SSRI +improving brain function drugs + psychological treatment,they were observed in the acute phase for 8 weeks,and clinical efficacy of different treatments were assessed with HAMD-17. Effective data were collected from three hundred and forty cases. Compare the differences among the four groups by using analysis of variance and chi-square test. Results Application of repeated measurement variance analysis and factorial analysis analysis showed that: In 340 cases,the reduced rate of HAMD-17 of group D was higher than group C,B and group A. There was no significant statistical difference between the reduced rate of HAMD-17 of group C and group A in 2nd week,4th week,the reduced rate of HAMD-17 of group C,B was higher than group A,in 6th week,8th week. All the treatment groups increased in deduction rate as the passing of time( F = 1618. 2,P <0. 01),and the interaction between the time and the classification of group existed( F = 7. 15,P < 0. 01).There was significant differences of HAMD-17 reduced rate in 2nd,4th,6th,8th weeks in whether SSRIs combine improving brain function drugs or not( F = 30. 70,F = 63. 75,F = 20. 47,F = 22. 09,all P < 0. 01).There was significant differences of HAMD-17 reduced rate whether the treatment combine psychological therapy or not in 6th,8th weeks( F = 25. 20,F = 36. 05,all P < 0. 01),but there was no significant differences in 2nd,4th weeks( F = 0. 23,F = 0. 27,all P < 0. 05). The two factors had no interaction effects in addition to 4th week( F = 7. 19,all P < 0. 01). Conclusion The combination therapy to treat patients with acuting depressive disorders is faster and more obvious in the short-term clinical efficacy,and the several treatments has the synergy.