糖尿病患者伴发抑郁症的临床对照研究

Paroxetine for Depression in Diabetes: A Randomized Controlled Trial

目的 :评价帕罗西汀治疗糖尿病患者伴发抑郁症的疗效和对患者血糖的影响。方法 :对 48名伴发抑郁症的糖尿病患者 ,进行 8周的随机对照研究 ,实验组、对照组各 2 4例。帕罗西汀 2 0 -4 0mg 日 ,以Beck抑郁问卷 (BDI)和汉密尔顿抑郁量表 (HAMD)评定疗效。糖化血红蛋白 (GHb)用于血糖控制的监测。结果 :帕罗西汀组抑郁症状的减轻明显优于对照组 (P <0 0 5～ 0 0 1) ,根据BDI评分 ,帕罗西汀组的显效率明显高于对照组 ( 62 5 % ,3 3 3 % ,P <0 0 5 )。根据HAMD评分 ,帕罗西汀组的治愈率高于对照组( 4 5 8% ,2 5 0 % ,P <0 0 5 ) ,帕罗西汀组GHb降低的趋势比对照组更明显 ( -0 5 % ,-0 1% )。结论 :帕罗西汀能有效减轻糖尿病患者的抑郁症状 ,这种治疗更有利于血糖的控制。

Objective: Depression is prevalent in patients with diabet es It is associated with poor glycemic control and is linked to an increased r i sk for diabetic complications In this study, we assessed the efficacy of Parox e tine for depression in patients with diabetes Methods: 48 pati e nts with diabetes (type 1, n=7; type 2,n=41) and major depressive disorder enter ed an 8-week randomized placebo-controlled trial Patients were given daily dos e s of Paroxetine (up to 40 mg/day) The Beck Depression Inventory (BDI) and Hami l ton Rating Scale for Depression (HAMD) were used to measure the severity of depr ession and to determine the percentage of patients who achieved substantial impr ovement or complete remission GHb levels were obtained to monitor glycemic con t rol Results: Reduction in depression symptoms was significantl y greater in patients treated with Paroxetine compared with those receiving place bo (BDI-141 vs -89, P<005;HAMD-107 vs -50, P < 001) The percentage of patients achieving a significant improvement i n depression per the BDI was also higher in the Paroxetine group (625%vs333 %, P<005) Additionally, trends toward a greater rate of depress io n remission (458% vs 250% per the HAMD) and greater reduction in GHb (-0 5vs -01%) were observed in the Paroxetine groupConclusion:Paro xe tine effectively reduces the severity of depression in diabetic patients Our s t udy demonstrated that after only 8 weeks, this treatment also produced a trend t oward better glycemic control