盐酸氟西汀联合激素与单纯激素补充治疗绝经期抑郁症的疗效比较

Comparison of the effect of fluoxetine combined with hormone replacement therapy (HRT) and single HRT in treating menopausal depression

目的 观察盐酸氟西汀及激素补充治疗 (HRT)用于绝经期抑郁症的疗效。方法 将已绝经并符合抑郁症诊断的患者 5 4例 ,随机分为两组 ,每组 2 7例。盐酸氟西汀联合HRT组 :每 2 8天为1个周期 ,应用结合雌激素 0 6 2 5mg/d与安宫黄体酮 5mg/d ,盐酸氟西汀 2 0mg/d ;单纯HRT组 :每 2 8天为 1个周期 ,应用结合雌激素 0 6 2 5mg/d与安宫黄体酮 5mg/d。两组均治疗 8周。于治疗开始日及治疗第 1、2、3、4、6、8周各随访 1次 ,应用汉密尔顿抑郁量表 (HAMD)评价抑郁症程度 ,应用Kupperman绝经指数 (KMI)评价绝经期症状。结果 治疗前HAMD评分 ,盐酸氟西汀联合HRT组与单纯HRT组分别为 (2 3± 5 )分和 (2 4± 5 )分 ,两组比较 ,差异无显著性 (P >0 0 5 )。治疗第 3周 ,盐酸氟西汀联合HRT组为 (10± 6 )分 ,与治疗前比较 ,差异有极显著性 (P <0 0 0 1) ;单纯HRT组为 (15± 7)分 ,与治疗前比较 ,差异有显著性 (P <0 0 5 ) ;但两组治疗后比较 ,差异无显著性 (P >0 0 5 )。治疗 3周后 ,两组HAMD评分比较 ,差异有显著性 (P <0 0 5 )。至治疗第 8周HAMD评分 ,盐酸氟西汀联合HRT组与单纯HRT组分别为 (3± 2 )分和 (11± 6 )分 ,两组比较 ,差异有极显著性 (P <0 0 0 1)。治疗前KMI评分 。

Objective To compare the treatment effects between fluoxetine plus hormone replacement therapy (HRT) and HRT alone on menopausal depression. Methods A total of 54 women with climacteric symptoms and depression were enrolled and randomly divided into two groups. The fluoxetine plus HRT group received fluoxetine (20 mg, qd, po) and cyclic use of conjugated estrogen 0.625 mg and medroxyprogesterone acetate 5 mg, while HRT group was assigned to receive cyclic use of conjugated estrogen 0.625 mg and medroxyprogesterone acetate 5 mg only. All subjects were interviewed and evaluated with Hamilton Depression score (HAMD) and Kupperman menopause index (KMI) at week 0, 1, 2, 3, 4, 6 and 8 of the treatment. Results There was no difference between two groups in HAMD and KMI before the trial ( P >0.05). HAMD scores at the 8th week in fluoxetine plus HRT group and HRT group were 3.0±2.3 and 11.2±5.8 respectively, being significantly different ( P <0.001). At the 6th week of treatment KMIs in fluoxetine plus HRT group and HRT group were 9±6 and 14±7 respectively, also significantly different ( P <0.05). The healing rates of fluoxetine plus HRT group and HRT group were 92% and 48% respectively, which were statistically different by Chi square test ( P <0.001). Conclusions The effect of fluoxetine plus HRT on menopausal depression is significantly superior than that of HRT only and the difference becomes more obvious with treatmant time. Both groups could ameliorate the climacteric symptoms with the effect of fluoxetine plus HRT more obvious.