皮质下动脉硬化性脑病伴发抑郁的治疗分析

Treatment of accompanied depression in subcortical arteriosclerotic encephalopathy

目的:观察抗抑郁治疗对皮质下动脉硬化性脑病伴发抑郁症患者抑郁症状、神经功能缺损及日常生活能力的改善情况。方法:选择2002-01/2005-06来自于河南省人民医院神经科门诊和住院的患者110例,随机分为米氮平治疗组(n=38),阿米替林治疗组(n=36)、对照组(n=36),各组均行常规神经营养药物和促智药物治疗,米氮平治疗组同时口服米氮平30mg/次,1次/晚;阿米替林组同时口服阿米替林25mg/次,分早晚两次口服,最大剂量为100mg/d,总疗程均为12～24周,治理期间不合并其他抗抑郁或精神障碍药。治疗前、治疗后1,2,4、8,12周及6个月分别采用汉密顿抑郁量表评定患者的抑郁症状。于治疗前及治疗后12周、6个月进行神经功能缺损和日常生活能力评定。记录治疗期间米氮平治疗组和阿米替林治疗组不良反应发生情况。并于6个月对各组患者的并发症及预后进行评定。结果:纳入患者110例,由于调查过程中停药、失访、患并发症、死亡等原因,米氮平治疗组、阿米替林治疗组和对照组分别脱落5、6和6例,分别进入结果分析33、30和30例。①汉密顿抑郁量表评分结果:米氮平治疗组在治疗第1,2,4,8,12周及6个月时汉密尔顿抑郁量表得分均明显低于治疗前及对照组(P<0.01～0.05),阿米替林组在治疗后第2,4,8,12周及6个月时汉密尔顿抑郁量表得分低于治疗前及对照组(P<0.01～0.05)。②神经功能缺损及日常生活能力评定。结果:米氮平治疗组及阿米替林治疗组在治疗后第12周、6个月时神经功能缺损评分均明显低于治疗前及对照组(P<0.01～0.05),日常生活能力得分明显高于治疗前及对照组(P<0.01～0.05)。③不良反应发生情况:治疗期间米氮平导致口干、便秘、视力模糊、恶心、呕吐、心电图异常、尿潴留等不良反应发生情况明显少于阿米替林治疗组(P<0.01～0.05)。④各组治疗后并发症及预后比较:对照组肺部感染、尿路感染、脑卒中、心血管事件的发生率高于米氮平治疗组、阿米替林治疗组(P<0.01～0.05),其死亡率也明显增高(P<0.01～0.05)。结论:抗抑郁治疗能有效改善皮质下动脉硬化性脑病伴抑郁的症状,有利于患者神经功能康复,提高生活能力,减少并发症,米氮平治疗副反应少,更安全。

AIM： To observe the ameliorating effect of anti-depression therapy on depressive symptoms, neurological impairment and activity of daily living in patients with subeortical arteriosclerotic encephalopathy （SAE） accompanied by depression. METHODS： 110 patients treated in the Out-patient Clinic and Inpatient Department of Neurology, Henan Provincial People＇s Hospital between January 2002 and June 2005 were randomly divided into mirtazapine treatment group （n=38）, amitriptyline treatment group （n=36） and control group （n =36）. Patients in all groups received routine treatment by intaking drugs of neurotrophy and nootropics. Meanwhile, patients in the mirtazapine treatment group took mirtazapine pills orally for 30 mg each time and once per night; Patients in the amitriptyline group took amitriptyline for 25 mg each time, twice a day in the morning and night respectively with the maximal dose of 100 mg per day, and the whole progress were 12-24 weeks without intaking other drugs against depression or mental disorder. The depressive symptoms of patients were measured with Hamilton rating scale for depression （HAMD） before treatment and 1, 2, 4, 8, 12 weeks as well as 6 months after treatment. The .neurological impairment and activity of daily living were evaluated before treatment and 12 weeks as well as 6 months after treatment. The incidence condition of adverse reaction in the mirtazapine treatment group and amitriptyline treatment group during curative period was recorded. At the 6^th month of treatment, the complications and prognosis of patients in all groups were evaluated. RESULTS： 110 patients were included, because of some reasons such as discontinuation, withdraw, complications and death, etc., in the investigation, 5 cases in the mirtazapine treatment group, 6 cases in the amitriptyline group and 6 cases in the control group withdrew from the experiment, and those involved in the analysis of results in three groups were 33, 30, 30 respectively. ① HAMD score： At the 1^th, 2^rd, 4^th, 8^th, 12^th weeks and the 6^th month of treatment, it was obviously lower in the mirtazapine group than that pretherapy and in the control group （P 〈 0.01- 0.05）, At the 2^nt, 4^th, 8^th, 12^th weeks and the 6^th month of treatment, it was obviously lower in the amitriptyline group than that pretherapy and in the control group （P 〈 0.01-0.05）. ② Evaluation on neurological impairment and activity of daily living： Scores of neurological impairment in the mirtazapine treatment group and amitriptyline treatment group at the 12^th week and 6^th month of treatment were significantly lower than those before treatment as well as in the control group （P 〈 0.01-0.05）, and scores of daily living activity were obviously higher than those before treatment and in the control group （P 〈 0.01-0.05）. ③Adverse effect condition： Adverse effects （including dry mouth, constipation, blurred vision, nausea, vomit,electrocardiographic abnormality, retention of urine and so on） in the mirtazapine group were significantly lower than those in the amitriptyline group （P 〈 0.01-0.05）.④ Comparison of complications and prognosis among groups： Incidences of pulmonary infection, urinary tract infection, stroke and cardiovascular disease in the control group were higher than those in the other two groups （P 〈 0.01-0.05）, and its mortality rate was also increased significantly （P 〈 0.01-0.05）. CONCLUSION： Anti-depression therapy can significantly ameliorate the symptoms of SAE accompanied by depression, which can benefit the recovery of neurological function, ameliorate the living ability as well as reduce the complications. Therapy by using mirtazapine is safer with fewer side effects.