抑郁症首次发病患者治疗前后认知功能的研究

The cognitive function in first-episode depression before and after therapy

目的研究抑郁症首次发病（以下简称首发）患者治疗前后的认知功能改变及其相关影响因素。方法对80例符合国际疾病分类第10版诊断标准的抑郁症首发患者（患者组），给予文拉法辛缓释剂（40例，75～300mg／d）或盐酸氟西汀胶囊（40例，20—40mg／d）治疗，共12周。于治疗基线和治疗末评定17项汉密尔顿抑郁量表（HAMD17）、韦氏记忆量表、韦氏成人智力量表、威斯康星卡片分类测验，并与41名健康志愿者（对照组）比较。结果（1）治疗后患者组的神经心理学测验成绩较治疗前均有明显提高（P〈0．05或P〈0．01）。（2）患者组记忆商数改变与睡眠障碍分改变呈负相关（r=-0．26，P=0．021），短时记忆分改变与HAMD17总分改变、睡眠障碍分改变呈负相关（r=-0．27和-0．34，P=0．017和0．002），语言智商改变与阻滞分改变呈负相关（r=-0．24，P=0．034）。（3）痊愈组（HAMD17总分≤7分）患者的长时记忆分[（41．96±3．77）分]低于对照组[（44．05±5．06）分]，症状残留组（HAMD17总分〉7分）的记忆商数（107．52±18．12）、长时记忆分[（40．89±5．06）分]、短时记忆分[（60．74±12．58）分]低于对照组[分别为（121．90±11．26）、（44．05±5．06）分和（71．41±8．51）分；P〈0．05和P〈0．01]。（4）治疗后仍有14例（18％）患者的记忆商数低于正常值范围下界（均数-1．96倍标准差），多于对照组[1例（2％）；P〈0．05]。结论抑郁症首发患者治疗后认知功能明显提高，认知障碍改善与临床症状缓解存在相关性，治疗后仍有少部分患者的记忆功能未恢复到正常水平。

Objective To study the cognitive function and the related factors in first episode depression before and after treatment. Methods Eighty patients with first-episode depression were given extended releasing venlafaxine （75-300 mg/d） or fluoxetine hydrechloride （20-40 mg/d） treatment for 12 weeks, and 41 healthy people were involved as controls. The depression severity was assessed with the 17item Hamilton Depression Scale （HAMD）, and cognitive function with a series of neurepsychological tests including the Wechsler memory scale, Wechsler adult intelligence scale and Wisconsin cards sorting test. Results The depressed patients made improvements in the neuropsychological tests after treatment （P〈0.05 or P 〈 0.01）. The improvement in memory quotient （MQ） was negatively correlated to the alleviation in sleeping disturbance symptom （r=0. 26, P = 0. 021 ）, improvement in short-term memory （STM） negatively to the reductions in HAMD total score and sleeping disturbance item score （r = -0. 27, P = 0. 017 ; r = - 0.34, P = 0. 002 ）, and improvement in verbal intelligence quotient negatively to the reduction in retardation （ r = - 0. 24, P = 0. 034）. In comparison with controls, the recovered patients （ with HAMD total score of ≤ 7 ） still had lower score on long-term memory （ LTM ） scale （ P 〈 0. 05 ）, and patients with residual symptoms had lower MQ score, LTM score and STM score （P 〈 0. 05 ）. There were 18% of patients had MQ score lower than the lowerbound of normal range after the treatment, which was statistically higher than 2% of the controls （P 〈 0. 05 ）. Conclusions The cognitive function improves after treatment in patients with first-episode depression, which is correlated to the symptoms alleviation, while nearly one-fifth of patients have memory impairment even after depression symptom remission.