小剂量帕罗西汀对维持性血液透析抑郁症患者炎症及营养不良的影响

Effect of small dose paroxetine on inflammation and malnutrition in maintenance hemodialysis patients with depression

目的探讨小剂量帕罗西汀对维持性血液透析抑郁症患者炎症和营养不良的影响。方法对45例维持性血液透析抑郁症患者采用帕罗西汀10 mg/d治疗8周,治疗期间观察药物不良反应;治疗前后应用汉密尔顿抑郁量表(HAMD)、超敏C反应蛋白(hs-CRP)和改良主观全面营养评价法(MSGAN),对患者分别进行抑郁状态、炎症和营养不良的评估,同时测定血清白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、铁蛋白(SF)、肌酐(SCr)、尿素氮(BUN)、钙(Ca)、磷(P)、全段甲状旁腺激素(iPTH)等生化指标。结果治疗后患者HAMD评分22.14±7.23 vs14.25±6.51、hs-CRP(10.58±4.53)mg/L vs(6.42±2.45)mg/L及营养不良评分(MS)18.74±6.58 vs 13.26±5.33均明显降低,差异有统计学意义(P<0.01),血清Alb、PA、SF、Hb、BUN水平较治疗前提高(P<0.01,P<0.05),而SCr、Ca、P及iPTH治疗前后未见明显差别(P>0.05)。患者不良反应发生率为11.11%,均可耐受。结论小剂量帕罗西汀能有效减轻维持性血液透析抑郁症患者的抑郁状态,同时改善患者的微炎症状态和营养不良。

Objective To investigate the effect of small dose paroxetlne on inflammation and malnutrition in maintenance hemodialysis （MHD） with depression. Methods Forty-five MHD patients with depression were selected to receive paroxetine 10 mg/d for eight weeks. Side effects were observed during treatment. Hamilton depression scale （HAMD）, high sensitivity C-reactive protein（hs-CRP）, the modified quantitative subjective global assessment of nutrition（MSGAN） and some biochemical parameters including serum albumin （Alb）, pre-albumin （PA）, hemoglobin （Hb）,serum ferritin （SF）, serum creatinine （SCr）, urea nitrogen （BUN）, calcium （Ca）, phosphorus （P） and intact parathormone （iPTH） were measured to evaluate the depressive state, microinflammatory state and nutritional status before and after treatment. Results HAMD scale 22.14±7.23 vs 14. 26± 6. 51, hs-CRP （10.58±4.53） mg/L vs （6. 42±2.45） mg/L and malnutrition score 18.74 ± 6.58 vs 13.26±5.33 were significantly decreased and the mean values of serum Alb, PA,SF, Hb and BUN were significantly increased after treatment than that before treatment（ P〈0.01, P〈0.05）. Whereas, there were no significant difference in serum Cr,Ca, P and iPTH before and after treatment （ P〉0.05）. Five patients （11.11%） showed slight endurable side effects. Conclusion Small dose paroxetine can alleviate the depressive state and improve the microinflammatory state as well as malnutrition in MHD patients with depression.