乌灵胶囊和西酞普兰并用治疗广泛性焦虑症的特点

Characteristics of citalopram plus Wuling capsule in the treatment of general anxiety disorder

目的:观察乌灵胶囊和西酞普兰治疗广泛性焦虑症的临床特点。方法:选择2005-10/2006-05于西安交通大学医学院第一附属医院精神科门诊就诊的广泛性焦虑症患者74例,按就诊及确诊顺序编号随机分为两组,单号为观察组38例,双号为对照组36例。①对照组给予西酞普兰,剂量20mg,晨起口服,1次/d。观察组除给予西酞普兰治疗外,同时合并乌灵胶囊0.99g,3次/d,口服。严重失眠者可加用苯二氮类药物劳拉西泮0.5～1.0mg。疗程为6周。②分别于治疗前及治疗后第1,2,4,6周采用汉密顿焦虑量表、汉密顿抑郁量表对两组患者焦虑、抑郁程度进行评定,以汉密顿焦虑量表减分率为疗效评定指标,减分率≤30%为无效,减分率31%～49%为好转,减分率50%～79%为显著好转,减分率≥80%为临床痊愈。③采用副反应量表评定不良事件及副反应发生情况。结果:纳入观察组38例,对照组36例,分别脱落8,6例,为不能及时复查和进行心理检验者。最后观察组30例,对照组30例进入结果分析。①汉密顿焦虑量表总分:观察组第1,2,4,6周末与治疗前比较,差异有高度显著性(13.8±4.1,11.7±3.8,9.8±3.5,8.3±2.9,21.5±5.8,P<0.01),对照组第2,4,6周末与治疗前比较,差异有高度显著性(13.8±3.6,10.3±3.4,8.1±3.2,20.9±5.3,P<0.01)。②汉密顿抑郁量表总分:观察组、对照组均从第2周末起与治疗前比较,差异有显著性(10.7±3.1,16.8±5.9;10.1±3.0,15.9±5.2,P<0.05),观察组、对照组第4周末、第6周末与治疗前比较,差异有高度显著性(观察组:9.0±2.6,7.3±1.9,16.8±5.9;对照组:8.9±2.4,7.5±2.1,15.9±5.2,P<0.01)。③对照组罗拉使用率高于观察组,差异有高度显著性(78.0%,36.5%,P<0.01);对照组西酞普兰平均剂量高于观察组,差异有显著性[(40.00±14.25)mg/d,(33.00±12.20)mg/d,P<0.05]。④治疗第1周末观察组有效率高于对照组,差异有高度显著性(53.5%,3.9%,P<0.01),治疗第2周末观察组有效率高于对照组,差异有显著性(89.0%,78.0%,P<0.05)。⑤在治疗第4周末时对照组副作用量表评分高于观察组,差异有高度显著性(4.35±1.23,3.26±1.12,P<0.01)。结论:西酞普兰合并乌灵胶囊治疗,较单用西酞普兰起效快,西酞普兰用量小,副作用较少。

AIM： To observe the clinical characteristics of Wuling capsule and citalopram in the treatment of generalized anxiety disorder （GAD）. METHODS： Seventy-four out-patients with GAD from October 2005 to May 2006 were selected from Department of Psychiatry, First Affiliated Hospital of Medical College, Xi＇an Jiao Tong University. All patients were divided into two groups according to their numbers of visiting and diagnosis, patients with odd numbers were assigned into study group （n=38） and those with even numbers were assigned into controlgroup （n=36）. ①Patients in the control group were treated by orally taking 20 mg of citalopram once a day in the morning. Those in the study group were treated orally with 20 mg of citalopram combined with 0,99 g of Wuling capsule three times a day. Patients with severe insomnia were given 0.5-1.0 mg of Lorazepam additionally. The treatment course for patients in the two groups was 6 weeks. ②Anxiety and depression levels of patients were evaluated with Hamilton Anxiety Rating Scale （HAMA） and Hamilton Depression Rating Scale （HAMD） respectively before treatment and 1, 2, 4, 6 weeks after the treatment. The decreased percent of HAMA was taken as the evaluation indicator： invalid as ≤30%, improved as between 31% and 49%, remarkably improved as between 50% and 79%, clinically healed as ≥ 80%. ② The side effects were measured with TESS. RESULTS： Eight patients in the study group and six patients in the control group withdrew from the study respectively, because they were unable to receive the reassessment and psychological test. Thirty patients in the study group and 30 patients in control group were involved in the analysis of resuhs.① The total score of HAMA： There were significant differences in the study group before treatment in comparison with that at the end of the 1^st, 2^nd, 4^th, 6^th weeks after the treatment （13.8±4.1,11.7±3.8,9.8±3.5, 8.3±2.9,21.5±5.8 ,P 〈 0.01）.There were significant differences in the control group at the end of the 2^nd, 4^th and 6^th weeks in comparison with those before treatment （13.8±3.6, 10.3±3.4, 8.1±3.2,20.9±5.3, P 〈 0.01）②The overall score of HAMD： There were significant differences from the end of the 2^nd week between the study group and control group （10.7±3.1, 16.8±5.9; 10.1±3.0,15.9±5.2,P 〈 0.05）, and there were significant differences at the end of the 4^th and 6^th weeks between the study group and control group （study group： 9.0±2.6,7.3±1.9,16.8±5.9; control group： 8.9±2.4, 7.5±2.1,15.9±5.2,P 〈 0.01）③The utilization of Lorazepam in the control group was significantly higher than that in the study group （78.0%, 36.5% ,P 〈 0.01）, and the average dose of Lorazepam in the control group was obviously higher than that in the study group ]（40.00±14.25） mg/d, （33.00±12.20） mg/d,P 〈 0.05]. ④The efficiency at the end of the first week was significantly higher in the study group than that in the control group （53.5%,3.9% ,P 〈 0.01）, and it was still remarkably higher at the end of the second week in the study group than that in the control group （89.0%,78.0%,P 〈 0.05）. ⑤ At the end of the 4^th week, the score of TESS in the control group was significantly higher than that in the study group （4.35±1.23,3.26±1.12,P 〈 0.01 ）.CONCLUSION：Citalopram integrated with Wuling capsule has a quicker effect than that by just using of citalopram. Citalopram is small in dose with less side effects.