托吡酯终止抑郁症病人吸烟效果的对照试验

Smoking cessation efficacy of topiramate in patients with depression

目的评价托吡酯戒烟治疗的有效性。方法99例抑郁症病人,分为托吡酯治疗组和对照组,治疗组50例[男性49例,女性1例,年龄(34±s9)岁],对照组49例[男性47例,女性2例,年龄(33±8)岁]。2组病人在用文拉法辛、米氮平和氟西汀等抗抑郁药物基础上接受认知行为治疗,托吡酯治疗组同时口服托吡酯200 mg·d^(-1);疗程12wk。观察治疗期间不同时点戒烟成功率(吸烟量≤1支·d^(-1)),评定汉密顿抑郁量表(HAMD)、焦虑状态/特性询问表(STAI)、可视性渴求强度测评表;以呼气一氧化碳浓度验证吸烟情况。结果治疗后,治疗组和对照组戒烟成功率分别为52%和18%,2组差异具有非常显著意义(P<0.01);治疗组渴求强度得分(2.1±1.0)分、CO呼出量(6.6±1.6)×10^(-6)、HAMD (3.1±1.7)分、STAI(44±5)分,均低于对照剂组(4.0±1.8)分,(12±4)×10^(-6),(7.2±1.7)分, (49±10)分,差异有非常显著意义(P<0.01)。治疗组不良反应轻微可耐受。结论托吡酯在12 wk内的戒烟疗效优于对照,不良反应轻,适用于抑郁症戒烟治疗。

AIM To evaluate the efficacy of topiramate on smoking cessation in patients with depression. METHODS Ninety-nine patients were divided into treatment group and control group, and all were treated with antidepressants and cognitive-behavioral interventions, hut topiramate 200 mg·d-1 was given indivi-dually to the treatment group in addition from the 1 st to 4 th week, and then decreased progressively from the 5 th week, and finelly discontinued at the end of the 8 th week; as a course of 12 weeks. At the end of 12 th week, the smoking abstinence rate, expiration carbon monoxide （CO） level, HAMD, STAI, etc were recorded and compared. RESULTS The complete abstinence rate of treatment group was 52 %, showing significant difference with that of the control group （18 %, P 〈 0.01） . The severity of smoking craving, score of HAND and STAI, concentration of expired CO in treatment group （2.1 ± 1.0, 3.1 ± 1.7, 44 ± 5, （6.6 ± 1.6） × 10^4） were significantly lower than those in control group （4.0 ± 1.8, 7.2 ± 1.7, 49 ± 10, （12± 4） × 10^4, P 〈 0.01） . The adverse reactions were mild and tolerable. CONCLUSION The results indicate that topiramate is immediately effective in smoking cessation for depressive smokers, with mild and tolerable adverse reactions.