抑郁症伴功能性食管病患者临床应用抗抑郁药物治疗价值探讨

Antidepressant paroxetine in functional esophageal diseases accompanied with depression

目的探讨抑郁症伴功能性食管病患者采用抗抑郁药物帕罗西丁治疗的临床价值。方法对32例抑郁症伴功能性食管病患者（观察组）进行帕罗西丁治疗，动态监测治疗前24h食管pH值以及治疗前后食管动力的变化，并与相关文献报道的正常人组结果进行对照。根据临床症状评定治疗前后消化系统评分，并进行比对。结果观察组治疗前24h食管pH值酸暴露6项指标与高萍等的正常国人对照组比较，差异无统计学意义（P〉0．05）；观察组治疗前食管上段括约肌静止压（58．1±15．9）mmHg与丁元伟的正常国人对照组（56．0±20．0）mmHg相似（P〉0．05），但治疗后较治疗前明显降低（T=2．826，P〈0．01）；观察组治疗前后食管体部运动紊乱发生率分别为81．25％（26／32）和25．00％（8／32），差异有统计学意义（χ^2=16．05，P〈0．01）。观察组治疗后消化系统评分为（6．75±4．05）分，较治疗前的（12．37±4．05）分明显降低（T=6．225，P〈0．01）。结论抑郁症伴功能性食管病患者无病理性的反流，但存在食管运动功能紊乱，帕罗西丁抗抑郁治疗能有效地恢复食管运动功能，改善消化系统症状。

Objective To evaluate the efficacy of Paroxetine for patients with functional esophageal diseases accompanied with depression. Methods Paroxetine was prescribed in 32 patients with functional esophageal diseases accompanied with depression. A 24-hour esophageal pH monitor before treatment and esophageal manometry before and after the treatment were recorded and compared with those of the normal populations. Symptom score before and after treatment were also recorded and compared. Results There was no significant difference in 24-hour esophageal pH monitor between pre-treatment and normal values reported by Gao Ping et al （P 〉0.05）. Upper esophageal sphincter pressure before treatment （58. 1 ±15.9 mm Hg） was similar with normal value （56. 00 ±20. 00 mm Hg） reported by Ding Yuanwei （P 〉 0.05 ）, and significantly decreased after treatment （ T = 2. 826, P 〈 0. 01 ）. Rates of esophageal body motility disor- der before treatment was 81.25% （26/32）, which was significantly different from that after treatment （25.00%, 8/32） （χ^2 = 16. 05, P 〈0. 01 ）. Symptom score before treatment （6. 75 ±4. 05） was significantly lower than that after the treatment （ 12.37 ±4.05 ） （ T = 6. 225, P 〈 0. 01 ）. Conclusion There is no abnormal acid reflux in patients with functional esophageal diseases accompanied with depression, while esophageal motility disorder is common. Antidepressant Paroxetine can restore normal esophageal motility and relieve digestive symptoms.