阿米替林治疗无效的抑郁症患者的相关因素分析

An analysis of correlations of amitriptylineresistant depression

目的分析阿米替林治疗无效的抑郁症患者的相关因素。方法在一定血药浓度标准下对５９例抑郁症患者采用阿米替林治疗８周，其间测查明尼苏达人格测查（ＭＭＰＩ）、听觉诱发电位（Ｐ３００）、２４小时尿３甲氧基４羟基苯乙二醇（ＭＨＰＧ）、血Ｔ３、Ｔ４等指标，以汉密尔顿抑郁量表（ＨＡＭＤ）和副反应量表（ＴＥＳＳ）评价疗效及副作用，将治疗前后ＨＡＭＤ量表减分率＜５０％者确定为“无效”。采用Ｌｏｇｉｓｔｉｃ回归方法分析形成治疗无效的相关因素，无效组与有效组之间以ｔ检验及χ２检验进行比较。结果显示情感病家族史、本次起病形式、躯体疾病和非精神科药物使用、ＭＭＰＩ中Ｄ因子分、偏执症状、副作用等６项指标与治疗无效的形成相关。而其它一些因素，如自杀、激越、Ｐ３００波幅等在两组间差异也有显著性。结论提示有情感病家族史、缓慢起病、伴有偏执症状的抑郁症患者对阿米替林的疗效不佳，这类患者的人格特征较为抑郁，治疗中的副作用较大。

Objective The purpose of the study was to determine the correlations of amitriptylineresistant depression. Methods Fifty-nine patients with depression were treated with amitriptyline, and their plasma drug concentration reached a certain level for at least eight weeks in this study. MMPI, Auditory Brain Evoked Potentials (P300 ), MHPG, triiodothyronine (T3), thyroxin (T4) and Life Events Scale (LES) were examined during the study. Outcome and side effects were assessed by Hamilton Depression Scale (HAMD) and Treatment Emergent Symptom Scale (TESS) respectively. The amitriptylineresistant depression was defined as the change of HAMD lower than 50%. Logistic regression analysis, ttest and chisquare test were used to analyze the correlations. Results Poor response to a therapeutic amitriptyline trial was significantly associated with family history of affective disorder, present form of episode, physical diseases, D factor in MMPI, paranoid idea in HAMD and side effects. Conclusion The study suggests that the patients with affective disorders, family history, associated with paranoid symptom, with depressive personality, with severe side effect of antidepressant, complicated with physical diseases tend to be amitriptylineresistant depression.