圣·约翰草提取物对老年不稳定型心绞痛患者伴发抑郁症的疗效

Effect of St. John＇s wort extracts on the treatment of depressive disorder in elderly patients with unstable angina

目的探讨抗抑郁植物药圣·约翰草提取物辅助治疗伴发抑郁症的老年不稳定型心绞痛患者的临床疗效。方法前瞻性研究天津医科大学第二医院2006年10月至2008年9月住院的老年不稳定型心绞痛并发抑郁症患者170例，年龄65～75岁。排除双相障碍和重性精神病患者、严重自杀倾向者，入选前3个月未应用抗精神药物。将入选170例患者随机分为4组：圣·约翰草提取物组（n=44）、黛力新组（n=44）、心理治疗组（n=42）和对照组（n=40），4组患者基线资料差异无统计学意义，均治疗12周。以汉密尔顿抑郁量表（HAMD）减分率评定疗效，以临床心绞痛发作及心电图改变判定临床疗效。统计学处理采用SPSS11．5统计软件包分析，计量资料采用（x±s）表示，治疗前、后两组间比较采用配对t检验，计数资料多组间比较采用X^2检验，计量资料多组间比较采用F检验，P〈0．05为差异具有统计学意义。结果（1）治疗组HAMD减分率分别为79．5％，56．8％，57．1％，与对照组比较，差异具有统计学意义（X^2=29．9，P〈0．001），圣·约翰草组疗效优于黛力新组及心理组（P〈0．05）；（2）治疗组加拿大心血管学会（CCS）心绞痛分级比较，显效率分别为88．7％，65．9％，57．1％，与对照组比较，差异具有统计学意义（X^2=15．4，P〈0．001），圣·约翰草组优于黛力新组及心理组（P〈0．05）。（3）治疗组心绞痛发作次数、发作持续时间、发作时心电图缺血改善明显优于对照组，差异具有统计学意义（F分别为值6．05，4．58，5．12，P〈0．01），圣·约翰草组优于黛力新组及心理组（P〈0．05）。结论圣·约翰草提取物能显著改善老年不稳定型心绞痛患者伴发的抑郁症，且有利于临床心绞痛发作的控制。

Objective To explore the effect of St. John＇s wort extracts （SWE） on depressive disorder in elder patients with unstable angina. Method A total of 170 patients, who fulfil the criteria, were enrolled in this prospective study. Patients were randomly assigned to SWE group （44 cases）, Deanxit group （44 cases）, psychotherapy group （42 cases） and control group （40 cases）. The effectiveness of the treatments were evaluated with the reduced percentages of hamihion depression （HAMD） scale and reduced frequency of angina pectoris attack, which were measured before and after 12 weeks of the above treatment. Results （1） The reduced percentages of HAMD scales were 79.5 %, 56.8 % and 57.1% in SWE, Deanxit and psychotherapy group, respectively. Compared with the control, the differences were significant （ P 〈 0.01 ）. The change in SWE group was even more significant than in Deanxit or psychotherapy group （ P 〈 0.05）. （2） Changes of angina pectofis evaluated by Canada Cardiac Society classification were significantly better in the treatment groups （88.7%, 65.9%, 57.1% ） than control group, and the change in SWE group was even more significant （P 〈 0.01 ）. （3） Angina pectofis attack frequencies, durations and electrocardiogram changes were significantly better in the treatment groups than control group （F = 6.05,4.58,5.12,P 〈 0.01）, and the change in SWE group was even more significant （P 〈 0.05）. Conclusions The present study demonstrated that SWE can improve depressive symptoms significantly in elderly patients with unstable angina than Deanxit or psychotherapy, which also contribute to better management of angina attack as well.