帕罗西汀治疗脑卒中后抑郁症的临床疗效和安全性及作用机制

The Effect,Safety and Mechanism of Paroxetine in the Treatment of Patients with Poststroke Depression

目的探讨帕罗西汀治疗脑卒中后抑郁症的临床疗效、安全性及作用机制。方法选择80例恢复期脑卒中抑郁症患者,随机分为帕罗西汀组和对照组。对照组予以常规神经系统药物和支持治疗。帕罗西汀组在与对照组相同治疗的基础上加用帕罗西汀20～40mg/d,疗程均为8周。两组患者分别在治疗前及治疗8周后,采用汉密尔顿抑郁量表(HAMD)评定抑郁症状;美国国立卫生院神经功能缺损量表(NIHSS)评定神经功能;Barthel指数(BI)评定日常生活活动能力(ADL)。根据HAMD评分减分率进行疗效评定。采用放射免疫法测定患者血浆P物质(SP)、神经肽Y(NPY)和促肾上腺皮质激素释放因子(CRF)的水平,并对帕罗西汀的安全性进行评估。结果治疗8周后,两组患者的HAMD、NIHSS评分均较治疗前明显下降,BI明显上升,而对照组下降或上升的幅度明显低于帕罗西汀组;同时帕罗西汀组患者的血浆SP和CRF水平明显降低,NPY水平明显升高,而对照组治疗前后血浆SP、NPY和CRF水平无明显变化。两组患者的疗效间差别有统计学意义(P<0.01)。治疗期间两组患者均未出现明显的药物不良反应。结论帕罗西汀可有效改善脑卒中后抑郁症患者的抑郁情绪,并能改善患者神经功能及日常生活能力,且安全性好,不良反应少。血浆NPY水平增加,SP和CRF水平降低可能是帕罗西汀治疗脑卒中后抑郁症的另外一种作用机制。

Objective To investigate the effect,safety and mechanism of paroxetine in the treatment of patients with poststroke depression.Methods 80 patients with poststroke depression who were in the convalescence stage were selected and were randomly divided into two groups,as paroxetine group and control group.The control group received routine nervous drugs and supporting therapy.Compared with that,Paroxetine group received extra treatment as taking paroxetine 20～40 mg/d,for 8 weeks.Pretherapy and 8 weeks after therapy,the depression level,nervous function and the activities of daily living of the patients were assessed by HAMD,NIHSS and BI respectively.Detect the levels of SP,NPY and CRF by radio-immunity,and assessed the safety of paroxetine.Results 8 weeks after treatment,comopared with pretherapy,the scores of HAMD and NISS of both the two groups descended significantly,BI ascend significantly.And the change of paroxetine group was more obviously than that of control group.In paroxetine group,the levels of SP and CRF descended significantly and the level of NPY ascended significantly,where was no significant change in the control group after therapy.The curative effect was significantly difference between group paroxetine and control（P〈0.05）.There was no adverse reaction during the treatment period both of the two groups.Conclusion Paroxetine can improve the depression emotions,the nervous function and activity of daily living of patients with the poststroke depression effectively,with good safety and few adverse reactions.To increase of level of NPY and the decrease the levels of the SP and CRF may be another mechanism of paroxetine treating poststroke depression.