文拉法辛治疗酒依赖伴焦虑抑郁障碍对照研究

A control study of venlafaxine in alcohol dependence with anxiety-depression disorder

目的 探讨文拉法辛治疗酒依赖伴焦虑抑郁障碍的临床疗效和安全性. 方法 将62例酒依赖伴焦虑抑郁障碍患者分为治疗组32例,对照组30例,两组均常规应用苯二氮（艹卓）类药物地西泮替代递减、大剂量B族维生素、支持对症治疗14 d,戒断反应消失后,治疗组口服文拉法辛治疗,对照组口服阿米替林治疗,观察6周.于治疗前及治疗1周、2周、4周、6周末采用汉密顿焦虑量表、汉密顿抑郁量表及临床疗效总评量表评定临床疗效,副反应量表评定不良反应. 结果 治疗后两组汉密顿焦虑量表、汉密顿抑郁量表、临床疗效总评量表总分均随治疗时间的延续呈持续性下降;同期两组间比较,治疗组汉密顿抑郁量表总分治疗2周、4周末显著低于对照组,汉密顿焦虑量表及临床疗效总评量表总分治疗2周末显著低于对照组,副反应量表各时段评分及不良反应发生率显著低于对照组（P＜0.05或0.01）;治疗6周末,治疗组总有效率为96.88%,对照组为86.67%（P＞0.05）. 结论 文拉法辛治疗酒依赖伴焦虑抑郁障碍疗效显著,且与阿米替林相当,但文拉法辛起效更快,不良反应轻微,安全性高,依从性好,可作为治疗酒依赖伴焦虑抑郁障碍的一线用药.

Objective To explore the clinical efficacy and safety of venlafaxine in alcohol dependence with anxiety-depression disorder. Methods Sixty-two alcohol dependence patients with anxiety-depression disorder were randomly divided into treatment group （n=32） and control group （n= 30）, both groups received benzodiazepines substitution decrement therapy, large dose vitamins B and supportive symptomatic treatment for 14 days, after disappearance of abstinence the treatment group took orally venlafaxine and the control did amitriptyline for 6 weeks. Clinical efficaeies were assessed with the Hanmilton Anxiety Scale （HAMA）, Hanmilton Depression Scale （HAMD） and Clinical Global Impression （CGI） and adverse reactions with the Treatment Emergent Symptom Scale （TESS） beore treatment and at the end of the 1st , 2nd, 4th and 6th week. Results After treatment, the total scores of the HAMA, HAMD and CGI lowered continouly with treatment; according to contemporary group comparison, the total scores of the HAMD at the end of the 2nd and 4th week, thoses of the HAMA and CGI at the end of the 2nd week, all points＇ scores of the TESS and incidences of adverse reactions （P〈0.05 or 0.01） were all siginificantly lower in the treatment than in the control group; at the end of the 6th week, total effective rates were respectively 96. 88% in the treatment and 86.67% in the control group （P〉0.05）. Conclusion Venlafaxine has a significant curative effect equivalent to amitriptyline, but the former takes effect more rapidly, has mild adverse reactions, higher safety and better compliance, and can be served as first-line drug in alcohol dependence with anxiety-depression disorder.