帕罗西汀对卒中后早期抑郁的疗效及血清白细胞介素类的影响

Therapeutic effect of paroxetine on patients with early poststroke depression and the serum interleu-kins

目的观察帕罗西汀对卒中后早期抑郁患者血清IL-1 β、IL-6水平的影响及对抑郁症状的改善情况。方法连续纳入发病<72h的卒中患者223例,选择发病后<72 h、汉密尔顿抑郁量表(HAMD)评分≥8的卒中后早期抑郁(PSD)患者42例。将其随机分为帕罗西汀治疗组(简称治疗组)20例,对照组22例。治疗组在卒中后72h时间点开始给予帕罗西汀20mg/d,疗程≥3个月,其他治疗两组相同。比较两组发病后72 h,1、3个月时血清IL-1β、IL-6的浓度,以及各时间点的HAMD评分。结果①两组发病72 h时,HAMD评分差异无统计学意义;治疗1、3个月时,治疗组HAMD评分均低于同期对照组,差异有统计学意义(P<0.01);两组治疗后1个月与3个月HAMD评分比较,差异均无统计学意义。②发病72 h,两组IL-1β、IL-6差异均无统计学意义;治疗1、3个月,治疗组IL-1β及IL-6均低于同期对照组,差异有统计学意义(P<0.01);两组IL-1β、IL-6均在治疗后1个月时达高峰,3个月时下降,但对照组仍高于72h时水平(P<0.01),治疗组则降至72 h时水平。结论血清IL-1 β、IL-6浓度升高可能参与卒中后早期抑郁患者的发病;帕罗西汀可能通过干预血清IL-1β、IL-6,改善患者的抑郁症状。

Objective To observe the effect of paroxetine on the levels of serum interleukin-1 beta （IL-1β） and IL-6 in patients with early poststroke depression （PSD） and the degree of improvement of the depressive symptoms. Methods Two hundred twenty-three consecutive patients with stroke within 72 hours of symptom onset were included. A total of 42 patients with early PSD whose Hamilton Depression Scale （HAMD） score ≥ 8 within 72 hours of onset were selected. They were randomly allocated into paroxetine treatment group （n = 20） and control group （n = 22）. The patients in the treatment group were treated with paroxetine 20 mg/d at the time point of 72 hours, and the course of treatment was ≥3 months. The other treatments were the same in both groups. The serum concentrations of IL-1β and IL-6 at 72 hours, 1 and 3 months after onset, as well as the HAMD scores at all time points were compared. Results ①There was no difference in the HAMD scores between the 2 groups at 72 hours after onset. The HAMD score in the treatment group was lower than that in the control group at the same time period 1 and 3 months after treatment. There were significant difference （P 〈 0. 01 ）. There was no significant difference in the HAMD scores between the 2 groups 1 and 3 months after treatment. ②There was no significant difference in serum IL-1β and IL-6 at 72 hours after onset in both groups of patients. The IL-1β and IL-6 in the treatment group were lower than those in the control group at the same time 1 and 3 months after treatment. There were significant difference （ P 〈 0. 01 ）. IL-1β and IL-6 reached the peaks at 1 month after treatment in both groups, and began to decrease at 3 months, but the control group was still higher than the level at 72 hours （P 〈 0.01 ）, and the treatment group was decreased to the level at 72 hours. Conclusion The increased serum IL-1β and IL-6 concentrations may be ralated to the onset of patients with early PSD. Paroxetine may improve the depressive symptoms of patients by the interference of the serum IL-1β and IL-6.