米氮平对伴糖尿病的抑郁障碍患者空腹血糖的影响

Effects of mirtazapine on fasting blood glucose of depressive disorder with type 2 diabetes

目的探讨米氮平对伴2型糖尿病的抑郁障碍患者空腹血糖(FBG)的影响。方法将87例伴糖尿病的中度抑郁障碍患者随机分为3组(各29例):米氮平组(30～45 mg.d-1)、舍曲林组(150～200 mg.d-1)和心理治疗组(以认知治疗为主,每周1～2次),治疗观察期均为12 wk。3组患者于治疗前及治疗后wk 4、8、12末测定FBG进行比较。结果米氮平组、舍曲林组、心理治疗组分别脱落3例、3例、1例。米氮平组与舍曲林组或心理治疗组比较,FBG均数均有显著差异(P<0.05,P<0.01),而舍曲林组与心理治疗组间无显著差异(P>0.05);3组wk 4末FBG与基线比较无显著差异(P>0.05),而wk 8或wk 12末与基线相比均有非常显著差异(均P<0.01)。wk 4、8末3组间FBG异常升高率无显著差异(P=0.996、P=0.631),wk 12末3组间FBG异常升高率均有显著差异(P=0.018),且其总体频率的95%置信区间为1.5%～2.0%。结论米氮平治疗伴2型糖尿病的中度抑郁障碍患者可出现有临床意义的FBG异常升高,且其发生可能存在一定的时间趋势。

AIM To explore the effects of mirtazapine on fasting blood glucose （FBG） of depressive patients with type 2 diabetes. METHODS Total 78 moderate depressive patients with type 2 diabetes were randomly divided into three groups： mirtazapine （30 - 45 mg .d-1） group, sertraline （150 - 200 mg .d-1） group, and psychotherapy （cognitive therapy once or twice a week） group, 29 for each. Each group have a 12- week treatment. The FBG were measured at baseline and at wk 4, 8 and 12 of the treatment for comparison. RESULTS The mirtazapine, sertraline and psychotherapy group had 3, 3 or 1 drop-our case, respectively. The FBG of the mirtazapine group had statistical difference compared with the sertraline group and the psychotherapy group （P 〈 0.05, P 〈 0.01） respectively, while there was no difference between the sertraline group and the psychotherapy group （P 〉 0.05）. The FBG of the three groups had no statistical difference between at baseline and at wk 4 （P 〉 0.05）, while there was statistical difference in FBG between at baseline and at wk 8 or 12 （P 〈 0.01 ）. The abnormally increased rates of FBG among the three groups had no statistical difference at week 4 or 8 （P = 0.996 or P = 0.631）, while it was statistical different among the three groups at week 12 （P = 0.018）, and the 95% confidence interval of the population rate is 1.5% to 2.0%. CONCLUSION The abnormal rise of FBG with clinical significance can occur among moderate depressive patients with type 2 diabetes who were treated by mirtazapine. The abnormally increased rate of FBG may have a time tendency.