舍曲林与帕罗西汀治疗抑郁症首次发病患者认知功能的相关研究

The cognitive functioning after sertraline and paroxetine treatment in first-episode major depression patients

目的比较舍曲林与帕罗西汀对抑郁症首次发病患者认知功能的影响及其相关因素，方法将符合同际疾病分类第10版关于抑郁发作诊断标准、17项汉密尔顿抑郁量表（HAMD17）评分≥17分、年龄18～65岁的100例首次发病的门诊患者，按照随机数字表法分为舍曲林组（51例，剂量范围25～150mg／d）和帕罗西汀组（49例，剂量范围10～40mg／d），共治疗12周。治疗基线与治疗末评估HAMD。中国修订韦氏成人智力量表（WAIS—RC）、威斯康星卡片分类测验（WCST）、Stroop字色测试（Stroop）。结果（1）组内比较：与治疗前比较，2组患者治疗后HAMD17评分及神经心理学测验成绩显著改善，舍曲林组治疗后Stroop字色测试的卡片C-色时间（67．59±15．48）s、卡片C-色错误数（3．66±4．03）个、卡片C-字错误数（5．68±5．02）个、SIE耗时数2（35．86±13．74）s和SIE错误数2（3．18±3．34）个，差异有统计学意义（P〈0．01或P〈0．05）。帕罗西汀组治疗后WCST的持续错误数[（26．55±22．51）个]较治疗前[（36．74±24．02）个]减少，正确应答数[（61．52±11．07）个]和概念化水平（0．74±0．23）较治疗前提高，差异有统计学意义（P〈0．01或P〈0．05）；Stroop字色测试的卡片C-色时间（73．02±16．45）s、卡片C-字错误数（3．90±4．12）个、卡片C-色错误数（6．00±5．01）个、SIE耗时数2（39．24±14．21）s和SIE错误数2（3．48±3．79）个，较治疗前显著降低，差异有统计学意义（P〈0．01或P〈0．05）。（2）组间比较：2组患者治疗后认知功能成绩比较差异无统计学意义（P〉0．05）。（3）认知功能的相关因素分析显示，治疗后HAMD。总分减分值与Stroop中卡片C-字错误数呈正相关（r=0．25，P〈0．05），体质量因子减分值与Stroop中SIE错误数改变量呈正相关（r=0．27，P〈0．05），认识障碍减分值与WCST中完成分类数、总应答数、持续错误数、非持续错误数、概念化水平和Stroop中卡片C-色错误数呈正相关（r=0．28、r=0．37、r=0．38、r=0．26、r=0．38、r=0．37，P〈0．05）。结论舍曲林与帕罗西汀均能改善抑郁症首次发病患者的认知功能，表现在注意力、执行能力、智力等方面，且认知功能的改善与抑郁症状的缓解具有相关性。

Objective To compare the effects of sertraline and paroxetine on cognitive function in first-episode major depressed patients, and to explore the related factors of cognitive function. Methods In this 12-week randomized open study, patients who met ICD-10 criteria for major depression, aged 18-65 years old, scored HAMD17 ≥ 17, signed in informed consent form were recruited and assigned to sertraline （ n = 51 ） or paroxetine treatment group （ n = 49）. Hamilton Depression Scale （ 17 item, HAMD17 ） were valuated at the baseline and endpoint of treatment, and neuropsychological assessments （WAIS-RC, WCST, Stroop） were performed twice to valuate cognition function. Result The patients had significant improvement in HAMD17 score and neuropsychological tests score after treatment. The patients with sertraline treatment had significantly reduced in Stroop card-CC time （67.59 ± 15.48 ） s, card-CC errors （3.66 ± 4. 03）, card-CW errors （5.68 ±5.02） ,SIE time2 （35.86 ± 13.74） s and SIE errors2（3.18 ±3.34） after treatment. The patients with paroxetine treatment had significantly reduced scores in WCST persistent errors （61. 52 ± 11.07） and Stroop card-CC time（73.02 ± 16.45 ） s, card-CW errors（3.90 ± 4. 12 ）, eard-CC errors （6. 00 ± 5. 01 ） , SIE time2 （ 39.24 ± 14. 21 ） s and SIE errors2 （ 3.48 ± 3.79 ）, had significantly improved in WCST correct answerings （ 26.55 ± 22. 51 ） and conceptualization （ 0. 74 ± 0. 23 ） after treatment. There was no statistic difference on neuropsyehologieal test score between the two groups,but the mean score of Stroop and WAIS was better in sertraline than paroxetine group. The amendment of Stroop card-CW errors had relation with the improvement degree of depressed symptom（ r = 0.25, P 〈 0.05 ） , the amendment of Stroop card-SIE errors had relation with the deduction of body weight （ r = 0. 27, P 〈 0. 05 ）, the amendment of WCST categories,total answering, persistent errors, random errors, conceptualization, and Stroop card-CC errors had relation with the deduction of cognitive disturbance（r = 0. 28,0. 37, 0. 38, 0.26, 0. 38, 0. 37, P 〈 0. 05 ）. Conclusion Cognitive function including attention, executive capacity, and intelligence of first-episode major depression patient could improve after antidepressants treatment. The amendment of cognitive function have relation with the improvement of depressed symptom.