艾司西酞普兰联合匹维溴铵对便秘型肠激惹综合征负性情绪及外周血5-HT水平的影响

Impact of citalopram combined with pinaverium bromide on negative emotion and peripheral blood 5-HT level in constipation-predominant IBS patients

目的探讨艾司西酞普兰与匹维溴胺联合用药对便秘型肠易激综合征(IBS)疾病转归的影响,以及对负性情绪以及外周血5-羟色胺(5-HT)、5-吲哚乙酸(5-HIAA)水平的影响。方法将90例便秘型IBS患者随机分为匹维溴胺组(A组,41例)、艾司西酞普兰组(B组,28例)及联合用药组(C组,21例),并分别服用匹维溴胺、艾司西酞普兰及两者联合用药,疗程均为6个月。另选健康对照组30例。分别在治疗前、治疗3个月及6个月对所有受试者进行总有效率评定、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分,并同时以高效液相色谱法及荧光分光光度法进行外周血5-HT、5-HIAA水平的测定。结果 3组总有效率分别为82.9%、78.6%及85.7%,C组略高于A组、B组,但差异无统计学意义(P均>0.05);与治疗前相比,治疗3个月及6个月,B、C2组二种量表评分均有一定程度下降(P均<0.05)。治疗3个月C组HAMA值低于A组、B组(P均<0.05);治疗6个月B组、C组HAMA值均低于A组(P均<0.05),且C组低于B组(P<0.05)。治疗3个月及6个月,A组血浆5-HT、5-HIAA水平与治疗前比较差异均无统计学意义(P均>0.05),而B组、C组均有显著性差异(P均<0.05);且B组、C组血浆5-HT、5-HIAA水平均高于A组(P均<0.05);治疗6个月B组5-HIAA水平高于C组(P<0.05)。便秘型IBS患者的负性情绪(HAMD、HAMA得分)与外周血5-HT和5-HIAA水平呈负相关(r1=-0.411,r2=-0.512,r3=-0.548,r4=-0.583;allP<0.05)。结论便秘型IBS患者负性情绪较为常见,艾司西酞普兰可显著改善其焦虑、抑郁情绪,与匹维溴胺联用未能明显优于单用艾司西酞普兰,是否两种作用机制不同药物具有较好的协同作用尚有待进一步较大临床样本的研究证实,这将会为临床治疗便秘型IBS提供有一定潜力的治疗方法。

Objective To investigate the impact of combination therapy of citalopram and pinaverium bromide on outcome of constipation-predominant irritable bowel syndrome （IBS） and on the negative emotion and 5-hydroxytryptamine （5-HT） ,5-indoleaacetic acid （5-HIAA） level of peripheral blood. Methods Ninety patients with constipation-predominant IBS were divided into three groups ： pinaverium bromide group （ A group）, citalopram group （ B group） and combined group （C group）. Pinaverium bromide,citalopram and citalopram plus pinaverium bromide were respectively taken in A,B and C groups for 6 months. Thirty healthy subjects were selected as control group. The total effective rate, the scores of hamilton de- pression rating scale （HAMD） and hamilton anxiety scale （HAMA） wore assessed before treatment, after treatment for 3 months and 6 months, respectively. The high performance liquid chromatography and fluorescence spectrophotometry methods were used to detect 5-HT and 5-HIAA level of peripheral blood. Results There was no significant difference in the total effective rate of A, B and C groups （82. 9%, 78. 6% and 85.7% respectively, P 〉 0. 05 ）. The scores of HAMD and HAMA in both B and C groups decreased after treatment for 3 months and 6 months （ all P 〈 0. 05）. The score of HAMA in C group was lower than those in A and B group （ all P 〈 0. 05 ） after treatment for 3 months. The scores of HAMA in B and C groups were all lower than that in A group after treatment for 6 month 3 （ all P 〈 0. 05 ）, and the score of HAMA in C group was lower than that in B group （ P 〈 0. 05）. After treatment for 3 months and 6 months, compared with plasma 5-HT and 5-HIAA level before treatment, there were no significant differences ＇in A group （ all P 〉 0. 05）, while there were significant differences in B and C groups （ all P 〈 0. 05 ） ;5-HT and 5-HIAA level in B and C groups were higher than those in A group （ all P 〈 0. 05）. 5-HIAA levels in B group was higher than that in C group after treatment for 6 months （P 〈 0. 05 ）. The results of correlation analysis showed that negative emotions and 5-HT and 5-HIAA levels of peripheral blood were negative associated （r1 = -0. 411, r2 = - 0. 512, r3 = - 0. 548, r4 = - 0. 583 ; all P 〈 0. 05 ）. Conclusions The negative emotion of constipation-predominant IBS is common. Citalopram can significantly improve anxiety and depression,but it combined with pinaverium bromide cannot acquire more beneficial advantages over citalopram alone. Thus,it might still need further study of large samples that whither the combined therapy of these two drugs of different mechanism has cooperative effect because of its therapeutic potentiality for treating constipation-predominant IBS.