艾司西酞普兰改善创伤后应激障碍症状及脑结构的磁共振研究

Effect of escitalopram on the symptoms and brain MRI images of patients with post-- traumatic stress disorder

目的探讨艾司西酞普兰对创伤后应激障碍（PTSD）核心症状、伴发症状及脑结构的影响。方法收集符合美国精神障碍诊断与统计手册第四版诊断标准的12例PTSD患者，单独应用艾司西酞普兰治疗3个月。采用临床应用的PTSD诊断量表（CAPS）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、威斯康星分类卡片（WCST）、韦氏记忆量表（WMS）对PTSD患者治疗前后进行评估。治疗前后，所有患者进行核磁共振扫描。采用基于体素的形态学分析（VBM）技术，用统计参数图5（SPM5）软件包分析治疗前后脑灰质体积的差异。结果PTSD患者经艾司西酞普兰治疗后CAPS、HAMD、HAMA、WCST、wMS评分均较治疗前明显下降（P〈0．05）。磁共振结果显示，经艾司西酞普兰治疗后PTSD患者额叶、颞叶等部分脑区灰质体积明显恢复。结论艾司西酞普兰能有效改善PTSD患者的核心症状，以及伴发的抑郁、焦虑及认知功能损害症状；并明显促进脑灰质体积的恢复。

Objective To evaluate the changes of key symptoms, concomitant symptoms and structural MRI in patients with Post-traumatic stress disorder （PTSD） after treatment with escitalo- pram. Methods We treated 12 PTSD patients （all met diagnostic and statistical manual of mental disor- ders- fourth edition （DSM-IV） criteria） with mono-therapy of escitalopram for 3 months. The following 5 scales were used for assessment before and after the treatment： Clinical Diagnosis Using DSM- IV PTSD Scale （CAPS）, Hamilton Anxiety Scale（HAMA）, Hamilton Depression Scale（HAMD）, Wisconsin Card Sorting Test（WCST） and,Wechsler Memory Scale（WMS）, and magnetic resonance imaging was taken too. Based on Voxel Based Morphometry（VBM）and Statistical Parametric Mapping 5（SPM5） were used to analyze the differences in gray matter volume before and after treatment. Results The scores of CAPS, HAMD, HAMA, WCST, and WPS were all declined obviously （P 〈0.05） after treatment. MRI indicated that the grey matter in frontal and temporal lobe was recovered after treatment. Conclusions Escitalopram can improve the key symptoms, concomitant symptoms such as depression and anxiety and the impaired cognitive function; at the same time it can promote the recovery of the grey matter volume apparently.