抑郁症与糖尿病共病的临床特征与治疗反应的对照研究

Clinical character and treatment effect on major depression patients with and without diabetes

目的探讨抑郁症糖尿病共病的临床特征以及治疗反应。方法研究对象为2006年1月至2008年1月在河北医科大学精神卫生研究所住院的抑郁症患者,其中抑郁症合并2型糖尿病患者32例,设为共病组;并随机抽取未合并糖尿病的抑郁症患者19例,设为非共病组。疗前采用17项汉密尔顿抑郁量表(HAMD-17)评定抑郁的严重程度,并评估体重指数、血压、血脂水平。随后对两组患者采用西酞普兰片(喜普妙)进行治疗,治疗剂量和疗程均相同,治疗后采用HAMD减分率评价两组疗效。并测共病组疗后的HbA1c水平,按照HbA1c水平再将共病组分为HbA1c达标组(HbA1c<6.5%,N=19)和HbA1c不达标组(HbA1c≥6.5%,N=10)两个亚组,并进行两个亚组的疗效比较。结果①共病组脱落3例,非共病组脱落2例。共病组的疗前体重指数、甘油三酯水平、HAMD得分[(24.10±2.08),(6.30±0.98),(32.41±9.54)]均高于非共病组[(21.57±6.24),(4.34±0.93),(22.71±10.32),P<0.05)];②治疗后共病组有效率(65.5%)明显低于非共病组(94.1%)(χ2=7.688,P<0.05),共病组痊愈率(41.4%)明显低于非共病组(82.4%)(χ2=5.749,P<0.05)。③共病组中HbA1c达标组有效率(68.4%)和HbA1c不达标组(70.0%)相比,没有明显差异(χ2=0.112,P=0.738),但HbA1c达标组痊愈率(63.2%)明显高于HbA1c不达标组(10.0%)(χ2=5.491,P<0.05)。结论抑郁症糖尿病共病患者治疗前抑郁程度较重,治疗反应明显低于非共病组,血糖控制不良的共病患者治愈率低。

Objective To explore the clinical feature and treat response between depression patients with and without type 2 diabetes. Methods 267 depression patients from the mental health institute of Hebei medical university were included in our study, total to collect 32 with depression and diabetes as comorbid group （fell off 3 ）, random to collect 19 with depression but without diabetes as non-comorbid group （fell off 2 ）. Dur- ing the hospitalization, we used Hamilton Depression Rating Scale 17 （HAMD-17） to assess the severity of de- pressive symptoms. We assessed body mass index （BMI） , blood pressure and blood fat level. Soon, All the pa- tients were administrated with citalopram （Cipramil） at the same dosage and course of treatment, the treatment effects between two groups were assessed by HAMD minus rate. The comorbid group was divided into two sub- groups according to the levels of HbA1 c after treatment, which were standard HbA1 c group （HbA1 c 〈 6. 5% , N = 19） and non-standard HbAlc group （HbAlc≥6. 5% , N = 10）, then the therapeutic effects between two subgroups were compared. Results （1）Significant differences were found in BMI, blood fat, and scores of HAMD between comorbid and non-comorbid group before treatment [ （ 24. 10±2. 08 ） vs. （ 21.57 ± 6. 24 ）, （6. 30 ± 0. 98） vs. （4. 34 ± 0. 93）, （32.41 ± 9. 54） vs. （22. 71 ± 10. 32）, P 〈 0.05 ]. （2） After treatment, the effective power of comorbid group （65.5 % ） was less than that of non-combid group （94. 1% ）, and there were differences between two groups （χ^2 = 7. 688, P 〈 0. 05 ）, and the recovery rate of comorbid group （41.4%） was also less than that of non-combid group （ 82.4% ） and there were differences between two groups （χ^2 = 5. 749 ,P 〈0. 05 ）. （3） After treatment, the effective power of standard HbAlc group（68.4% ） was not different from that of non-standard HbA1 c group （ 70. 0% ）, （χ^2 = 0. 112, P = 0. 738 ）, and the recovery rate of standard HbA1c group（63.2% ） was obviously higher than that of non-standard HbA1c group （ 10.0% ） and there were differences between two groups （χ^2 = 5.491, P 〈 0.05 ）. Conclusion The depressive symptom of depression pa- tients with diabetes was more severe than those without diabetes before therapy. Moreover, worse treatment re- sponse was found in patients with comorbid depression and type 2 diabetes, the recovery rate of uncontrol-sugar comorbid was less than that of control-sugar.