帕罗西汀对老年急性心肌梗死患者焦虑抑郁情绪及血清炎症标志物的影响

Therapeutic efficacy of paroxetine and influence on inflammatory markers in elderly acute myocardial infarction patients with anxiety and depression

目的探讨帕罗西汀干预老年急性心肌梗死患者焦虑抑郁情绪及对血清炎症标志物水平的影响。方法据医院情绪抑郁及焦虑量表评分，入选老年急性心肌梗死合并焦虑和／或抑郁患者136例。根据评分分为焦虑患者（n=54）、抑郁患者（n=39）、焦虑抑郁共病患者（n=43）。3类患者在评估后按单双号随机分为帕罗西汀组：在常规治疗基础上，给予帕罗西汀10—20mg／d口服；常规组：依据治疗指南进行常规治疗；28d后再次据医院情绪抑郁及焦虑量表进行评分。所有人选患者于入选次日晨起及治疗第29天抽取空腹肘静脉血检测高敏C反应蛋白（Hs-CRP），髓过氧化物酶（MPO）及肌钙蛋白I（cTnI）。结果帕罗西汀组中焦虑患者HADa、抑郁患者HADd、焦虑抑郁共患者HADa及HADd计分治疗后与治疗前比较差异具有统计学意义（P〈0．01）；常规组治疗前后HADS评分差异无显著性；帕罗西汀组中焦虑患者HADa、抑郁患者HADd、焦虑抑郁共患者HADa和HADd计分[分别为（10．52±2．74）分，（10．83±3．25）分，（9．49±2．57）分，（9．99±2．38）分]，低于对照组（P〈0．05）；2．焦虑患者帕罗西汀治疗后血清Hs．CRP、cTnI、MPO水平低于常规组∽〈0．05；抑郁患者帕罗西汀治疗后血清Hs—CRP、cTnI、MPO水平低于常规组∽〈0．05）；焦虑抑郁共患者帕罗西汀治疗后血清Hs-CRP、cTnI、MPO水平低于常规组（P〈0．05）。结论帕罗西汀对老年AMI患者焦虑抑郁情绪有显著疗效，显著降低血清炎症标志物水平。

Objective To investigate the therapeutic efficacy of paroxetine and influence on inflammatory markers in elderly acute myocardial infarction （AMI） patients with anxiety and depression. Methods 136 patients with AMI graded by ＂ the hospital depression and anxiety＂ score were divided into three class： （1）patients with anxiety （ n = 54） ; （2）Patients with depression （ n = 39） ; （3）Patients with anxiety and depression （ n = 43 ）. 136 patients were randomly divided into paroxetine group （paroxetine 10-20 rag/d）and conventional group （conventional drugs based on guidelines ）. After 28 days treatment, HAD scores, serum level of inflammatory markers （ Hs-CRP, MPO, and cTnI ） were compared between two groups. Results （1）HAD scores （ HADa and HADd） of paroxetine group were decreased significantly after 28 days treatment （P 〈 0.01 ） ;while there were no remarkable improvements in conventional group. With paroxetine treatment HAD scores of anxiety, depression, anxiety and de- pression（ 10.52 ± 2.74,10.83 ±3.25,9.49±2.57,9.99 ±2.38 ） were much lower than those of conventional group（P 〈 0.05 ）. （2）Serum Hs-CRP, MPO and cTnI of paroxetine group in patients with anxiety were much lower than those of conventional group （P 〈 0.05 ）. Serum Hs-CRP, MPO and cTnI of paroxetine group in patients with depression were much lower than those of conventional group （P〈 0.05 ）. Serum Hs-CRP, MPO and cTnI of paroxetine group in patients with anxiety and depression were much lower than those of Conventional group （P 〈 0.05 ）. Conclusion Paroxetine has remarkable treatment effect in elderly AMI patients with anxiety and depression, and paroxetine call significantly decreased serum levels of inflammatory markers.