艾司西酞普兰对脑卒中后抑郁症患者下丘脑-垂体-肾上腺素轴功能的影响

Effect of Escitalopram on Hypothalamic-pituitary-adrenergic Axis Function in Patients with Post-stroke Depression

目的:探讨艾司西酞普兰对脑卒中后抑郁症(PSD)患者下丘脑-垂体-肾上腺素轴功能的影响。方法:70例PSD患者随机分为观察组和对照组。两组患者均予以脑血管病常规对症及康复治疗,观察组患者在此基础上口服艾司西酞普兰片10 mg,qd,连用8周。观察两组患者治疗前后血浆皮质醇(Cor)、促肾上腺皮质激素释放激素(CRH)和促肾上腺皮质激素(ACTH)水平的变化,评估患者抑郁症状和神经功能变化以及治疗期间的不良反应。结果:治疗8周后,观察组抗抑郁的总有效率及神经功能恢复的总有效率均明显高于对照组(P<0.05),治疗期间无严重的药物不良反应。两组患者血浆Cor、CRH和ACTH水平均较治疗前明显下降(P<0.05或0.01),且观察组下降幅度较对照组更明显(P<0.05)。结论:艾司西酞普兰治疗PSD的疗效肯定,能明显改善患者抑郁情绪,促进患者神经功能恢复,不良反应轻,安全性较好。血浆Cor、CRH和ACTH水平降低可能是艾司西酞普兰治疗PSD的另外一种作用机制。

Objective：To investigate the effect of escitalopram on hypothalamic-pituitary-adrenergic axis function in patients with post-stroke depression（PSD）.Methods：70 cases with PSD were randomly divided into observation group and controlled group.Both groups were treated with conventional symptomatic and rehabilitation treatment of cerebrovascular disease,and based on it,the patients in the observation group were given oral escitalopram tablets 10mg qd for 8 weeks.Plasma cortisol（Cor）,corticotropin releasing hormone（CRH） and adrenocorticotropic hormone（ACTH） levels were observed in the two groups of patients before and after the treatment.The patients＇ depressive symptoms,nerve function changes and adverse reactions were assessed during the treatment.Results： After 8 weeks of treatment,the total effective rates of antidepressant efficiency and recovery of neurological function were significantly higher（P0.05） in the observation group.There were no serious adverse drug reactions during treatment.Plasma Cor,CRH and ACTH levels decreased significantly（P0.05 or 0.01） than those before the treatment in both groups,and the decline of the observation group was more obvious than that in the controlled group（P0.05）.Conclusion：Escitalopram was effective in the treatment of the PSD and it could significantly improve patients＇ depression and promote the recovery of neurological function with light adverse reaction and good safety.The decrease of plasma Cor,CRH and ACTH levels might be another mechanism of action of escitalopram in the treatment of the PSD.