帕罗西汀对慢性心力衰竭患者负性情绪及炎症介质水平的改善作用

Improvement Effect of Paroxetine on Negative Emotion and Mediators of Inflammation in Patients with Chronic Heart Failure

目的:观察帕罗西汀对慢性心力衰竭(CHF)患者负性情绪及炎症介质的改善作用。方法:选择CHF合并抑郁、焦虑、焦虑抑郁共病患者148例,按完全随机化法分为观察组(n=75)和对照组(n=73)。两组患者均给予常规治疗,观察组患者在常规治疗的基础上加服帕罗西汀,起始剂量10 mg/d,根据患者病情在2周内逐渐加至40 mg/d。两组患者疗程均为6周。观察并比较两组患者治疗前后焦虑抑郁评分、血清炎症标志物水平及不良反应发生情况。结果:观察组焦虑患者治疗后的焦虑亚量表(HADa)、抑郁患者治疗后的抑郁亚量表(HADd)、焦虑抑郁共病患者治疗后的HADa、HADd评分均较治疗前显著降低,差异有统计学意义(P<0.05);且观察组抑郁患者治疗后的HADd、焦虑抑郁共病患者治疗后的HADa、HADd评分均显著低于对照组,两组比较差异有统计学意义(P<0.05)。所有患者治疗后的高效C-反应蛋白、肿瘤坏死因子、白介素6均较治疗前显著降低,差异有统计学意义(P<0.05);且观察组显著低于对照组,两组比较差异有统计学意义(P<0.05)。观察组患者恶心、呕吐、口干、便秘、失眠、视物模糊、胸痹心悸等的发生率显著高于对照组,两组比较差异有统计学意义(P<0.05)。结论:帕罗西汀可以通过改善患者的负性情绪,降低其炎症介质水平。但是,帕罗西汀在治疗过程中会出现口干、心悸等毒蕈碱样反应,应用时需注意观察。

OBJECTIVE：To explore the influence of paroxetine on negative emotion and mediators of inflammation in patients with chronic heart failure（CHF）.METHODS：148 patients with CHF combined with depression,and / or anxiety admitted in our hospital were randomly divided into observation group（n=75）and control group（n=73）.Both groups received routine treatment.Observation group was given paroxetine on the basis of routine treatment with initial dose of 10 mg/d,and then increasing to 40 mg/d according to disease condition in 2 weeks.Treatment course lasted for 6 weeks in 2 groups.The anxiety-depression score,serum inflammatory markers and ADR were observed in 2 groups before and after treatment.RESULTS：The HADa score of patients with anxiety,the HADd score of depression patients,HADa and HADd score of patients with anxiety and depression in observation group after treatment were significantly lower than before treatment;there was statistical significance（P0.05）.The HADd of depression patients,HADa and HADd of patients with anxiety and depression in observation group after treatment were lower than in control group;there was statistical significance（P0.05）.Hs-CRP,TNF-α and IL-6 of all of patients were decreased significantly after treatment,there was statistical significance（P0.05）;those of observation group were lower than control group significantly,there was statistical significance（P0.05）.The incidence of nausea,vomiting,dry mouth,constipation,insomnia,blurred vision,chest stuffiness and palpitation in observation group were significantly higher than in control group,there was statistical significance（P0.05）.CONCLUSIONS：Paroxetine can improve mediators of inflammation and reducing corticosterone.The patients will suffer from dry mouth,palpitation and muscarinic reactions during treatment of paroxetine,which should be closely observed.