血液灌流联合氟西汀治疗维持性血液透析并发抑郁症患者的疗效观察

Observation on the Efficacy of Hemoperfusion Combined with Fluoxetine Treatment on Maintenance Hemodialysis Patients Complicated with Depression

目的 观察血液灌流联合氟西汀治疗维持性血液透析（MHD）并发抑郁症患者的疗效.方法 将2010年5月至2012年5月保定市第三中心医院收治的60例MHD并发抑郁症患者依据随机数字表法分为两组：药物组（30例）给予口服氟西汀胶囊20 mg,每日1次;联合组（30例）在氟西汀的基础上给予血液灌流治疗,每周1次,每次2h.两组患者均给予每周2～3次血液透析,每次4h.两组治疗均为12周,观察两组患者治疗前后汉密顿抑郁量表（HAMD）评分及白细胞介素1β（IL-1β3）、IL-6、肿瘤坏死因子α（TNF-α）的水平变化.结果 治疗后两组患者的IL-1β3、IL-6、TNF-α水平及HAMD评分均低于治疗前（P＜0.01）,且联合组下降水平更为显著,差异有统计学意义（P＜0.01）.结论 血液灌流联合氟西汀治疗可以更有效地降低MHD并发抑郁症患者的血清细胞因子水平,更好地改善HAMD总分,治疗抑郁症状.

Objective To observe the effect of hemoperfusion combined with fluoxetine in the treatment of MHD patients complicated with depression. Methods A total of 60 hemodialysis patients with depression from Baoding City Third Central Hospital during May 2010 and May 2012 were divided into drug treatment group and combined treatment group （30 cases）. The drug treatment group was given fluoxetine, 20 mg Po QD ; the combination treatment group was added hemoperfusion therapy on the basis of fluoxetine, 1 time a week ,2 hours each time. Both of the groups received hemodialysis 2-3 times per week ,4 hours each time. The two groups were treated for 12 weeks, and HAMD score and serum IL-1β , IL-6 ,TNF-αchanges before and after treatment were observed. Results After treatment, IL-1 β, IL-6, TNF-β and HAMD scores of both groups were lower than before treatment（ P 〈0.01 ） , and the combination treatment group decline was more significant, with statistically significant difference （ P 〈 0. 01 ）. Conclusion Hemoperfusion combined with fluoxetine treatment can effectively reduce the level of serum eytokines in MHD patients complicated with depression, improve HAMD score, treating the depression.