二甲双胍联合米氮平治疗厌食症伴消化不良的临床疗效及对血清NE、5-HT和DA的影响

Metformin combined with mirtazapine for treatment of anorexia nervosa with dyspepsia: Clinical effect and impact on serum levels of norepinephrine, 5-hydroxy tryptamine and dopamine

目的:探讨二甲双胍联合米氮平治疗神经性厌食症伴消化不良患者的临床疗效.方法:将邹平县精神卫生中心就诊的100例厌食症(anorexia nervosa,AN)伴消化不良患者随机分为观察组和对照组各50例,对照组口服米氮平片,观察组在对照组基础上口服二甲双胍片;比较两组患者治疗前后空腹胃液pH变化水平,治疗后2、6、12 wk患者体质量变化、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)积分,并对患者血清去甲肾上腺素(norepinephrine,NE)、5-羟色胺(5-hydroxy tryptamine,5-HT)、多巴胺(dopamine,DA)和血糖水平进行检测.结果:治疗后两组胃液pH均明显升高,其中观察组pH升高水平显著高于对照组,两组间差异具有统计学意义(t=5.658,P=0.000).治疗2、6、12 wk后两组患者体质量均开始增加,与治疗前相比差异具有统计学意义;其中治疗6、12 wk观察组患者体质量显著低于对照组(t=4.805,4.864,P<0.05).治疗后两组患者HAMD、HAMA评分显著降低,血清NE、5-HT、DA水平显著增加,与治疗前相比差异具有统计学意义(t=3.784,4.315,4.783,P<0.05).治疗后观察组FPG、HbAlc、2 h PG有降低趋势,但是与治疗前和对照组相比差异无统计学意义;两组治疗后TESS评分、各不良反应发生情况相比差异无统计学意义.结论:二甲双胍联合米氮平治疗AN能够改善患者抑郁症状和食欲,且患者增重不明显,并未出现低血糖等症状,值得临床推广.

AIM： To explore the clinical effect of metformin combined with mirtazapine in the treatment of anorexia nervosa（AN） with dyspepsia.METHODS： One hundred AN patients with dyspepsia treated at our hospital were randomly divided into either an observation group or a control group（n = 50 for each group）. The con-trol group was treated with mirtazapine tablets, and the observation group was additionally given oral metformin on the basis of mirtazapine tablets. Gastric juice pH was compared between before and after treatment and between thetwo groups. After 2, 6, and 12 wk of treatment, body weight changes, Hamilton depression scale（HAMD） score, and Hamilton anxiety scale（HAMA） score were compared between the two groups. Serum norepinephrine（NE）, 5-hydroxy tryptamine（5-HT）, dopamine（DA） and blood glucose levels were also compared. RESULTS： Gastric juice pH increased signifi-cantly after treatment in both groups, and the increase was more significant in the observation group（t = 5.658, P 〈0.05）. After 2, 6, and 12 wk of treatment, body weight significantly increased in both groups compared with before treatment. After 6 and 12 wk of treatment, body weight was significantly lower in the observation group than in the control group（t = 4.805, 4.864, P 〈0.05）. After treatment, HAMA and HAMD scores de-creased significantly, serum NE, 5-HT and DA levels significantly increased in both groups compared with before treatment（t = 3.784, 4.315, 4.783, P 〈0.05）. After treatment, fasting plasma glucose（FPG）, glycated haemoglobin（HbAlc）, and 2-h plasma glucose（2 h PG） tended to de-crease in the observation group compared with before treatment and the control group, but the differences were not statistically significant（P〉0.05）. TESS score and the incidence of adverse reactions showed no significant differences be-tween the two groups（P〉0.05）. CONCLUSION： Metformin combined with mir-tazapine can improve depressive symptoms and appetite in the treatment of AN, without obvi-ous weight gain or hypoglycemia symptoms.