盐酸舍曲林与阿米替林治疗脑卒中后抑郁的疗效、安全性及对血清细胞因子的影响

Therapeutic Efficacy and Safety of Sertraline Hydrochloride and Amitriptyline in the Treatment of Depression after Stroke and Effects of Them on Serum Cytokine

目的:比较盐酸舍曲林与阿米替林治疗脑卒中后抑郁的疗效、安全性及对血清细胞因子的影响。方法:92例脑卒中后抑郁患者随机均分为A组(盐酸舍曲林组)和B组(阿米替林组)。两组患者均给予降压、调脂、降糖、神经保护、脱水及相应的康复训练等常规治疗。在此基础上,A组患者给予盐酸舍曲林片,初始剂量50 mg、qd,晨起口服,2周内逐增为200 mg、qd;B组患者给予阿米替林片,初始剂量25 mg、bid,早晚口服,2周内逐增为100 mg、bid。两组患者疗程均为1个月。观察两组患者临床疗效,治疗前后白细胞介素6(IL-6)、IL-1β、肿瘤坏死因子α(TNF-α)水平及不良反应发生情况。结果:A组患者总有效率显著高于B组,两组比较差异有统计学意义(P<0.05)。治疗前两组患者IL-6、IL-1β、TNF-α水平比较,差异均无统计学意义(P>0.05);治疗后两组患者IL-6、IL-1β、TNF-α水平均显著低于同组治疗前,且A组低于B组,差异均有统计学意义(P<0.05)。A组患者不良反应发生率显著低于B组,差异有统计学意义(P<0.05)。结论:盐酸舍曲林治疗脑卒中后抑郁较阿米替林疗效更显著,且安全性较好。

OBJECTIVE ： To compare the therapeutic efficacy and safety of sertraline hydrochhride and amitriptyline in the treat- ment of depression after stroke and the effects of them on serum cytokine. METHODS： 92 patients with depression after stroke were randomly divided into group A （sertraline group） and group B （amitriptyline group）. Two groups were given conventional treat- ment, including lowering blood pressure and glucose, regulating blood lipid, neuroprotection, dehydration and rehabilitation train- ing, etc. On this basis, group A was given Sertraline hydrochloride tablets with initial dose of 50 mg, once a day , orally in the morning; gradually increased to 200 mg within 2 weeks, once a day, orally in the morning. Group B was given Amitriptyline tab- lets with initial dose of 25 mg, twice a day, orally in the morning and evening; gradually increased to 100 mg, twice a day, oral- ly in the morning and evening. They were treated for one month to observe the clinical efficacy of two groups, the levels of IL-6, IL-1β, TNF-α and ADR before and after treatment. RESULTS： The total effective rate of group A was significantly higher than that of group B, and there were statistically significant differences （P〈0.05）. There were no significant differences in IL-6, IL-1β and TNF-α between 2 groups before treatment （P〉0.05）. The levels of IL-6, IL-1β and TNF-α in 2 groups after treatment were all sig- nificantly lower than before, and in group A was lower than in group B; there was statistically significant difference （P〈0.05）. The incidence of ADR in group A was significant lower than in group B; there was statistically significant difference （P〈0.05）. CONCLUSIONS： Therapeutic efficacy of sertraline hydrochloride is better than amitriptyline in the treatment of depression after stroke, and has better safety.