奥氮平联合艾司西酞普兰治疗老年女性难治性抑郁症的疗效观察

Clinical observation of olanzapine combined with escitalopram in treatment of older women with refractory depression

目的：探讨奥氮平联合艾司西酞普兰治疗老年女性难治性抑郁症的临床疗效。方法选取2012年6月—2014年12月北京市顺义区精神病医院门诊和住院部收治的女性患者83例，随机分为对照组（41人）和治疗组（42人）。对照组开始口服草酸艾司西酞普兰片5 mg/d，2～4周内增加至10～20 mg/d。治疗组在对照组的基础上口服奥氮平片2.5 mg/次，每晚1次，2～4周内增加至3.75～5 mg/次，每晚1次。两组均连续治疗12周。应用汉密尔顿抑郁评定量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定疗效，同时对血糖（GLU），血脂指标总胆固醇（CHOL）、三酰甘油（TG）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）和体质量指数（BMI）进行比较，并且应用副反应量表（TESS）评定不良反应。结果治疗组总有效率（65.9%）明显高于对照组的总有效率（42.5%），两组比较差异具有统计学意义（P＜0.05）；治疗4、6、8、12周，两组的 HAMD 评分均较同组治疗前显著改善，且差异具有统计学意义（P＜0.05、0.01）；且治疗6、8、12周，治疗组的HAMD评分均较对照组同期显著改善，且差异具有统计学意义（P＜0.05、0.01）。治疗4、6、8、12周，对照组的HAMA评分均较同组治疗前显著改善，且差异具有统计学意义（P＜0.05、0.01）；治疗2、4、6、8、12周，治疗组的HAMA评分均较同组治疗前显著改善，且差异具有统计学意义（P＜0.05、0.01）；治疗2、6、12周，两组的观察指标GLU、CHOL、TG、HDL、LDL、BMI 较治疗前差异均无统计学意义，且治疗组较对照组同期各观察指标差异也无统计学意义；两组不良反应发生率比较差异无统计学意义。结论奥氮平联合艾司西酞普兰治疗老年女性难治性抑郁症有较好疗效，且安全性较高，具有一定的临床推广应用价值。

ObjectiveTo investigate the clinical effects of olanzapine combined with escitalopram in treatment of older women with refractory depression.Methods The patients （83 cases） with refractory depression in Beijing Shunyi District Mental Hospital from June 2012 to December 2014 were randomly divided into control （41 cases） and treatment （42 cases） groups. The patients in the control group werepo administered with Escitalopram Oxalate Tablets 5 mg/d. After 2 — 4 weeks, the dosage was gradually increased to 10 — 20 mg/d. On the basis of control group, the patients in the treatment group were po administered with Olanzapine Tablets 2.5 mg/d in the evening. After 2 — 4 weeks, the dosage was gradually increased to 3.75 — 5 mg/d in the evening. Two groups were treated for 12 weeks. Hamihon depression scale （HAMD） and Hamiton anxiety scale （HAMA） were assessed, and glucose （GLU）, lipid indexes total cholesterol chol （CHOL）, triacylglycerol （TG）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, and body mass index （BMI） were compared, and treatment-emergent signs and symptoms （TESS） were used to assess adverse reactions.Results The clinical efficacy in treatment group （65.9%） was higher than that in control group （42.5%） with significant difference （P〈0.05）. After treatment for 4, 6, 8, and 12 weeks, HAMD scores of two groups were improved more than those before treatment, and the difference was significant （P〈0.05, 0.01）; After treatment for 6, 8, and 12 weeks, HAMD scores of treatment group were improved more than those of control group with significant difference （P〈0.05）. After treatment for 4, 6, 8, and 12 weeks, HAMA scores of control group were improved more than those before treatment, and the difference was significant （P〈0.05, 0.01）; After treatment for 2, 4, 6, 8, and 12 weeks, HAMA scores of treatment group were improved more than those before treatment with significant difference （P 〈0.05, 0.01）. After treatment for 2, 6, and 12 weeks, there was no significant difference in GLU, CHOL, TG, HDL, LDL, and BMI of two groups, compared with those before treatment. And there was no significant difference in these obvervational indexes of treatment group, compared with those incontrol group at the same period. The incidence of adverse events of two groups was not statistically significant. ConclusionOlanzapine combined with escitalopram has good effect in treatment of older women with refractory depression, and is safer, which has a certain clinical application value.