缺血性慢性心衰合并抑郁症状患者服用草酸艾司西酞普兰的研究

The clinical efficacy of domestic escitalopram tablets on endothelial function and cardiovascular events in chronic ischemia heart failure patients with depressive disorder

目的:观察国产草酸艾司西酞普兰对缺血性慢性心力衰竭合并抑郁症状患者内皮功能及心血管事件的影响,进一步评价草酸艾司西酞普兰的临床疗效,并探讨其机制。方法:将100例确诊为慢性缺血性心力衰竭合并抑郁症状患者随机分为对照组(n=48)和治疗组(n=52),两组患者均给予慢性缺血性心力衰竭常规治疗和心理干预,治疗组患者每早加服国产草酸艾司西酞普兰10 mg,两组患者于治疗前及治疗8周末进行汉密尔顿抑郁量表(HAMD)评分,测定肱动脉血流介导的内皮依赖性血管舒张功能(FMD),并记录心绞痛、心力衰竭、急性心肌梗死和恶性心律失常的发生情况。结果:治疗8周后,治疗组与对照组的HAMD评分分别为(7.61±3.32)和(20.27±3.06)分,有统计学显著差异(P<0.05);治疗组与对照组的肱动脉血流介导的FMD分别为(4.40±0.52)%和(4.66±0.56)%,有统计学显著差异(P<0.01)。治疗组心绞痛发作、急性心肌梗死、急性心力衰竭及恶性心律失常发生率分别为7.69%,0%,3.85%和1.92%,对照组分别为16.67%,4.17%,6.25%和4.17%。两组的心血管事件有统计学差异意义(P<0.05)。结论:草酸艾司西酞普兰可以明显改善慢性缺血性心力衰竭合并抑郁症状患者的抑郁状态,改善患者的血管内皮功能,进一步降低心血管事件,且药物安全。

Objective： To study the efficacy and mechanism of domestic escitalopram tablets on chronic ischemia heart failure patients with depressive disorder by observing endothelial function and cardiovascular events.Methods： One hundren chronic ischemia heart failure patients with depressive disorder admitted to our hospital were enrolled. All patients were randomized to either control group（ n = 48） or treatment group（ n = 52）. Both groups were given conventional treatment for chronic ischemia heart failure combined with psychological intervention for 8weeks. Escitalopram tablets of 10 mg were added to the treatment group every morning. Hamilton depression rating scale（ HAMD） measurement was performed and the flow-mediated dilation（ FMD） of the brachial artery was assessed by ultrasound before treatment and at 8 weeks respectively. The onsets of angina pectoris attacks,acute myocardial infarction,acute heart failure,and malignant arrhythmia were observed. Results： After eight-week treatment,the HAMD score was（ 7. 61 ± 3. 32） and（ 20. 27 ± 3. 06） in the treatment group and control group,respectively（ P 0. 05）,the values of FMD were（ 4. 66 ± 0. 56） % in the treatment group and（ 4. 40 ± 0. 52） %in the control group,respectively（ P 0. 05）,The incidences of angina pectoris attacks,acute myocardial infarction,acute heart failure,and malignant arrhythmia were 7. 69%,0%,3. 85% and 1. 92% in the treatment group,and16. 67%,4. 17%,6. 25% and 4. 17% in the control group,respectively. The incidence of cardiovascular events was significantly different（ P 0. 05）. Conclusion： Escitalopram can significantly improve the depressive state and endothelial function,and decrease the incidence of cardiovascular events in chronic ischemia heart failure patients with depressive disorder,with good safety.