艾司西酞普兰联合尼莫地平、多奈哌齐治疗血管性痴呆伴发抑郁的临床效果

Effect of escitalopram combined with nimodipine and donepezil on treatment of patients with vascular dementia and depression

目的观察艾司西酞普兰联合尼莫地平、多奈哌齐治疗血管性痴呆(VD)伴发抑郁的疗效及对患者认知功能、血清脑源性神经营养因子(BDNF)及S100B蛋白的影响。方法 114例VD伴发抑郁患者随机分为对照组和观察组各57例,对照组给予多奈哌齐+帕罗西汀,观察组给予多奈哌齐+艾司西酞普兰。比较2组简易智能状态检查量表(MMSE)、改良长谷川简易智能评定量(HDS-R)、日常生活能力量表(ADL)、抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)评分及疗效,测定血清BDNF和S100B蛋白水平,记录不良反应。结果观察组有效率为87.7%,对照组为80.7%。治疗后,2组MMSE及HDS-R评分、BDNF含量显著升高,ADL、SDS及HAMD评分显著降低(P<0.05)。观察组S100B含量显著下降(P<0.05)。观察组治疗4周时的SDS及HAMD评分、S100B水平显著低于对照组(P<0.05)。观察组不良反应发生率为19.3%,显著低于对照组的42.1%(P<0.05)。结论艾司西酞普兰联合尼莫地平、多奈哌齐治疗血管性痴呆(VD)伴发抑郁起效快且不良反应少。

Objective To observe the effect of escitalopram combined with nimodipine and donepezil on treatment of patients with vascular dementia（ VD） and depression and its influence on cognitive function,brain derived neurotrophic factor（ BDNF） and S100 B. Methods A total of 114 patients with VD and depression were randomly divided into control group（ n = 57） and observation group（ n = 57）,the control group was given nimodipine,donepezil and paroxetine,and the observation group was given nimodipine,donepezil and escitalopram. The mini-mental state examination（ MMSE）,Hasegawa dementia scale revised（ HDS-R）,activity of daily living scale（ ADL）,selfrating depression scale（ SDS）,Hamilton depression scale（ HAMD） and clinical effects were compared between two groups. The serum levels of BDNF and S100 B were detected,and the adverse reactions were recorded. Results The total effective rate was 87. 7% in the observation group,which was 80. 7% in the control group. After treatment,the MMSE,HDS-R and serum BDNF levels increased significantly（ P〈0. 05）,ADL,SDS and HAMD decreased significantly in both groups,and serum S100 B decreased significantly in the observation group（ P〈0. 05）. For the observation group,4 week after treatments,SDS,HAMD and serum S100 B decreased significantly than those in control group（ P〈0. 05）. The incidence rate of adverse reactions was 19. 3% in the observation group,which was significantly lower than 42. 1% in the control group（ P〈0. 05）. Conclusion Escitalopram combined with nimodipine and donepezil is effective and safe in treatment of patients with VD and depression.