米氮平与舍曲林治疗首发抑郁症对认知功能影响的对照研究

Cognitive Function Comparison between Mirtazapine and Sertraline in First-episode Major Depression Treatment

【目的】比较米氮平和舍曲林治疗首发抑郁症对认知功能的影响。【方法】198例首发抑郁症患者随机予以米氮平（n=98）与舍曲林（n=100）治疗，疗程6周。采用汉密尔顿抑郁量表（HAMD-17）评定疗效；采用威斯康星卡片分类测验（WCST）、连线测验（TMT）、词语流畅作业（VF）、数字符号和数字广度测验评定认知功能。【结果】治疗6周后，米氮平组的有效率为82．7％，舍曲林组的有效率为81.0％，两组比较差异无统计学意义（P〉0．05）。治疗6周末，两组的WSCT正确数、分类个数较治疗前均有提高，错误数、持续错误数均有减少（P〈0．05）；两组的TMT连线时间均较治疗前明显减少（P〈0．05）；两组的VF总数均较治疗前明显增加（P〈0．05）；两组的数字符号均较治疗前明显增加（P〈O．05）；两组的数字广度治疗前后比较无显著性差异（P〉0．05）。米氮平组患者在治疗6周后，WSCT非持续错误数降低、TMT-A连线时间减少、VF总数增加均较舍曲林组更为显著（P〈0．05）。【结论】米氮平与舍曲林治疗抑郁症疗效相当，米氮平改善抑郁症伴发的认知功能障碍更为明显。

[Objective]To compare the efficacy of mirtazapine and sertraline on the cognitive function in first-episode depression patients. [Method]A total of 198 first-episode major depression patients were randomly assigned to mirtazapine （ n = 98）or sertraline （ n = 100）for 6 weeks. The efficacieS of patients were assessed by HAMD （Hamilton Depression Scale） and the cognitive functions were evaluated with Wisconsin card sorting test（WCST）, trail marking test（TMT）, verbal fluency task（VF）, digital symbol and digital span[Results] After 6 weeks of treatment, the effective rate of mirtazapine and sertraline were respectively 82.7% and 81.0 %. There was no significant difference between two groups（ P 〉0.05）. After 6-weeks treatment, the two group patients had improvement in WSCT （in terms of right response numbers, classification, errors, continuous errors）, reduced TMT times, and increased VF plus numbers and digital symbol（ P 〈0.05）. However, the digital span in two group patients had not obvious improvement after treatment（ P 〉 0.05）. In the 6th weekend of treatment, the WSCT random errors and TMT-A times in the mirtazapine group were significantly lower than in the sertraline group（ P 〈0.05）. The VF numbers in the mirtazapine group were significantly higher than sertraline group（ P 〈0.05）. [Conclusion] Mirtazapine is as effective as sertraline, and is superior in improving cognitive functions than sertraline.