早期症状改善预测西酞普兰治疗重性抑郁症有效性及性别差异

PREDICTIVE VALUE OF EARLY SYMPTOM IMPROVEMENT FOR THE CLINICAL EFFECT OF CITALOPRAM IN TREATMENT OF MAJOR DEPRESSION AND ITS SEX DIFFERENCE

目的探讨早期症状的改善是否能够预测西酞普兰治疗重性抑郁症住院病人6周的疗效,并分析预测准确性的性别差异。方法重性抑郁症住院病人93例,按照性别分为2组,男性组39例,女性组54例,第1周使用西酞普兰20mg/d口服治疗,根据病情需要2~6周西酞普兰可逐渐加至40mg/d,分别于治疗0、1、2、4、6周末,采用蒙哥马利抑郁量表(MADRS)评定疗效,并以MADRS减分率≥50%为有效。使用受试者ROC曲线分析西酞普兰治疗1、2、4周末MADRS的减分率并确定最佳临界值。结果在总体中,治疗1、2、4周末的MADRS减分率最佳临界值分别为15.79%、37.84%和45.94%,诊断灵敏度分别为73.77%、78.69%和95.08%,诊断特异度分别为71.87%、78.12%和87.50%,ROC曲线下面积(AUC)分别为0.729、0.810和0.955。在男性组中,治疗1、2、4周末的MADRS减分率最佳临界值分别为15.79%、37.84%和45.94%,诊断灵敏度分别为73.68%、78.95%和94.74%,诊断特异度分别为70.00%、75.00%和85.00%,AUC分别为0.711、0.808和0.929;女性组中,治疗1、2、4周末MADRS减分率最佳临界值分别为15.79%、35.48%和45.16%,诊断的灵敏度分别为73.81%、80.95%和95.24%,诊断特异度分别为75.0%、83.33%和91.67%,AUC分别为0.718、0.827和0.963。结论重性抑郁症住院病人早期症状的改善可以预测西酞普兰治疗的后期疗效,且女性病人的预测准确性高于男性。

Objective To investigate whether early symptom improvement can predict the outcome of patients with major depression treated with citalopram for 6 weeks,as well as the sex difference of predictive accuracy. Methods A total of 93 hospitalized patients with major depression were enrolled and divided into two groups according to sex.There were 39 patients in the male group and 54 patients in the female group.All patients were given oral citalopram 20 mg/d during week 1,and the dose of citalopram was gradually increased to 40 mg/d based on the patients＇ conditions.The Montgomery-Asberg Depression Rating Scale（MADRS）was used to evaluate the outcome at the end of weeks 0,1,2,4,and 6,and a reduction in MADRS score of≥50% was considered effective.The receiver operating characteristic（ROC）curve was used to analyze the reduction rate of MADRS score at the end of weeks 1,2,and 4 and determine the cut-off values. Results At the end of weeks 1,2,and 4,the cut-off values of the reduction rate of MADRS score were 15.79%,37.84%,and 45.94%,respectively,with diagnostic sensitivities of 73.77%,78.69%,and 95.08%,diagnostic specificities of 71.87%,78.12%,and 87.50%,and areas under the ROC curve（AUCs）of 0.729,0.810,and 0.955,respectively.In the male group,the cut-off values of the reduction rate of MADRS score were15.79%,37.84%,and 45.94%,respectively,at the end of weeks 1,2,and 4,with diagnostic sensitivities of 73.68%,78.95%,and 94.74%,diagnostic specificities of 70.00%,75.00%,and 85.00%,and AUCs of 0.711,0.808,and 0.929,respectively.In the female group,the cut-off values of the reduction rate of MADRS score were 15.79%,35.48%,and 45.16%,respectively,at the end of weeks 1,2,and 4,with diagnostic sensitivities of 73.81%,80.95%,and 95.24%,diagnostic specificities of 75.0%,83.33%,and 91.67%,and AUCs of 0.718,0.827,and 0.963,respectively. Conclusion Early symptom improvement in hospitalized patients with major depression can predict the late clinical effect of citalopram,with a higher predictive accuracy in female patients than in male patients.