度洛西汀治疗伴疼痛症状的广泛性焦虑障碍的研究

Clinical Effect of Duloxetine on Generalized Anxiety Disorder with Painful Symptoms

目的探讨度洛西汀治疗伴有疼痛症状的广泛性焦虑障碍(GAD)的疗效及安全性。方法将80例伴有疼痛症状的GAD患者按随机数字表法分为度洛西汀组(D组,40例)和艾司西酞普兰组(A组,40例),观察8周。分别于基线时,治疗第2周末、第4周末和第8周末进行汉密顿焦虑量表(HAMA)、疼痛视觉模拟量表(VAS)、患者健康状况问卷15项(PHQ-15)、治疗时出现的症状量表(TESS)评定,比较2组疗效及不良反应。结果治疗后,2组各观察时点HAMA总分、VAS评分和PHQ-15总分均较基线时显著下降(P<0.01);且D组各观察时点的VAS评分均明显低于A组(P<0.05);D组在治疗后第2周末HAMA总分、PHQ-15总分显著低于A组(P<0.05),而其他观察时点比较差异无统计学意义(P>0.05)。2周末、4周末、8周末VAS减分率与HAMA减分率呈正相关(r2周末=0.267、r4周末=0.452、r8周末=0.598,P<0.05or P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论度洛西汀治疗伴有疼痛症状的GAD效果好、安全性高,能快速、有效地改善患者的焦虑症状,并能明显改善患者的疼痛症状;疼痛症状改善越明显,治疗焦虑症状的效果越好。

ObjectiveTo explore the effectiveness and safety of duloxetine in the treatment of generalized anxiety disorder（GAD） with painful symptoms. Methods Eighty GAD patients with painful symptoms were randomly treated with either duloxetine（group D,40 cases） or escitalopram（group A,40 cases）.The scores of Visual Analog Scale（VAS）,Hamilton Anxiety Scale（HAMA）,Patient Health Questionnaire-15（PHQ-15） and Treatment Emergent Symptom Scale（TESS） were measured at baseline,second,fourth and eighth weekends.In addition,curative effect and adverse reactions were compared between the two groups. Results The scores of HAMA,VAS and PHQ-15 at the second,fourth and eighth weekends were lower than those at baseline after treatment in both groups（ P 〈0.01）.Compared with group A,VAS score decreased at all time points and total scores of HAMA and PHQ-15 reduced at the second weekend in group D（ P 〈 0.05）.There were no significant differences in HAMA and PHQ-15 scores between the two groups at the fourth and eighth weekends（ P 〉0.05）.The VAS score reduction rate was positively correlated with the HAMA score reduction rate（ r =0.267,0.452 and 0.598 at the second,fourth and eighth weekends,respectively; P 〈0.05 or P 〈0.01）.No significant difference was found in the incidence of adverse reactions between the two groups（ P 〉0.05）. Conclusion Duloxetine treatment can effectively,safely and quickly relieve anxiety and pain in GAD patients with painful symptoms.The improvement of pain symptoms is positively associated with the treatment outcome of anxiety symptoms.