童年期创伤对艾司西酞普兰治疗成年抑郁症疗效的影响

Impact of childhood trauma on the efficacy of escitalopram for the treatment of adult depression

目的探讨童年期创伤对艾司西酞普兰治疗成年期抑郁症疗效的影响。方法研究纳入68例不伴精神病症状的成年抑郁症患者，所有患者均进行童年创伤问卷（childhood trauma questionnaire，CTQ）测评，并给予8周的艾司西酞普兰标准化治疗。分别在第2、4、8周末对所有患者进行Beck抑郁自评量表（Beck depression inventory，BDI）和HAMD-17测评，观察不同CTQ因子阳性患者在第2、4、8周末的BDI得分和HAMD-17得分的变化。结果（1）总体干预疗效方面，4周末和8周末的临床痊愈比例分别为25．0％和45．6％，总有效率为94．1％。在4周末童年期创伤任一因子阳性组的临床痊愈比例（19．5％）与童年期创伤所有因子阴性组（33．3％）比较差异无统计学意义（X^2=1．66，P〉0．05）；在8周末的临床痊愈比例在两组间差异无统计学意义（阳性组39．0％，阴性组55．6％，X^2=1．79，P〉0．05）。（2）童年期创伤任一因子阳性组在4周末的HAMD-17总分减分率[阳性（46．26±24．79）％，阴性（58．39±23．25）％]、BDI总分减分率[阳性（51．63±16．03）％，阴性（66．28±18．05）％]和在8周末的BDI总分减分率[阳性（59．13±15．42）％，阴性（68．50±20．91）％]均低于童年期创伤任一因子阴性组，均差异有统计学意义（均P〈0．05）；（3）除性虐待因子外，CTQ各因子分与4周末、8周末BDI总分减分率之间呈显著负相关（r=-0．46^-0．06，P〈0．05）。结论童年期创伤对艾司西酞普兰治疗成年抑郁症的疗效存在不良影响。

Objective To explore the effect of childhood trauma on escitalopram treatment of adult depression. Methods There were 68 adult patients with major depression disorder recruited. All patients were assessed with Childhood Trauma Questionnaire （CTQ） and given 8 weeks of standardized treatment with escitalopram. Beck Depression Inventory （BDI） and HAMD-17 were assessed at the end of the 2nd,4th and 8th week respectively. The changes of BDI score and HAMD-17 score in patients with different CTQ factors were observed. Results （1） The overall effect of intervention was 25.0% at the end of 4th week and 45.6% at the end of 8th week. The total effective rate was 94.1%. At the end of 4th week,there was no significant difference in the clinical recovery rate between the positive group（19.5%） and the negative group （33.3%） （X^2=1.66,P〉0. 05）. There was no significant difference in clinical recovery between the two groups at the end of 8th week（ positive group ： 39.0%, negative group ： 55.6%, X^2 =1.79,P〉0.05）. （2） The total score reduction rate of HAMD-17 （（46.26±24.79） %, （ 58.39±23.25）%） and BDI （（51.63±16.03） %, （66.28±18.05） % ） at the end of 4th week and the total score reduction rate of BDI at the end of 8th week （（59.13±15.42） %, （68.50±20. 91）%） in the positive group were lower than those in the negative group （P〈0.05）. （3） Except for sexual abuse, there was a significant negative correlation between CTQ scores and the reduction rate of BDI scores at end of 4th and 8th week（r=-0. 46^-0. 06,P〈0. 05）. Conclusion Childhood trauma has adverse effects on the efficacy of eseitalopram in the treatment of adult depression.