度洛西汀与舍曲林治疗老年抑郁症的研究及生活事件对治疗效果的影响

Study of duloxetine and sertraline in the treatment of geriatric depression and the impact of life event on efficacy

目的对比分析老年抑郁症应用度洛西汀与舍曲林治疗的临床效果与安全性以及生活应激事件对老年抑郁症患者治疗效果的影响。方法 74例老年抑郁症患者,随机分为度洛西汀组(38例)与舍曲林组(36例),比较两组治疗效果。结果治疗前度洛西汀组与舍曲林组汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)评分比较差异无统计学意义(P>0.05);治疗后1~6周HAMD、HAMA评分均低于治疗前,且度洛西汀组低于舍曲林组,差异有统计学意义(P<0.05)。度洛西汀组痊愈20例,显效10例,有效5例,无效3例,总有效率为92.11%;舍曲林组痊愈12例,显效15例,有效3例,无效6例,总有效率为83.33%;两组总有效率比较差异有统计学意义(P<0.05)。度洛西汀组不良反应发生率为7.89%,舍曲林组不良反应发生率为8.33%,比较差异无统计学意义(P>0.05)。对患者生活事件量表(LES)与HAMD治疗前后减分率进行相关分析发现,生活事件评分越高,患者的HAMD减分率越低(P<0.05)。结论生活事件对患者造成的压力越大,其治疗效果越差。老年抑郁症采用度洛西汀治疗,其临床效果优于舍曲林,且不良反应轻微,是一种安全有效的治疗方式,值得推广。

Objective To compare and analyze the clinical effect and security of duloxetine and sertraline in the treatment of geriatric depression, and impact of life stress events on treatment effect in geriatric depression patients. Methods A total of 74 geriatric depression patients were randomly divided into duloxetine group (38 cases) and sertraline group (36 cases). Treatment effect was compared in two groups. Results There were no statistically significant difference in Hamilton depression scale (HAMD) and Hamilon anxiety scale (HAMA) score between duloxetine group and sertraline group before treatment ( P>0.05). Both groups had lower HAMD and HAMA score after 1~6 weeks of treatment, and the duloxetine group had lower scores than sertraline group. Their differences had statistical significance (P<0.05). The duloxetine group had 20 cured cases, 10excellent cases, 5 effective cases and 3 ineffective cases, with total effective rate as 92.11%. The sertraline grouphad 12 cure cases, 15 excellent cases, 3 effective cases and 6 ineffective cases, with total effective rate as 83.33%.There was statistically significant difference in total effective rate in two groups (P<0.05). The duloxetine grouphad incidence of adverse reactions as 7.89%, while 8.33% in the sertraline group, and there was no statisticallysignificant difference (P>0.05). Correlation analysis was made on score-reducing rate in life event scale (LES)and HAMD before and after treatment, which showed that the higher the life events scale was, the lower of scorereducing rate in HAMD was (P<0.05). Conclusion Higher pressure by life event in patients leads to worse curative effect. Duloxetine shows better clinical effect than sertraline for the treatment of geriatric depression with light adverse reactions. So it is a safe and effective treatment method and it is worth promotion.