米氮平与度洛西汀对老年抑郁症失眠者的疗效及5-HT的影响

Efficacy of mianzapine and duloxetine on the insomnia patients of senile depression and on 5-HT

目的研究米氮平及度洛西汀对主诉失眠的老年抑郁症患者的疗效及其对患者血清5-羟色胺(5-HT)水平以及睡眠质量的影响。方法研究对象为140例主诉失眠的老年抑郁症患者,采取随机数字表法分成米氮平组与度洛西汀组,每组70例。治疗前后分别采用汉密尔顿抑郁量表(HAMD)和匹兹堡睡眠质量指数评定量表(PSQI)进行评估,同时记录药物不良反应。治疗前后抽取外周血检测血清5-HT含量。结果治疗后,2组不同时间点HAMD评分比治疗前明显下降(P<0.01),治疗2周时米氮平组评分显著低于度洛西汀组(P<0.01),但4和6周时2组差异无统计学意义(P>0.05);2组不同时间点HAMD睡眠障碍因子评分比治疗前明显下降(P<0.01),且米氮平组均较度洛西汀组显著降低(P<0.01);2组各时间点PSQI评分均显著低于治疗前(P<0.01),米氮平组治疗2,4和6周显著低于度洛西汀组(P<0.01);2组血清5-HT水平均较治疗前明显上升(P<0.01),但2组差异无统计学意义(P>0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论对主诉失眠的老年抑郁症患者采用米氮平与度洛西汀治疗均能有效减轻患者的抑郁情绪,调节神经内分泌系统,米氮平在改善失眠方面效果更为突出。

Objective To compare the clinical effects on the depressed elderly complaining of anhypnia between mirtazapine and dutoxetine and their effects on serum5-hydroxytryptaphane(5-HT)level and sleep quality.Methods The subjects were selected from140cases of patients with senile depression who complained of anhypnia admitted in our hospital.The patients were divided into the mirtazapine group and dutoxetine group on the basis of random time table,each group70cases.The clinical effects of the2groups were evaluated respectively by adopting Hamilton′s depression scale(HAMD)and Pittsburgh sleep quality index(PSQI)before and after treatment.The adverse reactions were recorded,and the peripheral blood was sampled before and after treatment to test the content of5-HT.Results The HAMD scores of both groups at different times after treatment evidently declined as compared with those before treatment(P<0.01).The HAMD scores of the mirtazapine group were remarkably lower than that of the dutoxetine group after2weeks of treatment(P<0.01),but no big difference was found between the2groups after4and6weeks of treatment(P>0.05).The HAMD dysomnia factor sores of both groups at different times after treatment evidently declined as compared with those before treatment(P<0.01),and the afore mentioned scores of the mirtazapine group got remarkable decrease as compared with that of the other group(P<0.01).The PSQI scores of the2groups at different times after treatment were significantly lower than those before treatment(P<0.01),and the PSQI scores of the mirtazapine group2,4,6weeks after treatment were obviously lower than their counterparts in the dutoxetine group(P<0.01).Compared with the pre-treatment serum5-HT level,those of the2groups both got a significant increase(P<0.01),but no difference found between the2group neither before nor after the treatment in terms of the serum5-HT level(P>0.05).The incidence of adverse reactions of the2groups had no difference(P>0.05).Conclusion Both martazapine and dutoxetine can effectively relieve depression in depressed elderly complaining of anhypnia and adjust the function of their neuroendocrine system,but in improving the sleep quality mirtazapine prevails.