西酞普兰联合心理干预对乳腺癌患者心理健康状况及细胞免疫的影响

Effect of citalopram combined with psychological intervention on mental health status and cellular immunity in breast cancer patients

目的探讨西酞普兰联合心理干预对乳腺癌患者心理状况与细胞免疫的影响,验证心理因素与乳腺癌细胞免疫的关系。方法收集96例乳腺癌患者,采用症状自评量表评分,96例患者中40例高于抑郁因子上限(抑郁组),32例高于焦虑因子上限(焦虑组),其中8例同时存在抑郁与焦虑(并入焦虑组)。将抑郁、焦虑患者分别随机抽样分为4组:对照组、药物组(西酞普兰片20 mg/d)、心理干预组(CBT为主的心理干预,约40 min/次,2次/周,共8次)和联合组(药物联合心理干预),每组各10例。连续治疗4周。治疗前及治疗后测试所有患者抑郁自评量表评分(self-rating depression scale,SDS)、焦虑自评量表(self-rating anxiety scale,SAS)评分及T细胞亚群+自然杀伤(natural killer,NK)细胞活性。结果抑郁、焦虑患者心理干预组、药物组和联合组治疗后SDS和SAS评分均降低(均P<0.05)。抑郁患者干预组(药物组+心理干预组+联合组)治疗后CD4^+/CD8^+比值和NK细胞活性均升高,焦虑患者干预组治疗后CD3^+细胞活性、CD4^+/CD8^+比值和NK细胞活性均升高(均P<0.05)。结论乳腺癌患者心理健康状况与细胞免疫功能相关,西酞普兰、心理干预或二者联合对于患者的抑郁、焦虑状态及免疫功能有一定的改善作用。

Objective To explore the effect of citalopram combined with psychological intervention on mental health status and cellular immunity in breast cancer patients. Methods Totally 96 breast cancer patients were screened and scored by the symptom self-rating scale. Among the 96 patients, 40 patients were higher than the upper limit of depression factor(depression section), 32 patients were higher than the upper limit of anxiety factor(anxiety section), and 8 patients had both depression and anxiety(anxiety section). Patients with depression and anxiety were randomly assigned into four groups(n=10 each group) respectively: control group, drug group(citalopram 20 mg/d), psychological intervention group(CBT-based psychological intervention, about 40 min/time, 2 times/week, a total of 8 times), and combination group(drug combined psychological intervention). Treatment continued for 4 weeks. Before and after treatment, all patients were tested for self-rating depression scale(SDS), self-rating anxiety scale(SAS), and T cell subgroup and NK cell activity were tested to evaluate the outcome of the treatment. Results After the intervention, the psychological intervention group, drug group and combination group of both sections made a progress in mood status, manifested as the decline of SDS/SAS. The depression-intervention group(the drug group, psychological intervention group and combination group) had a higher CD4^+/CD8^+ ratio and NK cell activity than before the intervention, while the anxiety-intervention group had a higher CD3^+, CD4^+/CD8^+ ratio, and NK cell activity than before the intervention. Conclusion The mental health status of breast cancer patients is related to the cellular immune function. Citalopram combined with psychological intervention can improve the mental status, reduce depression, anxiety and immune function of the patients.