探讨人类肠道菌群调节剂联合抗抑郁药物治疗抑郁症的临床疗效

Clinical efficacy of human intestinal flora regulators combined with antidepressant drugs in treatment of depression

目的探讨人类肠道菌群调节剂联合抗抑郁药物治疗抑郁症的临床疗效。方法将300例抑郁症患者随机分为艾司西酞普兰+培菲康组、舍曲林+培菲康组、米氮平+培菲康组、艾司西酞普兰组、舍曲林组和米氮平组,各50例。治疗前和治疗1、2、4周后,分别采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简明精神病(科)量表(BPRS)、蒙特利尔认知评估(MoCA)、社会功能量表(SFRS)对所有患者进行评估,再采用药物副反应量表(TESS)于治疗1、2、4周时评估药物相关的不良反应。结果治疗1周后,联合应用培菲康的三组患者各量表评分与未联合应用培菲康的三组患者差异无统计学意义(P>0.05);治疗2周和4周后,联合应用培菲康的三组患者的HAMD、HAMA、BPRS、MoCA和SFRS评分均优于未联合应用培菲康的三组患者(P<0.05);随着疗程的延长,各组TESS评分均逐渐下降,组内差异有统计学意义(P<0.05)。三组之间治疗1周和治疗4周后HAMD、HAMA、BPRS和SFRS评分差异均无统计学意义(P>0.05);而治疗2周后,艾司西酞普兰+培菲康组和米氮平+培菲康组的HAMD、HAMA、BPRS和SFRS评分均优于舍曲林+培菲康组(P<0.05),但这两组间比较差异无统计学意义(P>0.05);各组间各时间段MoCA、TESS评分比较差异均无统计学意义(P>0.05)。结论在抗抑郁药物基础上联合应用肠道菌群调节剂对抑郁症患者临床症状、不良行为、认知功能和社会功能的改善作用优于单用抗抑郁药物,且起效快,安全性好,司西酞普兰和米氮平联合培菲康的起效速度比舍曲林联合培菲康快。

【Objective】To investigate the clinical efficacy of human intestinal flora regulators combined with antidepressant drugs in the treatment of depression.【Methods】A total of 300 patients with depression were randomly divided into escitalopram+bifico group,sertraline+bifico group,mirtazapine+bifico group,escitalopram group,sertraline group and mirtazapine group,50 cases each.Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Brief Psychiatric Rating Scale(BPRS),Montreal Cognitive Assessment(MoCA)and Social Function Rating Scale(SFRS)were used to evaluate all patients before treatment and 1,2 and 4 weeks after treatment.Drug-related side effects were assessed by Treatment Emergent Side Effect Scale(TESS)at 1,2 and 4 weeks after treatment.【Results】After one week of treatment,there was no significant difference in the scores of HAMD,HAMA,BPRS and SFRS between drug combination groups and groups without bifico(P>0.05).After 2 and 4 weeks of treatment,the scores of each scale in the three groups with bifico were better than those without bifico(P<0.05).With the prolongation of the course of treatment,the TESS scores of each group decreased gradually,with statistical significance(P<0.05).There was no significant difference in the scores of each scale among the three groups after 1 and 4 weeks of treatment(P>0.05).However,after 2 weeks of treatment,the scores of each scale in escitalopram+bifico group and mizapine+bifico group were better than those in sertraline+bifico group(P<0.05),and there was no significant difference between the two groups(P>0.05).There was no significant difference in TESS and MoCA scores among the three groups(P>0.05).【Conclusion】For patients with depression,the efficacy of intestinal flora regulators combined with antidepressants may be better than antidepressants alone in clinical symptoms,bad behavior,cognitive function and social function.It has quick onset and good safety.The efficacy of combination of citalopram and mirtazapine with bifico is faster than that of combination of sertraline and bifico.