早发与晚发抑郁障碍住院患者用药情况的回顾性分析

Retrospective analysis of medication in hospitalized patients with early-onset and late-onset depressive disorder

目的调查抑郁障碍住院患者的精神科药物使用情况,为临床治疗提供参考。方法利用京津冀大数据平台,对2015—2019年在北京安定医院住院、符合条件的抑郁障碍患者的相关数据进行回顾性分析,比较早发与晚发抑郁障碍患者的精神科药物使用情况。结果共纳入抑郁障碍患者6043例,其中早发患者1820例(30.12%),晚发患者4223例(69.88%)。早发患者使用的抗抑郁药类别主要为选择性5-羟色胺再摄取抑制剂(SSRIs;61.54%,1120例)、去甲肾上腺素再摄取抑制剂(SNRIs;21.26%,387例)和去甲肾上腺素和特异性5-羟色胺能抗抑郁药(NaSSA;7.25%,132例),其中舍曲林(25.05%,456例)、草酸艾司西酞普兰(21.98%,400例)、文拉法辛(13.68%,249例);抗精神病药物使用率为68.08%(1239例),其中喹硫平(29.67%,540例)、阿立哌唑(15.93%,290例)、奥氮平(10.11%,184例);心境稳定剂使用率为33.85%(616例),其中碳酸锂(18.08%,329例)、丙戊酸盐(15.44%,281例)、拉莫三嗪(0.33%,6例)。晚发患者使用的抗抑郁药物类别是SSRIs(61.59%,2601例)、SNRIs(27.97%,1181例)和NaSSA(19.37%,818例),其中艾司西酞普兰(27.73%,1171例)、舍曲林(9.91%,841例)、米氮平(19.37%,818例);抗精神病药物使用率59.10%(2496例),其中喹硫平(30.59%,1292例)、奥氮平(12.48%,527例)、阿立哌唑(5.23%,221例);心境稳定剂使用率8.69%(367例),其中碳酸锂(3.84%,162例)、丙戊酸盐(4.62%,195例)、拉莫三嗪(0.21%,9例)。早发患者未用抗抑郁药物比例高于晚发患者[12.03%(219/1820)比3.43%(145/4223);χ^(2)=166.153,P<0.001],联合抗抑郁药物比例低于晚发患者[11.65%(212/1820)比20.03%(846/4223);χ^(2)=61.913,P<0.001]。两组间舍曲林、艾司西酞普兰、氟伏沙明、氟西汀、帕罗西汀、米氮平、度洛西汀、碳酸锂、丙戊酸盐、阿立哌唑、氨磺必利、氯氮平、奥氮平的使用率差异均有统计学意义(均P<0.05)。早发抑郁障碍更多使用SSRIs类药物,更多合并抗精神病药物和心境稳定剂。结论真实世界中早发抑郁障碍患者治疗药物与晚发患者有较大区别,在临床治疗中应引起重视。

Objective To investigate the use of psychiatric drugs in hospitalized patients with depressive disorder,and to provide references for clinical treatment.Methods Using the Beijing-TianjinHebei big data platform,the data of eligible patients with depressive disorder admitted to Beijing Anding Hospital from 2015 to 2019 were retrospectively analyzed,and the use of psychotropic drugs in patients with early-onset or late-onset depressive disorder was compared.Results A total of 6043 inpatients were enrolled,including 1820(30.12%)patients with early-onset depressive disorder and 4223(69.88%)patients with late-onset depressive disorder.The main classification of antidepressants used in early-onset patients were SSRIs(61.54%,n=1120),SNRIs(21.26%,n=387)and NaSSA(7.25%,n=132)respectively,including sertraline(25.07%,n=456),escitalopram(21.98%,n=400)and venlafaxine(13.68%,n=249).The use rate of antipsychotics was 68.08%(n=1239),including quetiapine(29.67%,n=540),aripiprazole(15.93%,n=290)and olanzapine(10.11%,n=184);the use rate of mood stabilizers was 33.85%(n=616),including lithium carbonate(18.08%,n=329),valproate(15.44%,n=281)and lamotrigine(0.33%,n=6).The main classification of antidepressants used in late-onset patients were SSRIs(61.59%,n=2601),SNRIs(27.97%,n=1181)and NaSSA(19.37%,n=818),including escitalopram(27.73%,n=1171),sertraline(9.91%,n=841)and mirtazapine(19.37%,n=818);the use rate of antipsychotics was 59.10%(n=2496),including quetiapine(30.59%,n=1292),olanzapine(12.48%,n=527 cases)and aripiprazole(5.23%,n=221);the use rate of mood stabilizers was 8.69%(n=367),including lithium carbonate(3.84%,n=162),valproate(4.62%,n=195),lamotrigine(0.21%,n=9).The proportion of early-onset patients without antidepressants was higher than that of late-onset patients[12.03%(219/1820)vs.3.43%(145/4223);χ^(2)=166.153,P<0.001],and the proportion of combination with antidepressants was lower than that in late-onset patients[11.65%(212/1820)vs.20.03%(846/4223);χ^(2)=61.913,P<0.001].There were statistically significant differences in the use rates of sertraline,escitalopram,fluvoxamine,fluoxetine,paroxetine,mirtazapine,duloxetine,lithium carbonate,valproate,aripiprazole,amisulpride,clozapine and olanzapine between the two groups(all P<0.05).Patients with early-onset depressive disorder were more likely to use SSRIs,and were more likely combined with antipsychotics and mood stabilizers.Conclusions In the real world,there are great differences between the drugs used for patients with early-onset depressive disorder and those with late-onset depressive disorder,which should be paid more attention to in clinical treatment.