丙戊酸镁治疗双相情感障碍40例

Magnesium valproate for the treatment of bipolar disorder in 40 patients

目的探讨丙戊酸镁和碳酸锂治疗双相情感障碍的疗效和对患者血清指标及生存质量的作用。方法将诸暨市第五人民医院2017年3月至2020年5月收治的双相情感障碍患者80例作为研究对象,采用抽签法分为对照组和观察组,每组40例。分别采用碳酸锂、丙戊酸镁治疗3个月。比较两组疗效和血清指标及生存质量。结果观察组总有效率为95.0%(38/40),明显高于对照组的75.0%(30/40),差异有统计学意义(χ^(2)=6.28,P=0.012)。两组治疗前肿瘤坏死因子α(TNF-α)、尿酸(UA)、总胆红素(TBIL)、白蛋白水平均差异无统计学意义(均P>0.05),治疗后两组TNF-α、UA、TBIL、白蛋白水平均改善(均P<0.001),治疗后观察组TNF-α、UA水平分别为(136.5±6.2)ng/L、(307.9±15.2)μmol/L,均低于对照组的(148.9±7.5)ng/L、(335.6±18.9)μmol/L,TBIL、白蛋白水平分别为(11.0±2.3)μmol/L、(45.5±3.6)g/L,均高于对照组的(8.4±2.1)μmol/L、(42.8±3.0)g/L,均差异有统计学意义(t=12.20、7.22、5.28、3.64,均P<0.001)。两组治疗前生存质量各项维度评分均差异无统计学意义(均P>0.05),治疗后两组生存质量各项维度评分均提高(均P<0.001),治疗后观察组生理机能、生理职能、躯体疼痛、精力、一般健康状况、社会功能、情感职能、精神健康评分分别为(75.2±4.4)分、(71.9±4.6)分、(76.2±4.7)分、(71.8±3.9)分、(66.8±4.0)分、(75.9±4.4)分、(70.5±3.9)分、(69.9±4.0)分,均明显高于对照组的(68.0±4.0)分、(65.5±4.3)分、(69.8±4.0)分、(66.5±3.5)分、(61.8±3.5)分、(68.1±4.0)分、(64.1±3.6)分、(63.3±3.9)分,均差异有统计学意义(t=7.66、6.43、6.56、6.40、5.95、8.30、7.63、7.47,均P<0.001)。结论丙戊酸镁治疗双相情感障碍患者,能够提升机体抗氧化能力,抑制免疫炎性损伤,改善异常代谢,从而有效控制患者抑郁、躁狂症状,提升生存质量,较碳酸锂有效性良好。

Objective To investigate the efficacy of magnesium valproate versus lithium carbonate in the treatment of bipolar disorder and their effects on serum indexes and quality of life.Methods 80 patients with bipolar disorder treated in the Fifth People's Hospital of Zhuji City from March 2017 to May 2020 were included in this study.They were randomly assigned to receive either lithium carbonate(control group,n=40)or magnesium valproate(treatment group,n=40)for 3 months.Efficacy,serum indexes,and quality of life were compared between the two groups.Results Total effective rate was significantly higher in the observation group than in the control group[95.0%(38/40)vs.75.0%(30/40),χ^(2)=6.28,P=0.012].There were no significant differences in tumor necrosis factor-α,uric acid,total bilirubin,and albumin levels between the two groups(all P>0.05).Tumor necrosis factor-αand uric acid levels in each group were decreased after treatment compared with before treatment(both P<0.001).Total bilirubin and albumin levels in each group were increased after treatment compared with before treatment(both P<0.001).Tumor necrosis factor-2 and uric acid levels measured after treatment were(136.5±6.2)ng/L and(307.9±15.2)μmol/L,respectively in the observation group,which were significantly lower than those in the control group[(148.9±7.5)ng/L,(335.6±18.9)μmol/L in the control group,t=12.20,7.22,both P<0.001].Total bilirubin and albumin levels measured after treatment were(11.0±2.3)μmol/L and(45.5±3.6)g/L,respectively in the observation group,which were significantly higher than those in the control group[(8.4±2.1)μmol/L,(42.8±3.0)g/L,t=5.28,3.64,both P<0.001).There were no significant differences in scores of all dimensions of quality of life between the two groups before treatment(all P>0.05).Scores of all dimensions of quality of life in each group increased after treatment compared with befor treatment(all P<0.001).Scores of physical functioning,physical role functioning,bodily pain,vitality,social role functioning,emotional role functioning,and mental health measured after treatment were(75.2±4.4)points,(71.9±4.6)points,(76.2±4.7)points,(71.8±3.9)points,(66.8±4.0)points,(75.9±4.4)points,(70.5±3.9)points,and(69.9±4.0)points respectively in the observation group,which were significantly higher than those in the control group[(68.0±4.0)points,(65.5±4.3)points,(69.8±4.0)points,(66.5±3.5)points,(61.8±3.5)points,(68.1±4.0)points,(64.1±3.6)points,(63.3±3.9)points,t=7.66,6.43,6.56,6.40,5.95,8.30,7.63,7.47,all P<0.001].Conclusion Magnesium valproate for the treatment of bipolar disorder can improve the antioxidant capacity,inhibit immune-inflammatory injury,improve abnormal metabolism,effectively control the symptoms of depression and mania,and improve the quality of life.Magnesium valproate is more effective than lithium carbonate in the treatment of bipolar disease.