文拉法辛联合阿戈美拉汀治疗老年抑郁症患者的疗效及对血清脑源性神经营养因子的影响

Effect of venlafaxine combined with agomelatine on the efficacy of senile depression and the effect of serum brain-derived neurotrophic factor

目的探讨文拉法辛联合阿戈美拉汀对老年抑郁症患者疗效及血清脑源性神经营养因子(BDNF)的影响。方法选取广元市精神卫生中心2019年10月至2020年11月收治的104例老年抑郁症患者为研究对象,以随机数字表法分为研究组(52例)与对照组(52例)。对照组采用阿戈美拉汀联合安慰剂治疗,研究组采用文拉法辛联合阿戈美拉汀治疗。比较两组治疗前后的汉密尔顿抑郁量表(HAMD)评分、临床疗效及BDNF、中枢神经特异蛋白(S100β)、认知功能情况,记录两组的药物安全性。结果对照组治疗4、12周后的HAMD评分为(15.58±3.01)、(11.37±2.13)分,研究组为(12.11±2.34)、(9.23±1.57)分,均低于治疗前,差异有统计学意义(P<0.05);两组治疗12周后的HAMD评分均低于治疗4周后,差异有统计学意义(P<0.05);研究组治疗4、12周后的HAMD评分均低于对照组,差异有统计学意义(P<0.05)。研究组的总有效率(92.31%,48/52)高于对照组(76.92%,40/52),差异有统计学意义(P<0.05)。对照组治疗4、12周后的S100β为(1.81±0.32)、(1.41±0.25)μg/L,研究组为(1.52±0.28)、(1.19±0.18)μg/L,均低于治疗前,差异有统计学意义(P<0.05);两组治疗12周后的S100β均低于治疗4周后,差异有统计学意义(P<0.05);对照组治疗4、12周后的BDNF为(29.18±5.46)、(43.52±8.24)μg/L,研究组为(33.43±6.17)、(47.49±7.83)μg/L,均高于治疗前,差异有统计学意义(P<0.05);两组治疗12周后的BDNF均高于治疗4周后,差异有统计学意义(P<0.05);研究组治疗4、12周后的S100β均低于对照组,BDNF均高于对照组,差异均有统计学意义(均P<0.05)。对照组治疗12周后的重复性成套神经心理状态测验(RBANS)评分为(78.28±10.23)分,研究组为(82.09±11.76)分,均高于治疗前、治疗4周后,差异有统计学意义(P<0.05);研究组治疗12周后的RBANS评分高于对照组,差异有统计学意义(P<0.05)。两组总药物不良反应发生率比较差异无统计学意义(P>0.05)。结论文拉法辛联合阿戈美拉汀可明显降低老年抑郁症患者的抑郁症状评分,增强疗效,改善神经功能及认知功能,且安全性良好。

Objective To explore the effect of venlafaxine combined with agomelatine on the efficacy of senile depression and the effect of serum brain-derived neurotrophic factor(BDNF).Methods A total of 104 elderly patients with depression admitted to Guanyuan Mental Health Center from October 2019 to November 2020 were selected as the research objects,and they were divided into study group(52 cases)and control group(52 cases)by a random number table.The control group was treated with agomelatine combined with placebo,and the study group was treated with venlafaxine combined with agomelatine.The scores of Hamilton Depression Scale(HAMD),clinical efficacy,BDNF,S100βand cognitive function were compared between the two groups before and after treatment.The drug safety of the two groups were recorded.Results The HAMD scores of the control group after 4 weeks of treatment and after 12 weeks of treatment were(15.58±3.01)points and(11.37±2.13)points respectively,and the study group were(12.11±2.34)points and(9.23±1.57)points respectively,which were all lower than those before treatment(P<0.05).HAMD scores of the two groups after 12 weeks of treatment were lower than those after 4 weeks of treatment(P<0.05).HAMD scores of the study group after 4 weeks and after 12 weeks of treatment were lower than those of the control group(P<0.05).The total effective rate of the study group(92.31%,48/52)was higher than that of the control group(76.92%,40/52)(P<0.05).The S100βof the control group after 4 weeks of treatment and after 12 weeks of treatment were(1.81±0.32)μg/L and(1.41±0.25)μg/L,study group were(1.52±0.28)μg/L and(1.19±0.18)μg/L,which were lower than those before treatment(P<0.05).S100βafter 12 weeks of treatment in two groups was lower than that after 4 weeks of treatment(P<0.05).The BDNF of the control group after 4 weeks of treatment and after 12 weeks of treatment were(29.18±5.46)μg/L and(43.52±8.24)μg/L,and the study group were(33.43±6.17)μg/L and(47.49±7.83)μg/L,which were higher than those before treatment(P<0.05).BDNF after 12 weeks of treatment in both groups was higher than that after 4 weeks of treatment(P<0.05).The S100βof the study group after 4 weeks of treatment and 12 weeks of treatment were lower than that of the control group(P<0.05),and BDNF was higher than that of the control group(P<0.05).The score of the Repetitive Neuropsychological State Test(RBANS)after 12 weeks of treatment in the control group was(78.28±10.23)points,the study group was(82.09±11.76)points,which were both higher than those before treatment and 4 weeks after treatment(P<0.05).The RBANS score of the study group after 12 weeks of treatment was higher than that of the control group(P<0.05).There was no significant difference in the incidence of total adverse drug reactions between the two groups(P>0.05).Conclusions Venlafaxine combined with agomelatine can significantly reduce the score of depression symptoms in elderly depression patients,enhance the efficacy,improve neurological function and cognitive function,and has good safety.