奥氮平辅助米氮平治疗PSD的疗效及对血清神经递质水平的影响

Efficacy of olanzapine combined with mirtazapine in the treatment of PSD and its effect on the level of serum neurotransmitters

目的探讨奥氮平辅助米氮平治疗卒中后抑郁(PSD)的疗效及对血清神经递质水平的影响。方法选取98例PSD患者,随机分为观察组和对照组。对照组在基础治疗上给与米氮平治疗。观察组在基础治疗上给与小剂量奥氮平联合米氮平治疗。6周后,观察并比较两组患者的HAMD、HAMA、CSS和BI评分以及血清神经递质5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)、谷氨酸(Glu)和γ-氨基丁(GABA)水平。结果治疗前,两组患者的HAMD、HAMA、CSS和BI评分以及神经递质水平差异无显著性(P>0.05)。治疗后,两组CSS评分、Glu水平以及Glu/GABA低于治疗前(P<0.01);患者血清5-HT、DA和NE以及GABA水平均高于治疗前(P<0.01),两组患者间比较差异具有显著性(P<0.01)。结论奥氮平辅助米氮平治疗PSD疗效确切,可明显降低患者抑郁和焦虑程度,缓解抑郁和焦虑症状,调节神经递质表达,提高日常生活活动能力,值得临床推广使用。

Aim To investigate the effect of olanzapine combined with mirtazapine in the treatment of post-stroke depression and its influence on the level of neurotransmitters in serum.Methods 98 patients with PSD were randomly divided into observation group and control group.Both groups were given basic treatment,while the control group was given mirtazapine on the basis of basic treatment.The observation group was given low dose olanzapine combined with mirtazapine on the basis of basic treatment.After 6 weeks,the clinical efficacy and serum levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),dopamine(DA),glutamic acid(Glu)and gamma aminobutyric acid(GABA)were observed and compared between the two groups.Results Before treatment,there was no significant difference in HAMD,HAMA,CSS,BI scores and neurotransmitter level between the two groups(P>0.05).After treatment,CSS score,Glu levels and Glu/GABA were lower than before treatment(P<0.01),and serum levels of 5-HT,Da,NE and GABA were higher than before treatment(P<0.01),and there was significant difference between the two groups(P<0.01).Conclusion Olanzapine combined with mirtazapine has definite curative effect in the treatment of PSD.It can significantly reduce the degree of depression and anxiety,relieve the symptoms of depression and anxiety,regulate the expression of neurotransmitters,and improve the activity of daily living.It is worthy of clinical use.