小剂量氟伏沙明联合米氮平对老年脑卒中合并抑郁患者认知功能的影响

Effect of low-dose fluvoxamine combined with mirtazapine on cognitive function of elderly stroke patients with depression

目的探讨小剂量氟伏沙明联合米氮平对老年脑卒中合并抑郁患者认知功能的影响。方法选取长安医院神经内科2018年1月至2021年1月收治的96例老年脑卒中合并抑郁患者为研究对象,按随机数表法分为联合组与对照组各48例。对照组患者采用米氮平治疗,联合组患者在对照组治疗基础上加用小剂量马来酸氟伏沙明治疗,两组均持续治疗4周。比较两组治疗前后的汉密尔顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NIHSS)、蒙特利尔认知量表(MoCA)评分和血清S100B蛋白(S100B)、血清脑源性神经营养因子(BDNF)水平,同时比较两组患者的不良反应发生情况。结果治疗后,两组患者的HAMD、NIHSS评分均明显降低,其中联合组患者的HAMD、NIHSS评分分别为(5.21±1.29)分、(8.67±2.97)分,明显低于对照组的(9.21±2.21)分、(12.25±3.51)分,差异均有统计学意义(P<0.05);治疗后,两组患者的命令、语言、注意力、记忆、视空间、抽象、定向评分均明显上升,其中联合组患者的注意力、记忆、视空间、抽象评分分别为(2.67±0.16)分、(4.47±0.51)分、(2.67±0.56)分、(5.36±0.39)分,明显高于对照组的(2.56±0.21)分、(3.56±0.52)分、(2.05±0.57)分、(4.99±0.42)分,差异均有统计学意义(P<0.05);治疗后,两组患者的血清S100B水平均降低,其中联合组患者的血清S100B水平为(0.05±0.01)μg/L,明显低于对照组的(0.07±0.02)μg/L,差异均有统计学意义(P<0.05);治疗后,两组患者的血清BDNF水平均上升,其中观察组患者的血清BDNF水平为(12.98±1.29)μg/L,明显高于对照组的(10.21±2.01)μg/L,差异均有统计学意义(P<0.05);联合组患者的不良反应发生率为16.67%,略高于对照组的12.50%,但差异无统计学意义(P>0.05)。结论小剂量氟伏沙明联合米氮平治疗老年脑卒中合并抑郁可显著改善患者认知功能,临床应用效果较好,且安全性较高。

Objective To investigate the effect of low-dose fluvoxamine combined with mirtazapine on cognitive function in elderly stroke patients with depression.Methods A total of 96 elderly patients with stroke and depression who were admitted to the Department of Neurology,Chang'an Hospital from January 2018 to January 2021 were selected as the research objects.The patients were divided into a combination group and a control group by random number table method,with 48 cases in each group.The patients in the control group were treated with mirtazapine,and the patients in the combination group were additionally treated with low-dose fluvoxamine maleate on the basis of the treatment in the control group.Both groups were treated for 4 weeks.The Hamilton Depression Scale(HAMD),National Institutes of Health Stroke Scale(NIHSS),Montreal Cognitive Scale(MoCA)score,serum S100B protein(S100B),serum brain-derived neurotrophic factor were compared between the two groups before and after treatment(BDNF)levels.The occurrence of adverse reactions between the two groups were compared.Results After treatment,HAMD and NIHSS scores in the two groups were significantly decreased,and the HAMD and NIHSS scores in the combination group were(5.21±1.29)points,(8.67±2.97)points,which were significantly lower than(9.21±2.21)points,(12.25±3.51)points in the control group(P<0.05).After treatment,the scores of command,language,attention,memory,visuospatial,abstraction,and orientation of patients in the two groups increased significantly,and the scores of attention,memory,visuospatial,and abstraction in the combination group were(2.67±0.16)points,(4.47±0.51)points,(2.67±0.56)points,(5.36±0.39)points,respectively,significantly higher than(2.56±0.21)points,(3.56±0.52)points,(2.05±0.57)points,(4.99±0.42)points in the control group(P<0.05).After treatment,the serum S100B level in both groups decreased,and the serum S100B level in the combination group was(0.05±0.01)μg/L,which was significantly lower than(0.07±0.02)μg/L in the control group(P<0.05).After treatment,the serum BDNF level in both groups increased,and the serum BDNF level in the combination group was(12.98±1.29)μg/L,which was significantly higher than(10.21±2.01)μg/L in the control group(P<0.05).The incidence of adverse reactions in combination group was 16.67%,slightly higher than 12.50%in control group,but the difference was not statistically significant(P>0.05).Conclusion The dose of fluvoxamine combined with mirtazapine in the treatment of elderly patients with stroke complicated with depression can significantly improve the cognitive function of patients,with good clinical application effect and high safety.