舍曲林联合盐酸氟西汀对产后抑郁患者神经递质和炎症细胞因子表达的影响

Effects of sertraline combined with fluoxetine hydrochloride on the expression of neurotransmitters and inflammatory cytokines in patients with postpartum depression

目的 分析舍曲林联合盐酸氟西汀对产后抑郁患者神经递质和炎症细胞因子表达的影响。方法 选取2018年11月—2021年11月在温州康宁医院行产后抑郁治疗的患者80例为研究对象,随机将80例患者分为对照组和联合组,每组各40例。对照组患者给予盐酸氟西汀治疗,联合组患者给予舍曲林联合盐酸氟西汀治疗,两组患者均治疗6周。采用爱丁堡产后抑郁量表(EPDS)、匹兹堡睡眠质量指数(PSQI)评定患者抑郁情况和睡眠质量,采用酶联免疫吸附试验法检测超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β)水平,采用电化学发光免疫法检测5-羟色胺(5-HT)、去甲肾上腺素(NE)及多巴胺(DA)水平,比较两组患者临床疗效和安全性。结果 治疗前,两组患者EPDS、PSQI评分比较,差异均无统计学意义(P>0.05)。治疗后,两组患者EPDS、PSQI评分均低于治疗前,差异均有统计学意义(均P<0.05);治疗后,联合组患者EPDS、PSQI评分[(2.49±0.38)分、(8.45±1.11)分]均低于对照组[(6.62±2.49)分、(14.37±2.45)分],差异均有统计学意义(t=10.371、13.922,均P<0.05)。治疗前,两组患者hs-CRP、TNF-α及IL-1β水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者hs-CRP、TNF-α及IL-1β水平低于治疗前,差异均有统计学意义(均P<0.05);治疗后,联合组患者hs-CRP、TNF-α及IL-1β水平[(3.51±0.95)mg/L、(9.05±1.90)pg/ml及(4.90±2.71)pg/ml]均低于对照组[(5.40±1.25)mg/L、(13.41±2.48)pg/ml及(9.42±3.53)pg/ml],差异均有统计学意义(t=7.613、8.826及6.424,均P<0.05)。治疗前,两组患者5-HT、NE及DA水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者5-HT、NE及DA水平均高于治疗前,差异均有统计学意义(均P<0.05);治疗后,联合组患者5-HT、NE及DA水平[(196.25±21.36)μg/L、(46.98±5.74)ng/ml及(3.88±0.68)μmol/L]均高于对照组[(148.70±16.50)μg/L、(35.17±4.91)ng/ml及(2.72±0.38)μmol/L],差异均有统计学意义(t=11.141、9.888及9.418,均P<0.05)。治疗后,联合组患者治疗总有效率(92.50%)高于对照组(70.00%),差异有统计学意义(χ^(2)=6.646,P<0.05)。治疗后,联合组患者不良反应总发生率(22.50%)高于对照组(15.00%),但差异无统计学意义(χ^(2)=0.738,P>0.05)。结论 对产后抑郁患者采用舍曲林联合盐酸氟西汀进行治疗,可有效缓解患者抑郁程度,改善睡眠质量和激素水平,升高5-HT水平,降低hs-CRP水平,减轻炎症反应,临床治疗效果显著。

Objective To analyze the effects of sertraline combined with fluoxetine hydrochloride on the expression of neurotransmitters and inflammatory cytokines in patients with postpartum depression.Methods A total of 80 patients who received postpartum depression treatment in Wenzhou Kangning Hospital from November 2018 to November 2021 were selected as the research objects,and 80 patients were randomly divided into the control group and the combined group,with 40 cases in each group.The patients in the control group were treated with fluoxetine hydrochloride,and the patients in the combination group were treated with sertraline combined with fluoxetine hydrochloride.Both groups were treated for 6 weeks.The Edinburgh Postpartum Depression Scale(EPDS) and Pittsburgh Sleep Quality Index(PSQI) were used to evaluate the depression and sleep quality of patients.The levels of hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) were detected by enzyme-linked immunosorbent assay.The levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE) and dopamine(DA) were detected by electrochemiluminescence immunoassay,and the clinical efficacy and safety of the two groups were compared.Results Before treatment,there was no significant difference in EPDS and PSQI scores between the two groups(P>0.05).After treatment,the EPDS and PSQI scores of the two groups were lower than those before treatment,and the differences were statistically significant(all P0.05).After treatment,the levels of hs-CRP,TNF-α and IL-1β in the two groups were lower than those before treatment,and the differences were statistically significant(all P0.05).After treatment,the levels of 5-HT,NE and DA in the two groups were higher than those before treatment,and the differences were statistically significant(all P0.05).Conclusion Sertraline combined with fluoxetine hydrochloride in the treatment of postpartum depression can effectively relieve the degree of depression,improve sleep quality and hormone levels,increase 5-HT level,decrease hs-CRP level,reduce inflammatory response,and clinical therapeutic effect.