无抽搐电休克疗法联合艾司西酞普兰治疗重度抑郁症的疗效及对血清BDNF、IFN-γ、IL-4水平的影响

Efficacy of modified electroconvulsive therapy combined with escitalopram in the treatment of major depressive disorder and its influence on serum levels of BDNF, IFN-γ, and IL-4

目的:探讨无抽搐电休克疗法(modified electroconvulsive therapy,MECT)联合艾司西酞普兰治疗重度抑郁症(major depressive disorder,MDD)的疗效及对血清脑源性神经营养因子(brain-derived neuro-trophicfactor,BDNF)、干扰素γ(interferon-gamma,IFN-γ)、白细胞介素-4(interleukin-4,IL-4)水平的影响。方法:选取MDD患者80例,随机分为对照组(n=40)与观察组(n=40);对照组予以艾司西酞普兰口服治疗,观察组予以MECT联合艾司西酞普兰治疗,两组均连续治疗4周。于治疗前和治疗后行17项汉密尔顿抑郁量表(Hamilton Depression Scale-17,HAMD-17)评分、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分,并行血清5-羟色胺(5-hydroxytryptamine,5-HT)、BDNF、IFN-γ、IL-4的测定,比较两组疗效和安全性。结果:与对照组相比,观察组总有效率(94.74%)提高,差异有统计学意义(P<0.05)。治疗后,观察组HAMD-17和PSQI评分均显著低于对照组(均P<0.05);观察组血清5-HT、BDNF、IL-4水平均显著高于对照组(均P<0.05),IFN-γ水平及IFN-γ/IL-4(Th1/Th2)比值均显著低于对照组(均P<0.05)。两组不良反应发生率的差异无统计学意义(P<0.05)。结论:MECT联合艾司西酞普兰治疗MDD可提高疗效,具有提高BDNF表达和调节免疫的作用。

Objective: To investigate the efficacy of modified electroconvulsive therapy(MECT) combined with escitalopram in the treatment of major depressive disorder(MDD) and its influence on serum levels of brain-derived neurotrophic factor(BDNF), interferon-γ(IFN-γ), and interleukin-4(IL-4). Methods: A total of 80 patients with MDD were randomly divided into a control group(n=40) and an observation group(n=40). The control group was treated with escitalopram orally, and the observation group was treated with MECT combined with escitalopram. Both groups were treated for 4 weeks. Before and after the treatment, Hamilton Depression Scale-17(HAMD-17) scores, Pittsburgh Sleep Quality Index(PSQI) scores, and serum 5-hydroxytryptamine(5-HT), BDNF, IFN-γ, and IL-4 were measured. The efficacy and safety of the 2 groups were compared. Results: Compared with the control group, the total effective rate of the observation group(94.74%) was increased, and the difference was statistically significant(P<0.05). After the treatment, HAMD-17 and PSQI scores in the observation group were significantly lower than those in the control group(both P<0.05);the levels of serum 5-HT, BDNF, and IL-4 in the observation group were significantly higher than those in the control group(all P<0.05), and the levels of IFN-γ and the ratio of IFN-γ/IL-4(Th1/Th2) were significantly lower than those in the control group(both P<0.05). There was no significant difference in adverse reactions between the 2 groups(P<0.05). Conclusion: MECT combined with escitalopram in the treatment of MDD can improve the efficacy, and increase BDNF expression and regulate immunity.