阿戈美拉汀联合舍曲林治疗抑郁症伴失眠的疗效及对睡眠质量评分、多导睡眠监测参数和血清神经递质的影响

Efficacy of Agomelatine Combined with Sertraline in the Treatment of Depression with Insomnia and its Effects on Sleep Quality Score,Polysomnography Monitoring Parameters and Serum Neurotransmitters

目的:观察阿戈美拉汀联合舍曲林治疗抑郁症伴失眠的疗效及对睡眠质量评分、多导睡眠(PSG)监测参数和血清神经递质的影响。方法:选取2020年4月~2021年12月期间来贵州省第二人民医院就诊的80例抑郁症伴失眠患者作为观察对象,采用随机数字表法分为实验组和对照组各40例,对照组患者接受舍曲林治疗,实验组患者接受阿戈美拉汀联合舍曲林治疗,对比两组疗效、匹兹堡睡眠质量指数(PQSI)评分、PSG相关指标参数、汉密尔顿抑郁量表(HAMD)评分、血清神经递质水平变化,记录两组治疗期间不良反应发生情况。结果:实验组的临床总有效率为90.00%(36/40),高于对照组的67.50%(27/40),差异有统计学意义(P<0.05)。两组治疗8周后PSQI、HAMD评分均下降,且实验组的变化程度大于对照组(P<0.05)。两组治疗8周后睡眠总时间(TST)、睡眠效率(SE)、非快速眼动睡眠阶段3+4的百分比(SWS)、快速眼动睡眠阶段睡眠时间(RT)增加,非快速眼动睡眠阶段1的百分比(S1)、非快速眼动睡眠阶段2的百分比(S2)减少,且实验组的变化程度大于对照组(P<0.05)。两组治疗8周后去甲肾上腺素(NE)、5-羟色胺(5-HT)水平均升高,且实验组的升高程度大于对照组(P<0.05)。两组不良反应发生率组间对比未见差异(P>0.05)。结论:阿戈美拉汀联合舍曲林治疗抑郁症伴失眠,可有效改善抑郁和失眠症状,同时还可调节血清神经递质水平,是一个较为安全可靠的治疗方案。

Objective: To observe the efficacy of agomelatine combined with sertraline in the treatment of depression with insomnia and its effects on sleep quality score, polysomnography(PSG) monitoring parameters and serum neurotransmitters. Methods: 80patients with depression with insomnia who came to our hospital from April 2020 to December 2021 were selected as the observation objects. They were randomly divided into experimental group and control group with 40 patients in each group. The patients in the control group were treated with sertraline, and the patients in the experimental group were treated with agomelatine combined with sertraline. The efficacy, Pittsburgh sleep quality index(PQSI), PSG related index parameters, Hamilton Depression Scale(HAMD) score,serum neurotransmitter levels changes of the two groups were compared. Adverse reactions of the two groups during treatment were recorded. Results: The total clinical effective rate of the experimental group was 90.00%(36/40), which was higher than 67.50%(27/40)of the control group,and the difference was statistically significant(P<0.05). PSQI and HAMD scores of the two groups decreased at 8weeks after treatment, and the change degree of the experimental group was greater than that of the control group(P<0.05). 8 weeks after treatment, the total sleep time(TST), sleep efficiency(SE), the percentage of 3+4 in non REM sleep phase(SWS), and the sleep time in REM sleep phase(RT) increased, while the percentage of non REM sleep phase 1(S1) and the percentage of non rem sleep phase 2(S2)decreased in the two groups, and the degree of change in the experimental group was greater than that in the control group(P<0.05). 8weeks after treatment, the norepinephrine(NE) and 5-hydroxytryptamine(5-HT) levels in two groups increased, and the degree of increase in the experimental group was greater than that in the control group(P<0.05). There was no difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Agomelatine combined with sertraline in the treatment of depression with insomnia can effectively improve the symptoms of depression and insomnia, and regulate the levels of serum neurotransmitters. It is a relatively safe and reliable treatment plan.