米那普仑治疗中度卒中后抑郁的疗效分析

Efficacy of milnacipran in treatment of moderate post-stroke depression

目的 观察米那普仑治疗首次发病伴有症状的脑梗死恢复期中度抑郁患者的疗效及安全性。方法 将符合标准的脑梗死引起的中度抑郁患者随机分为观察组和对照组。观察组口服米那普仑25 mg bid,1周后加量为50 mg bid;对照组口服文拉法辛75 mg qd, 1周后加量为150 mg qd,均治疗6个月。比较2组患者治疗前和治疗后5-羟色胺(5-HT)、脑源性神经营养因子(BDNF)水平,抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD17)、蒙哥马利抑郁评定量表(MADRS)、匹兹堡睡眠质量指数(PSQI)、Barthel指数(BI)评分和药物不良反应。结果 2组血浆5-HT、BDNF水平在治疗3、6个月后分别比治疗前和治疗3个月显著升高(P<0.01),组间比较无显著差异(P>0.05)。与治疗前比较,治疗3个月后2组SDS、HAMD17、MADRS、PSQI评分显著下降,BI评分显著增高(P<0.01);与治疗3个月比较,治疗6个月后2组PSQI评分显著下降,BI评分显著增高(P<0.05);组间评分比较均无显著差异(P>0.05)。2组患者治疗有效率和药物不良反应发生率均无显著差异(P>0.05)。结论 米那普仑治疗中度卒中后抑郁患者安全、有效,能减轻抑郁症状,提高生活质量,改善睡眠状况。

AIM To observe the efficacy and safety of milnacipran in the treatment of patients with moderate depression in convalescent stage of cerebral infarction with symptoms at the first attack.METHODS Patients with moderate depression caused by cerebral infarction who met the criteria were randomly divided into observation group and control group.The observation group took milnacipran 25 mg bid orally,and the dosage increased to 50 mg bid after one week.The control group was treated with venlafaxine 75 mg qd,and the dosage increased to 150 mg qd afer one week.Both groups were treated for 6 months.The levels of 5-hydroxytryptamine(5-HT),brain derived neurotrophic factor(BDNF),the scores of selfrating depression scale(SDS),Hamilton depression scale(HAMDr,),Montgomery depression rating scale(MADRS),Pittsburgh sleep quality index(PSQI)and Barthel index(BI),and adverse drug reactions were compared between the two groups before and after treatment.RESULTS The plasma levels of 5-HT and BDNF in the two groups were significantly higher after 3 and 6 months of treatment than before and 3 months of treatment respectivly(P<0.01),without significant difference between the two groups(P>0.05).Compared with before treatment,the scores of SDS,HAMDiz,MADRS and PSQI in the two groups decreased significantly and the scores of BI increased significantly after 3 months of treatment(P<0.01):compared with 3 months of treatment,the PSQI score of the two groups decreased and the BI score increased significantly after 6 months of treatment(P<0.05);there was no significant difference in socres between the two groups(P>0.05).There was no significant difference in the effective rate of treatment and the incidence of adverse drug reactions between the two groups(P>0.05).CONCLUSION Milnacipran is safe and effective in the treatment of patients with moderate post-stroke depression,which can alleviate depressive symptoms,enhance quality of life,and improve sleep status.