奥氮平联合艾司西酞普兰治疗难治性强迫症患者的临床研究

Clinical trial of olanzapine combined with escitalopram in the treatment of patients with refractory obsessive-compulsive disorder

目的观察奥氮平联合艾司西酞普兰对难治性强迫症患者强迫症状和血清脑源性神经营养因子(BDNF)、皮质醇水平的影响。方法将难治性强迫症患者,随机分为对照组和试验组。对照组给予艾司西酞普兰片,起始剂量5 mg·d^(-1),依据病情1周内逐渐加量,直至达10~20 mg·d^(-1),口服,连续治疗8周;试验组在对照组的基础上给予奥氮平片2.5 mg·d^(-1),口服,视患者的病情调整用药量,保证剂量在5.0~10.0 mg·d^(-1),连续治疗8周。用耶鲁布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估2组的临床症状与疗效,以蒙特利尔认知评估量表(MoCA)、威斯康星卡片测试(WCST)、韦氏记忆测试(WMS)评估认知水平,记录2组的血清5-羟色胺(5-HT)、脑源性神经营养因子(BDNF)、皮质醇水平、生活质量评分及药物不良反应发生情况。结果试验组和对照组各54例。试验组和对照组治疗有效率分别为88.89%和72.22%,差异有统计学意义(P<0.05)。治疗后试验和对照组Y-BOCS评分分别为(12.46±1.28)和(15.67±1.59)分,HAMA评分分别为(5.64±0.59)和(6.48±0.65)分,HAMD评分分别为(5.47±0.58)和(6.66±0.69)分,MoCA评分分别为(24.06±2.47)和(22.08±2.23)分,WCST评分分别为(112.35±12.41)和(95.06±9.67)分,WMS评分分别为(78.44±8.26)和(64.67±6.53)分,血清5-HT分别为(20.43±2.19)和(16.13±1.64)ng·mL^(-1),BDNF分别为(29.36±3.08)和(23.41±2.44)ng·mL^(-1),皮质醇分别为(0.07±0.02)和(0.10±0.03)mg·L^(-1),差异均有统计学意义(均P<0.05)。治疗后第4周试验组和对照组生活质量评分分别为(78.44±7.89)和(73.75±7.48)分,治疗后第8周分别为(84.28±8.59)和(80.45±8.12)分,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为11.11%和7.41%,差异无统计学意义(P>0.05)。结论奥氮平联合艾司西酞普兰治疗难治性强迫症可明显减轻其强迫症状,改善BDNF、皮质醇等水平,提高认知功能与生活质量,安全性好。

Objective To analyze the effects of olanzapine combined with escitalopram on obsessive-compulsive symptoms and serum brain-derived neurotrophic factor(BDNF)and cortisol levels in patients with refractory obsessive-compulsive disorder(OCD).Methods A total of patients with refractory OCD were randomly divided into control group and treatment group.Control group was treated with oral escitalopram tablets(the initial dose was 5 mg·d^(-1),and the dose was gradually increased within one week according to the condition till 10-20 mg·d^(-1));the treatment group was treated with oral olanzapine tablets(2.5 mg·d^(-1),the dose was adjusted according to the condition and maintained 5.0-10.0 mg·d^(-1))combined with escitalopram.Both groups were treated for 8 weeks.After 8 weeks of continuous treatment,the symptoms and clinical effect were evaluated with the Yale-Brown Obsessive Compulsive Scale(Y-BOCS),Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD).Cognitive level was assessed with the Montreal Cognitive Assessment(MoCA)scale,Wisconsin Card Sorting Test(WCST)and Wechsler Memory Test(WMS).Serum 5-hydroxytryptamine(5-HT),brain derived neurotrophic factor(BDNF)and cortisol levels,quality of life scores and adverse drug reactions were recorded.Results There were 54 cases each in control group and treatment group.The clinical efficacy in treatment group and control group were 88.89%and 72.22%,the difference was statistical significant(P<0.05).After treatment,the Y-BOCS scoresin treatment group and control group were 12.46±1.28 and 15.67±1.59;the HAMA scores were 5.64±0.59 and 6.48±0.65;the HAMD scores were 5.47±0.58 and 6.66±0.69;the MoCA scores were 24.06±2.47 and 22.08±2.23;the WCST scores were 112.35±12.41 and 95.06±9.67;the WMS scores were 78.44±8.26 and 64.67±6.53;serum 5-HT levels were(20.43±2.19)and(16.13±1.64)ng·mL^(-1);BDNF levels were(29.36±3.08)and(23.41±2.44)ng·mL^(-1);cortisol levels were(0.07±0.02)and(0.10±0.03)mg·L^(-1),the difference were statistical significant(all P<0.05).The quality of life scores at 4 weeks after treatment in treatment group and control group were 78.44±7.89 and 73.75±7.48;the quality of life scores at 8 weeks after treatment were 84.28±8.59 and 80.45±8.12,the differences were statistically significant(all P<0.05).The incidences of adverse drug reactions in treatment group and control group were 11.11%and 7.41%,without significant difference(P>0.05).Conclusion Olanzapine combined with escitalopram for treating refractory OCD can significantly relieve obsessive-compulsive symptoms and improve the levels of BDNF and cortisol,cognitive function and quality of life,with good safety.