抗抑郁药对伴发抑郁障碍2型糖尿病患者的疗效

Effect of antidepressant on patients with type 2 diabetes mellitus complicated depressive disorder

目的 探讨抗抑郁药对 2型糖尿病伴发抑郁障碍患者的疗效。 方法 汉密顿抑郁量表 (HAMD)总分≥ 14的 2型糖尿病患者 6 2例 ,分为氟西汀组 (2 0例 ,2 0mg/d)、阿米替林组 (19例 ,5 0～ 15 0mg/d)和对照组 (2 3例 ) ,治疗 6周及 12周后检测HAMD、副反应量表 (TESS)、空腹和餐后 2h血糖 (FPG ,2hPG)、糖化血红蛋白 (GHbAIC)等生化及体查指标。 结果 氟西汀组及阿米替林组治疗 6周及 12周后HAMD总分均显著下降 (P <0 .0 0 1) ,但两组间无显著性差异 (P <0 .0 5 ) ;而与对照组比较 ,差异有显著性 (P <0 .0 5 ) ;前两组FPG、2hPG在 6周和 12周后均显著低于治疗前和对照组 (P <0 .0 5～ 0 .0 0 1) ;GHbAIC6周后均未见显著下降 ,12周后前两组显著下降 ,组间比较仅氟西汀组显著低于对照组。TESS显示氟西汀组不良反应 9例 (4 5 .0 % ) ,阿米替林组 16例 (84 .2 % ) ,有显著性差异 (P <0 .0 1)。 结论 氟西汀及阿米替林对 2型糖尿病合并抑郁障碍患者的抑郁症状及血糖水平均有明显的改善作用 ,但氟西汀的血糖控制作用以及耐受性、治疗依从性等方面优于阿米替林。

Objective To study the effect of antidepressant on patients with type 2 diabetes mellitus complicated depressive disorder. Methods Sixty two patients with type 2 diabetes mellitus complicated depressive disorder were studied.Among them,2O patients were treated with fluxetine (20mg/d),19 patients were treated with amitriptyline (50～150mg/d),23 patients were taken as vacuity control group.After 6 and 12 weeks of treatment, HAMD, FPG,2h PG,GHbA IC were detected. Results The HAMD score, FPG and 2hPG of fluxetine group and amitriptyline group were decreased significantly after treating 6 and 12 weeks (P<0.05～ 0.001 ), and significantly lower than the vacuity control group (P<0.05). GHbA IC of fluxetine group was significantly lower than the vacuity control group after treating 12 weeks (P<0.05). the untoward effect of fluxetine group was less than amitriptyline group(P<0.01). Conclusion Fluxetine and amitriptyline could improve glucose control and depressive disorder in patients with type 2 diabetes mellitus complicated depressive disorder. The tolerance, compliance and glucose control of fluxetine are better than amitriptyline.