抗抑郁剂治疗2型糖尿病伴发抑郁障碍对照研究

Controlled trial for treating depressive disorder in type 2 diabetes mellitus

目的 探讨抗抑郁剂的应用对 2型糖尿病伴发抑郁障碍患者的影响。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)和空白对照组 (2 3例 ) ,治疗 6周及 12周后用HAMD及副反应量表 (TESS)作评定 ,并检测空腹和餐后 2小时血糖 (FPG ,2hPG)、糖化血红蛋白 (HbAIC)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) ,且两组间无显著差异 (P >0 0 5 ) ,而与空白对照组差异显著 (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空白对照组 (P <0 0 5～ 0 0 0 1) ;HbAIC6周后均未见显著下降 ,12周后前两组显著下降 ,组间比较则仅氟西汀组显著低于空白对照组。氟西汀组TESS总分明显低于阿米替林组 ,并显示氟西汀组不良反应 9例 (45 0 % ) ,阿米替林组 16例 (84 2 % ) ,差异显著 (P <0 0 1)。结论 氟西汀及阿米替林对于 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显著的改善作用 ,且氟西汀对血糖的控制作用以及药物副作用等方面优于阿米替林。

Objective To study the action of antidepressant for depressive disorder in type 2 diabetes mellitus. Methods 62 patients with type 2 diabetes mellitus and depressive disorder entered the trial. 20 patients were treated with Fluxetine (20 mg/d), 19 patients were treated with amitriptyline (50～150 mg/d), 23 patients were taken as vacuity-control group. HAND, FPG, 2h PG, Hb AIC after 6 and 12 weeks of the treatment. Results The HAMD score, FPG, 2h PG in fluxetine group and amitriptyline group were significantly decreased after 6 and 12 weeks of treatment ( P<0.05～0.001 ), as compared to the vacuity-control group ( P<0.05 ). Hb AIC in the fluxetine group was significantly lower as compared with the vacuity-control group after 12 weeks of treatment ( P<0.05 ). The patients on fluxetine reported less side affects. Conclusions Fluxetine and amitriptyline could improve glucose control and depressive disorder in type 2 diabetes mellitus. Fluxetine is better than amitriptyline in terms of glucose control and side affect.