拉莫三嗪与丙戊酸钠分别联用帕罗西汀治疗难治性抑郁症的临床研究

Clinical Study on Curative Effect of Paroxetine Combined with Lamotrigine or Valproate on Refractory Depression

目的:通过拉莫三嗪与丙戊酸钠分别联用帕罗西汀两种联合用药方案,比较两者治疗难治性抑郁症的疗效和安全性,以期找到更安全高效的治疗方案,提高难治性抑郁症的治疗效果。方法:将100例难治性抑郁症患者随机分为帕罗西汀联合拉莫三嗪组(LTG+PXT)和帕罗西汀联合丙戊酸钠缓释片组(VPA+PXT),两组均持续治疗8周,于入组前和入组后第2,4,6,8周分别采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、副反应量表(TESS)和生活质量综合评定问卷(GQOLI-74)评定临床疗效。结果:治疗第8周末抗抑郁显效率LTG+PXT组为76%,VPA+PXT组为68%(P=0.373),差异无统计学意义;两组有效率分别为92%和88%(P=0.505),亦无统计学差异。两组间评分比较,HAMD评分治疗2,4,6,8周均有显著差异,其中在治疗后4周(P=0.000)和6周(P=0.002)最为显著。HAMA评分治疗2,4,6,8周均有显著差异,其中在治疗后6周(P=0.001)和8周(P=0.001)最为显著。组间比较HAMA和HAMD的减分值结果显示:两组在治疗第2周末(P=0.000)、第4周末(P=0.000)的HAMD减分值及第2周末(P=0.003)的HAMA减分值上差异具有统计学意义。治疗后LTG+PXT组GQOLI-74总分、躯体健康维度、心理健康维度、社会功能维度均显著高于VPA+PXT组(P<0.01)。结论:帕罗西汀联用拉莫三嗪治疗难治性抑郁症疗效优于帕罗西汀联用丙戊酸钠。

Objective: To compare the efficacies and safeties of lamotrigine and valproate , combined with paroxetine respectively , in the treatment of refractory depression so as to find a safer and more effective protocol and improve the curative effect on the disease . Methods: A total of 100 patients with refractory depression were randomly divided into LTG+PXT and VPA+PXT groups , and treated for 8 weeks . The clinical effects were evaluat-ed before treatment and at weeks 2 , 4 , 6 and 8 after administration by HAMD , HAMA , TESS and GQOLI-74 . Results: The significantly effective rates at the end of week 8 after treatment in LTG+PXT and VPA+PXT groups were 76% and 68%( P = 0 . 373 ) , while the effective rates were 92% and 88%( P = 0 . 505 ) , respectively , which showed no significant differences. The HAMD scores of the two groups showed significant difference at weeks 2,4,6 and 8,and showed the most significant difference at weeks 4 (P = 0.000)and 6 (P = 0.002)after treatment.The HAMA scores of the two groups showed significant difference at weeks 2 , 4 , 6 and 8 , and showed the most signifi-cant difference at weeks 6(P = 0.001)and 8(P = 0.001)after treatment.The HAMD minus scores at weeks 2(P =0 . 000 ) and 4 ( P = 0 . 000 ) as well as the HAMA minus scores at week 2 ( P = 0 . 003 ) after treatment showed signifi-cant difference in the two groups . The total score of GQOLI-74 , physical health , mental health and social function in LTG+PXT group were significantly higher than those in VPA+PXT group ( P < 0 . 01 ) . Conclusion: Lamotrigine combined with paroxetine is more effective than Paroxetine combined with sodium valproate in the treatment of re-fractory depression .