度洛西汀与舍曲林治疗老年抑郁症的研究及生活事件对疗效的影响

发布时间：2018-03-10 20:30

本文选题：老年抑郁症　切入点：度洛西汀　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的比较老年抑郁症患者服用度洛西汀与舍曲林后的治疗效果和不良反应并观察病前生活负性事件与疗效的关系。方法研究对象为97例符合ICD-10抑郁症诊断,年龄≥60岁的老年抑郁症患者。按照随机数字表法分为度洛西汀组(49例)和舍曲林组(48例),分别给予度洛西汀(60mg/d)和舍曲林(50-100mg/d)进行治疗,为期6周。在治疗前、治疗后第1周末、第2周末、第4周末、第6周末分别采用汉密顿抑郁量表(Hamilton Depression Scale,HAMD-24)和汉密顿焦虑量表(Hamilton Anxiety Scale,HAMA)对患者进行评定,治疗中发生的不良反应用治疗副反应量表(Treatment Emergent Symptom Scale,TESS)对患者进行评定。患者病前生活负性事件采用生活事件量表(Life Event Scale,LES)进行测定。结果治疗前对度洛西汀组和舍曲林组的汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)评分经比较差异无统计学意义(P0.05),两组治疗后第1周末、第2周末、第4周末、第6周末汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)评分均低于治疗前,且度洛西汀组评分均低于舍曲林组,经比较差异有显著统计学意义(P0.05)。度洛西汀组治愈19例,显效14例,有效10例,无效6例,总有效率为87.76%;舍曲林组治愈10例,显效15例,有效12例,无效11例,总有效率为77.08%,度洛西汀组的总有效率高于舍曲林组,经比较差异有显著统计学意义(P0.05)。两组治疗初期均有不良反应的发生,但症状轻微,没有给予特殊处理,均随着治疗的进程而自行缓解。度洛西汀组不良反应发生率为16.33%(3例轻微胃部不适、3例恶心、2例呕吐),舍曲林组不良反应发生率为14.58%(3例轻微胃部不适、1例恶心、3例头晕),度洛西汀组不良反应发生率高于舍曲林组,但两组差异经比较无统计学意义(P0.05)。利用生活事件量表(LES)对两组患者病前一年所经历的生活负性事件进行分析,经统计和比较可得,度洛西汀组病前负性生活事件得分与舍曲林组病前负性生活事件得分经比较差异无统计学意义(P0.05),治疗后对两组老年抑郁症患者病前负性生活事件分数与汉密顿抑郁量表(HAMD)治疗前后减分率进行相关分析发现,负性生活事件与患者的治疗效果呈显著负相关,负性生活事件分数越高,患者的汉密顿抑郁量表(HAMD)的减分率越低。结论老年抑郁症患者病前负性生活事件与患者的治疗效果呈显著负相关,及患者病前所遭受的负性生活事件对其造成的影响越大,其后的治疗效果越差。老年抑郁症采用度洛西汀治疗,其临床效果优于舍曲林,且不良反应轻微,是一种安全有效的治疗方法。
[Abstract]:Objective to compare the efficacy and adverse reactions of doxicetine and sertraline in elderly patients with depression and to observe the relationship between pre-morbid negative events and efficacy. Methods 97 patients with ICD-10 depression were included in the study. Elderly patients with depression aged more than 60 years were divided into two groups according to random number table: doxoxetine group (49 cases) and sertraline group (48 cases) were treated with doloxetine 60 mg / d and sertraline 50-100 mg / d respectively for 6 weeks. The patients were assessed with Hamilton Depression scale (Hamd 24) and Hamilton Anxiety scale (Hama) at weekend 2, weekend 4 and weekend 6, respectively. Adverse reactions occurred during treatment were assessed with treatment Emergent Symptom scale (TESS). Negative life events before treatment were measured by Life Event ScaleLes. Results Doxetine group and sertrexil group were evaluated before treatment. There was no significant difference in the scores of Hamilton Depression scale (Hamd) and Hamilton anxiety scale (Hamma) between the two groups (P 0.05). At the end of the first week of treatment, there was no significant difference between the two groups. At weekend 2, weekend 4 and weekend 6, the scores of Hamilton Depression scale (Hamd) and Hamilton anxiety scale (Hamma) were lower than those before treatment, and the scores of Doxetine group were lower than those of sertraline group. There were significant differences between the two groups: 19 cases were cured, 14 cases were effective, 10 cases were effective, 6 cases were ineffective, the total effective rate was 87.766.In the sertraline group, 10 cases were cured, 15 cases were markedly effective, 12 cases were effective, 11 cases were ineffective. The total effective rate was 77.08, and the total effective rate of duloxetine group was higher than that of sertraline group, and the difference was statistically significant (P 0.05). There were adverse reactions in both groups at the early stage of treatment, but the symptoms were mild and no special treatment was given. The incidence of adverse reactions in the doxoxetine group was 16.33. 3 cases of mild stomach discomfort 3 cases of nausea and 2 cases of vomiting. The incidence of adverse reactions of sertraline group was 14.58 cases of mild stomach discomfort in 1 case and nausea in 3 cases. The incidence of adverse reactions in the group of dizziness and doxetine was higher than that in the group of sertraline. However, the difference between the two groups was not statistically significant (P 0.05). Life events scale (LES) was used to analyze the negative life events experienced by the two groups one year before the disease. There was no significant difference between the scores of negative life events before illness and sertraline group (P 0.05). After treatment, the scores of negative life events before illness and Hamilton depression in two groups of elderly depression patients were inhibited. The score reduction rate before and after treatment with HAMD-depression scale was found by correlation analysis. The negative life events were negatively correlated with the therapeutic effect of the patients. The higher the score of negative life events, the higher the scores of negative life events. Conclusion there is a significant negative correlation between the negative life events and the therapeutic effect of the elderly depression patients, and the more negative life events the patients suffer before their illness, the greater the impact of the negative life events on the patients. The worse the treatment was, the better the clinical effect was compared with sertraline, and the less adverse reaction was, it was a safe and effective treatment for senile depression.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.4

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