西酞普兰治疗阿尔茨海默病患者精神行为症状及认知障碍的对照研究

发布时间：2018-06-09 06:01

本文选题：西酞普兰 + 阿尔茨海默病　；参考：《青岛大学》2017年硕士论文

【摘要】：目的本研究是观察西酞普兰治疗阿尔茨海默病患者的精神行为症状、认知功能的疗效和安全性,其次观察看护者在压力方面的改变。方法从2015年4月至2016年2月在青岛市精神卫生中心收集80例中度(根据临床痴呆评定量表,CDR)阿尔茨海默病并伴有精神行为症状的患者,并将其随机分为治疗组和对照组,每组各40例。治疗组给予西酞普兰10-30mg/d治疗,以10mg/d为起始剂量,根据患者对药物的反应性及耐受性逐渐加量至最高剂量30mg/d,对照组给予同剂量的安慰剂,两组均口服盐酸美金刚10mg bid,疗程12周。用简易精神状态检查(MMSE)测量认知功能损害,神经精神科问卷(NPI)测量精神行为症状及看护者压力,每位患者每月常规复查血常规、尿常规、生化、心电图、脑电图,以检测服药对机体的影响,副反应量表(TESS)评定有无不良反应,比较两组患者的疗效和安全。结果1、治疗组和对照组经治疗12周后,在激越/攻击、情感淡漠/漠不关心、抑郁/心境恶劣和焦虑四项比较有显著差异(P0.05),治疗组经治疗后减分率较高的为激越/攻击、抑郁/心境恶劣和焦虑这三项减分率分别为:40.80%、30.89%、35.27%。2、对照组激越/攻击减分率为30.34%,减分率小于治疗组(30.34%40.80%)。3、两组在看护者压力的改变及NPI总分改变也有显著差异(P0.05),其余症状改善无显著性(P0.05)。4、治疗组和对照组在MMSE测评中有显著差异(P0.05)。5、两组TESS量表未见明显差异(P0.05),对照组有两名患者口干,1名患者因力比多能增加退出研究,治疗组2名患者每天服用西酞普兰30mg/d而出现QTc间期延长,其中1名退出研究。两组因不良反应皆退出1名。结论1、西酞普兰合并盐酸美金刚可以改善精神行为症状,主要是激越/攻击、情感淡漠/漠不关心、抑郁/心境恶劣和焦虑这四个临床症状,在激越/攻击、抑郁/心境恶劣和焦虑这三个临床症状治疗效果显著,西酞普兰联合盐酸美金刚比单用盐酸美金刚在改善激越/攻击症状效果更为显著。2、与单用盐酸美金刚相比,西酞普兰联合盐酸美金刚在降低看护者压力和NPI总分的更为有效,但整体临床改善疗效可能有限。3、西酞普兰合并盐酸美金刚比单用盐酸美金刚更好的改善认知功能。4、西酞普兰耐受性好,半衰期长,无明显的抗肾上腺素能及抗胆碱能作用,对细胞色素P450作用小,不良反应小,适合老年人使用,有望成为治疗痴呆患者精神行为症状的主要药物。意义研究表明西酞普兰辅助治疗阿尔茨海默病患者精神行为症状有潜在功效。有望成为改善阿尔茨海默病精神行为症状的主要药物。
[Abstract]:Objective to observe the efficacy and safety of citalopram in the treatment of mental and behavioral symptoms, cognitive function and stress in patients with Alzheimer's disease. Methods from April 2015 to February 2016, 80 patients with moderate Alzheimer's disease associated with psychobehavioral symptoms were collected from Qingdao Mental Health Center and were randomly divided into treatment group and control group. There were 40 cases in each group. The treatment group was treated with citalopram 10-30mg/d at the initial dose of 10mg/d. According to the response and tolerance of the patients to the drug, the dosage was gradually increased to the maximum dose of 30 mg / d. The control group was given the same dose of placebo. Both groups were given orally 10mg bidbidin hydrochloride for 12 weeks. MMSE was used to measure cognitive impairment, NPI (neuropsychiatric questionnaire) was used to measure mental and behavioral symptoms and stress of caregivers. Blood routine examination, urine routine examination, biochemistry, electrocardiogram, electroencephalogram (EEG) were performed in each patient. The efficacy and safety of the two groups were compared by examining the effect of taking medicine on the body and evaluating the adverse reactions by using the side effects scale (TESS). Results 1. After 12 weeks of treatment, there were significant differences between the treatment group and the control group in terms of agitation / aggression, apathy / indifference, depression / bad mood and anxiety (P 0.05). The three subtraction rates of depression / mood disorder and anxiety were respectively: 40.80,30.89 and 35.27.2, respectively. In the control group, the reduction rate of agitation / aggression was 30.34, which was lower than that of the treatment group (30.34.80). There was also a significant difference between the two groups in the changes of stress and NPI scores in the carers (P0.05), and the other symptoms in the control group (P < 0.05). There was no significant difference between the treatment group and the control group in the MMSE test. There was no significant difference in Tess scale between the two groups (P 0.05). Two patients in the treatment group received citalopram 30mg/d daily with prolonged QTC intervals, one of whom withdrew from the study. Both groups dropped out of 1 because of adverse reactions. Conclusion 1 citalopram combined with MJ can improve the symptoms of mental behavior, such as agitation / aggression, apathy / indifference, depression / bad mood and anxiety. The clinical symptoms of depression / mood disorder and anxiety were significantly effective. Citalopram combined with methadramide hydrochloride was more effective in improving agitation / aggression symptoms than that of MJ hydrochloride alone, compared with meadronium hydrochloride alone. Citalopram combined with methadine hydrochloride was more effective in reducing stress and NPI scores in caregivers. However, the overall clinical improvement effect may be limited. Citalopram combined with methadramide hydrochloride can improve cognitive function better than meadronium hydrochloride alone. Citalopram has good tolerance, long half-life and no obvious antiadrenergic and anticholinergic effects. It has little effect on cytochrome P450, less adverse reaction, and is suitable for the elderly. It is expected to be the main drug for the treatment of mental and behavioral symptoms of dementia patients. Significant studies have shown that citalopram adjuvant treatment of Alzheimer's disease patients with mental behavior symptoms have potential efficacy. It is expected to be a major drug for improving symptoms of mental behavior in Alzheimer's disease.
【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】：R749.16

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