摘要
目的对疑为“心绞痛”经冠状动脉造影阴性同时伴抑郁障碍患者进行抗抑郁治疗后,观察抑郁障碍与胸痛症状改善的相关性及不同抗抑郁的治疗方案疗效、起效快慢和安全性。方法对123例疑为“心绞痛”住院并经冠状动脉造影均排除冠心病,但同时符合轻、中度抑郁焦虑障碍的患者随机设盲分为三组:氟西汀组41例;安慰剂组40例;氟西汀+奥氮平组42例。三组疗程均为4周,治疗前、治疗1、2、4周分别用Hamilton抑郁量表HAMD、Hamilton焦虑量表HAMA和胸痛自评表观察不同治疗组起效时间、疗效的差异及抑郁焦虑障碍与胸痛症状改善情况的相关性。结果氟西汀+奥氮平组抗抑郁焦虑及改善胸痛症状最好,氟西汀组次之,安慰剂组最差。其中氟西汀+奥氮平组起效最快1周见效,HAMD、HAMA减分率均为54.1%±17.0%,胸痛自评量表减分率为63.1%±22.4%;治疗4周后氟西汀+奥氮平组HAMD、HAMA减分率分别为78.1%±13.2%、78.3%±13.5%,与安慰剂组(HAMD20.9%±8.8%,HAMA22.9%±11.4%)和氟西汀组(HAMD66.3%±13.7%,HAMA66.5%±13.5%)比较差异有统计学意义(P<0.05);氟西汀组2～4周见效。治疗4周后胸痛自评减分率与HAMD、HAMA减分率呈正相关(r分别为0.867、0.854,均P<0.001)。治疗过程中三组均无严重药物不良反应。结论对冠状动脉造影排除冠心病的胸痛伴有抑郁、焦虑障碍的患者,抗抑郁焦虑治疗后在改善抑郁焦虑症状的同时也明显缓解胸痛症状,并且安全性好,其中短程小剂量奥氮平联合氟西汀较单用氟西汀作用能更快速有效。这些患者抑郁焦虑症状的改善和胸痛症状的改善存在明显的相关性。
Objective We observed the therapeutic effectiveness and safety of different antidepressants as well as the correlation between symptomatic improvement of depression and improvement of chest pain in patients with susceptive ＂ angina peetofis＂ and negative coronary angiogram complicating comorbid depression. Methods In this double-blinded randomized study, a total of 123 eligible patients were allocated into three groups： （1） Group F： fluoxetine 20 mg QN （n =41） ; （2） Group P： Placebo 1 tablet QN （n =40） ; （3） Group F ＋ O： fluoxetine 20 mg ＋ olanzepine 2. 5 mg QN for the former 2 weeks and only fluoxetine 20 mg QN for the latter 2 weeks （ n = 42）. The total therapy duration was 4 weeks. HAMD, HAMA and self-evaluation table of chest pain were obtained before therapy, at the end of 1 and 2 weeks after therapy. Results Baseline HAMD and HAMA scores and self-evaluation score of chest pain were similar among 3 groups and all scores were significantly improved post various therapies in the order of group F ＋ O 〉 group F 〉 group P. The rate of score decrease were seen after 1 week treatment in group F ＋ O and after 2 week treatment in group F. There was a significant positive correlation between the rates of self- evaluation chest pain score decrease and HAMD （ r = 0. 867, P 〈 0. 001 ） and HAMA （ r = 0. 854, P 〈 0. 001 ） score decreases after 4 weeks therapies （ P 〈 0. 05 ）. During the whole course of treatment, no serious adverse reaction was found in all patients. Conclusion In patients with suspected ＂angina pectoris＂ and negative coronary angiogram complicating comorbid depression, the antidepressants were safe and significantly improved the symptoms of depression and anxiety and chest pain. Low dose fluoxetine plus short term olanzapine regimen was superior to fluoxetine alone regimen in terms of stronger and quicker symptom improvement.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2006年第12期1097-1100,共4页
Chinese Journal of Cardiology
