【摘要】 目的比较文拉法辛缓释剂与盐酸氟西汀对首发抑郁症患者认知功能的影响。方法80例首发抑郁患者接受12周文拉法辛缓释剂(A组,n=40)或盐酸氟西汀(B组,n=40)治疗。治疗前和治疗12周末采用17项汉密顿抑郁量表(HAMD17)和汉密顿焦虑量表(HAMA)评定疾病严重程度,韦氏记忆量表(WMSRC)、韦氏成人智力量表(WAISRC)、威斯康星卡片分类测验(WCST)评定患者神经心理学测验成绩,采用NicoletSpiritCA-1000型脑诱发电位仪对2个治疗组和正常对照组进行认知电位P300测试。结果①经配对t检验,治疗后A组和B组的记忆商数、长时记忆、短时记忆、瞬间记忆、语言智商、作业智商、智商均比治疗前明显改善(P<0.05或P<0.01),A组的WCST总数和持续错误数明显减少(P<0.05);A组P300波幅明显提高(P<0.05),B组P300潜伏期明显缩短(P<0.05)。②经OnewayANOVA检验,治疗前与对照组(n=36)比较,2组患者P300潜伏期均显著性延迟,P300波幅显著降低(P<0.05)。治疗后A组P300潜伏期和波幅与对照组无统计学差异(P>0.05),B组P300波幅仍显著低于对照组(P<0.05)。③经方差分析,治疗后A组重度患者(n=22)的HAMD17总分、睡眠分、HAMA总分、精神焦虑分均显著低于B组(n=29)(P<0.05或P<0.01);短时记忆分和操作智商均显著高于B组(P<0.05),WCST总数低于B组(P<0.05);治疗后A组重度患者(n=17)P300波幅显著高于B组重度患者(n=23)(P<0.05)。④经多元逐步回归分析,重度患者的记忆商数变化和短时记忆分变化均与睡眠分变化呈负相关(P<0.05或P<0.01),操作智商变化和智商变化均与药物治疗组呈负相关(P<0.05),P300波幅的变化与HAMA精神焦虑分改变呈负相关(P<0.01)。中度患者的语言智商变化与HAMA躯体焦虑分变化呈负相关(P<0.01),WCST分类数变化与HAMD17睡眠分变化呈正相关(P<0.05),P300潜伏期变化与HAMD17睡眠分变化呈正相关(P<0.05)。结论文拉法辛缓释剂和盐酸氟西汀治疗首发抑郁症均能改善患者的认知功能,文拉法辛缓释剂缓解重度抑郁症患者的临床症状、改善神经心理学成绩和提高P300波幅的作用比氟西汀明显。更多还原

【Abstract】 Objective To compare the cognition function of the first episode major depressed patients after Venlafaxine extended release and Fluoxertine hydrochloride treatment. Methods 80 patients were parallel assigned to two groups receiving Venlafaxine extended release(n=40) and Fluoxetine hydrochloride(n=40) antidepressant 12 weeks respectively. Using Hamilton Depression Scale(17 item) and Hamilton Anxiety Scale to evaluate severity, and using WMS-RC, WAIS-RC and WCST neuropsychological tests and performing P300 test twice before and after treatment to evaluate cognition function of the two groups patients. Results (1) The patients had improvement in HAMD 17 scale score, HAMA scale score, neuropsychological tests scores and P300 performance after treatment(P<0.05 or P<0.01).(2) Compared with control group, two groups patients had obviously longer P300 latency and lower P300 amplitude(P<0.05)before treatment, Fluoxetine hydrochloride group had lower P300 amplitude after treatment(P<0.05).(3)After treatment, severe patients in Venlafaxine group had better performance in HAMD 17 scale and HAMA scale assessment, neuropsychological test scores and P300 amplitude than did severe patients in Fluoxertine hydrochloride group (4) In severe degree patients, improvement of memory quotient (MQ) and short-term memory(STM)were both negatively correlative with sleep disturbance alleviation(P<0.05 or P<0.01),improvement of practical intelligence quotient (PIQ) and intelligence quotient(IQ) were both negatively correlative with different antidepressant (P<0.05), P300 amplitude increment was negatively correlative with HAMA scale psychical anxiety item score decrease(P<0.01).In moderate degree patients ,verbal intelligence quotient(VIQ) improvement was negatively correlated with HAMA somatic anxiety item score decrease(P<0.01),WCST category number increase was positively related to HAMD 17sleep disturbance score decrease (P<0.05), P300 latency decrease was positively related with HAMD 17sleep disturbance score decrease(P<0.05). Conclusions Venlafaxine extended release and Fluoxertine hydrochloride can improve cognition function of first episode depressive patient,Venlafaxine extended release has superiority to alleviate severe depressive patient symptoms, improve performance in neuropsychological tests and P300 than Fluoxertine hydrochloride does.更多还原