黛力新治疗48例伴有抑郁或焦虑的偏头痛患者的临床分析

目的探索治疗偏头痛伴有抑郁和/或焦虑患者的有效方法以及研究加用抗抑郁/焦虑药物是否比头痛发作时单用镇痛药物疗效更佳。方法将88例伴有抑郁和/或焦虑的偏头痛患者随机分为2组,治疗组48例,用氟哌噻吨及美利曲辛合剂(黛立新) 非言(非甾体抗炎药,主要成份是双氯芬酸钠)治疗,对照组40例,用散立痛治疗,并进行随机单盲对照研究,同时用汉密尔顿抑郁量表评分(HAMD)和汉密尔顿焦虑量表评分(HAMA),对其抑郁和/或焦虑进行治疗前及治疗后(第4,8周)的评估。结果治疗组患者头痛发作次数显著减少(第4周P<0.05,第8周P<0.01),头痛程度显著减轻(第4周P<0.05,第8周P<0.01),头痛发作持续时间缩短(第4,8周均P<0.01);同时能显著减少HAMD(第4,8周均P<0.01)及HAMA(第4,8周均P<0.01)。结论伴有抑郁和/或焦虑的偏头痛患者,除对症治疗外,可以合并应用黛立新。     

氟哌噻吨美利曲辛片治疗脑卒中后抑郁疗效观察

目的观察氟哌噻吨美利曲辛片(黛力新)治疗脑卒中后抑郁(PSD)的疗效。方法入选的160例PSD患者随机分成2组,治疗组(80例)服用黛力新,每日早、中午各服1片,连服4周;对照组(80例)服用多赛平半片,3次/d,连服4周。结果治疗组治疗后Hamilton抑郁量表评分为(10.07±5.88)分,较治疗前的(24.86±6.94)分显著下降(P>0.05)。治疗组治疗后神经功能缺损评分为(9.16±6.98)分,较治疗前的(19.36±7.54)分显著下降(P<0.01);而对照组治疗前后比较差异无统计学意义(P<0.05)。结论黛力新治疗PSD疗效明显,并能促进神经功能康复,且依从性好,不良反应少,安全性好。     

氟哌噻吨美利曲辛联合多虑平治疗脑卒中后中重度抑郁

目的探讨氟哌噻吨美利曲辛联合多虑平治疗脑卒中后中重度抑郁的疗效。方法选择69例脑卒中后中重度抑郁症患者,随机分为观察组35例和对照组34例,两组在针对脑卒中给予常规治疗基础上,观察组接受氟哌噻吨美利曲辛联合多虑平抗抑郁治疗,对照组单纯服用多虑平,疗程为6周。治疗前及治疗6周对所有患者进行汉密尔顿抑郁量表（HAMD,24项标准）、神经功能缺损程度（NDS）及日常生活活动能力（BI）评分。结果观察组抗抑郁治疗有效率为91．43％,对照组有效率为70．59％,两组差异有统计学意义（P〈0．05）。观察组神经功能缺损疗效为88．57％,对照组为67．65％,两组差异有统计学意义（P〈0．05）。治疗后两组BI评分均较治疗前均增加,且两组治疗后差异有显著统计学意义（P〈0．001）。结论氟哌噻吨美利曲辛联合多虑平治疗卒中后中重度抑郁疗效优于单独应用多虑平抗治疗,同时可有效改善患者神经功能缺损,减轻残疾程度,提高生活质量。     

神经末梢受体在胃食管反流病中的作用

目的探讨辣椒素受体(TRPV1,也称瞬时感受器电位香草酸受体1)在胃食管反流疾病(GERD)患者组织中的表达及其与患者症状的关系。方法利用电子胃镜采集58例GERD患者[反流性食管炎(RE)患者26例,非糜烂性反流病(NRED)患者32例]及胃镜检查正常对象(对照组)的食管黏膜组织(胃食管连接处上方3cm),采用HE染色评估组织炎症反应程度、免疫组化染色S-P法判定组织TRPV1表达情况、反流性疾病诊断问卷(RDQ)对患者的症状评分并进行组间比较和相关性分析。结果 GERD患者的RDQ症状积分、GS炎症积分与对照组比较差异有统计学意义(P0.05);RE患者、NRED患者的RDQ症状积分分别为16.77±5.39、17.52±5.03,均显著高于对照组(P0.05),RE患者NRED患者对照组的GS炎症积分(P0.05)。GERD患者的TRPV1表达OD值显著高于对照组(P0.05),RE组OD值(0.023 1±0.002 6)显著高于NRED组和对照组(P0.05),NRED组显著高于对照组(P0.05)。GERD患者与RDQ症状积分呈显著的正相关(r=0.517),与GS炎症积分呈显著的正相关(r=0.554);RE患者与RDQ症状积分呈显著的正相关(r=0.632),与GS炎症积分呈显著的正相关(r=0.532);NRED患者与RDQ症状积分呈显著的正相关(r=0.671),与GS炎症积分呈显著的正相关(r=0.512)。结论 GERD患者的TRPV1表达显著高于正常人群,且与患者的临床症状、炎症反应的严重程度有一定的相关关系。     

氟哌噻吨美利曲辛治疗卒中后抑郁疗效分析

目的 探讨氟哌噻吨美利曲辛治疗脑卒中后抑郁（post stroke depression disorder,PSD）的疗效.方法 选取我院PSD患者72例随机分为对照组和治疗组,每组36例.对照组予以常规抗血小板聚集、调脂稳定斑块、控制血压、控制血糖等综合治疗,治疗组在以上综合治疗基础上予以口服氟哌噻吨美利曲辛治疗;于治疗前、治疗4周、治疗12周时分别对2组患者行汉密尔顿抑郁量表（HAMD）评定、NIHSS评分及BI指数测定.结果 治疗组治疗前、4周、12周时HAMD评分、NIHSS评分、BI指数较前均有明显改善,差异具有统计学意义（P＜0.05）,与对照组比较,差异具有统计学意义（P＜0.05）.结论 氟哌噻吨美利曲辛治疗PSD疗效显著,且能改善脑卒中患者预后,提高卒中患者生活质量.     

氟哌噻吨美利曲辛联合舍曲林对青年卒中后抑郁患者抑郁及对神经功能康复的影响

目的 探讨氟哌噻吨美利曲辛联合舍曲林对青年卒中后抑郁患者抑郁及神经功能康复的影响.方法 将我院住院治疗的118例青年卒中后抑郁患者按照随机数字表法分为对照组与观察组,给予对照组患者舍曲林口服,观察组患者接受氟哌噻吨美利曲辛联合舍曲林治疗.采用汉密尔顿抑郁量表（HAMD）、改良Barthel指数及FMA运动功能量表评估患者抑郁状况、日常生活能力（ADL）及肢体运动功能.结果 治疗后4周观察组治疗有效率显著高于对照组（96.7% vs 74.1%,P〈0.05）;治疗后2周及4周,观察组HAMD评分显著低于对照组（P〈0.05）;观察组改良Barthel指数及FMA评分显著高于对照组,差异具有统计学意义（P〈0.05）.结论 氟哌噻吨美利曲辛联合舍曲林治疗青年卒中后抑郁,可显著改善患者抑郁状态,促进神经功能的康复.     

氟哌噻吨美利曲辛联合马来酸曲美布汀治疗肠易激综合征并焦虑抑郁的效果

目的 分析氟哌噻吨美利曲辛联合马来酸曲美布汀治疗肠易激综合征合并焦虑、抑郁患者的临床效果。方法选取2010-05—2013-06我院收治的肠易激综合征患者52例,随机分为观察组及对照组,均采用马来酸曲美布汀片治疗,观察组加用氟哌噻吨美利曲辛片,均治疗4周,观察2组治疗效果。结果 治疗前2组患者症状评分、SDS和SAS评分差异无统计学(P>0.05),治疗后2组症状评分、SDS和SAS评分均有所改善,而观察组改善情况优于对照组,差异有统计学意义(P<0.05)。治疗后观察组总有效率92.3%,对照组69.2%,观察组总有效率高于对照组,差异有统计学意义(χ2=4.46,P<0.05)。结论 氟哌噻吨美利曲辛联合马来酸曲美布汀治疗肠易激综合征并焦虑、抑郁患者临床效果满意,可有效改善患者临床症状和焦虑、抑郁情绪。     

黛力新治疗伴有精神症状偏头痛的临床分析

目的探索偏头痛伴有抑郁和(或)焦虑症状的有效治疗方法。方法将伴有抑郁和(或)焦虑症状的偏头痛患者128例随机均分为2组,即治疗组用黛力新(氟哌噻吨美利曲辛合剂)+醋氯芬酸钠片,对照组用醋氯芬酸钠片进行随机对照研究,同时用汉密尔顿抑郁量表评分(HAMD)和汉密尔顿焦虑量表评分(HAMA);对其抑郁和(或)焦虑情况进行治疗前及治疗后(第2、4、6周)进行评估。结果治疗组能显著减少头痛发作次数(第4周P0.05,第6周P0.01),显著减轻头痛程度(第2周P0.05,第4、6周均P0.01),缩短头痛发作持续时间(第2、4、6周均P0.01),同时能显著减少HAMD(第2周P0.05,第4、6周均P0.01)及HAMA(第2、4、6周均P0.01)。结论伴有抑郁和(或)焦虑症状的偏头痛患者,除对症治疗外,合并应用黛力新疗效更佳。     

Psychological distress is not associated with treatment failure in patients with gastroesophageal reflux disease

Objective

Symptoms of anxiety and depression are common in patients with gastroesophageal reflux disease (GERD). We aim to examine the relationship between psychological distress and response to proton pump inhibitors (PPI).

Methods

In this prospective study, GERD patients receiving PPI once or twice daily were divided into 3 groups: responders to PPI once daily (group A, N = 111), non-responders to PPI once daily (group B, N = 78) and non-responders to PPI twice daily (group C, N = 56). All patients completed demographic and clinical questionnaires, Rome III Diagnostic Questionnaire for irritable bowel syndrome, Hospital Anxiety and Depression Scale (HADS), Satisfaction with Life Scale (SWLS) and the Gastroparesis Cardinal Symptom Index (GCSI) questionnaires.

Results

A total of 245 patients (59.3% females, 52 ± 17.2 years) participated in this study. No differences were observed between groups with respect to age, sex, psychiatric medications or pre-existing major depression. Anxiety (HADS—anxiety > 7) was seen in 32%, 31% and 34% of groups A, B and C, respectively (p = ns). Depression (HADS—depression > 7) was present in 30%, 31% and 21% of groups A, B and C, respectively (p = ns). Global satisfaction with life (SWLS > 20) was present in 63% of group C patients, compared to 78% of group A and 78% of group B (p = 0.04, p = 0.05, respectively). GCSI scores (mean ± SD) were 11.1 ± 9.2, 14.07 ± 8.5 and 16.3 ± 10.4, for groups A, B and C, respectively (p = 0.002). GCSI correlated significantly with HADS—anxiety (r = 0.20, p = 0.002) and SWLS (r = − 0.2, p = 0.01).

Conclusion

Lack of response to PPI was associated with lower life satisfaction but not anxiety or depression. Symptoms suggestive of gastroparesis were associated with anxiety and low satisfaction with life in patients with GERD.     

The effect of antireflux treatment on patients with gastroesophageal reflux disease undergoing a mental arithmetic stressor

Background Acute stress exacerbates heartburn in gastroesophageal reflux disease (GERD) patients by enhancing the perceptual responses to intraesophageal acid. The aim of the study was to determine if antireflux treatment can still alter stimulus response functions to acid in patients undergoing acute stress as compared with placebo. Methods Symptomatic GERD patients with erosive esophagitis (EE) or an abnormal pH test were included. Patients underwent stimulus response functions to intraesophageal acid perfusion using the mental arithmetic stressor test. Thereafter, patients were randomized (2 : 1 ratio) to either esomeprazole 40 mg once daily or placebo for 8 weeks. On the last day of treatment, subjects underwent stimulus response functions to intraesophageal acid perfusion using a similar stressor as baseline. Key Results A total of 31 patients were randomized into the treatment arm (mean age 48.6 ± 2.8, M/F 21/10) and 16 into the placebo arm (mean age 52.3 ± 4.3, M/F 12/4). In the esomeprazole group, there was a significant increase in lag time to symptom perception (P = 0.02) and decreased in intensity rating (P = 0.01) as well as acid perfusion sensitivity score (P = 0.01). There was no significant difference in any of the stimulus response functions to acid in the placebo group between baseline and treatment. Interpersonal sensitivity was the only independent clinical predictor factor for response to antireflux treatment. Conclusions & Inferences Long‐term antireflux treatment with a proton pump inhibitor is effective in reducing esophageal perception responses to acid during acute stress.     

Decreased sympathetic inhibition in gastroesophageal reflux disease

This study was undertaken to evaluate autonomic nervous system function in patients with gastroesophageal reflux disease. Based on clinical criteria, 28 consecutive patients with no history of heart, metabolic, or neurologic disease (mean age 41 y, range 20–62 y) reporting with upper gastrointestinal symptoms typical of gastroesophageal reflux underwent esophageal manometry, ambulatory 24-hour pH study with electrocardiographic monitoring, power spectral analysis of heart rate variability, and cardiovascular tests. Twelve healthy subjects served as controls. A positive result of prolonged esophageal pH study (pH in the distal esophagus less than 4, lasting more than 4.2% of recording time) was observed in 21 patients (reflux group); seven patients were categorized in the nonreflux group. No patient showed arrhythmias or any correlation between heart rate variability changes during electrocardiographic monitoring and episodes of reflux (pH less than 4, lasting more than 5 minutes). A decrease of sympathetic function occurred only in the reflux group (p<0.05) supported by the lower increase of systolic/diastolic blood pressure at sustained handgrip. No other cardiovascular tests showed statistically significant differences in the control or nonreflux groups. Total time reflux showed an inverse correlation with sympathetic function in the reflux group (r=-0.415, p<0.028). We concluded that there is some evidence for a slightly decreased sympathetic function in patients with gastroesophaged reflux disease that is inversely correlated with total time reflux. In these patients, decreased sympathetic function may cause dysfunction of intrinsic inhibitory control with increased transient spontaneous lower-esophageal sphincter relaxations, thus resulting in gastroesophageal reflux disease.     

Association of gastroesophageal reflux disease with weight gain and apnea, and their disturbance on sleep.

Obesity is a common predisposition to gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS). By statistical analysis of the respondents to a questionnaire that was distributed to members of the Kansai Rugby Association, we examined whether weight gain increased the incidence of these diseases and whether GERD alone disturbs sleep. Prevalence distribution of GERD by age differed from another survey, which suggests that predispositions other than age may contribute to GERD. Weight gain tended to increase the incidence of GERD. In our epidemiological study, both GERD (particularly nocturnal reflux) and OSAS significantly contributed to sleep disturbance. Although GERD alone seemed to be one of several independent factors of sleep disturbance, it was not a weak factor.     

Relationships between sleep disturbances and gastroesophageal reflux disease in Asian sleep clinic referrals

Objective

Studies on the association between gastroesophageal reflux disease (GERD) and sleep apnea syndrome (SAS) have reported conflicting results, and attention has not been paid to the relationship between GERD and other sleep disorders. The aim of the study was to evaluate the relationship between GERD and various aspects of sleep disturbances.

Methods

A total of 564 subjects who were referred to a sleep laboratory were enrolled in the study. They underwent nocturnal polysomnography (NPSG), and they were asked to complete a GERD questionnaire. The questionnaire consisted of 14 items, and included questions on seven reflux symptoms, namely, heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, coughing and epigastric soreness. Subjects reporting heartburn or acid regurgitation at least once a week were classified as having GERD.

Results

Among 564 participants, 51 subjects (9.0%) were diagnosed as having GERD. GERD patients had higher scores in Beck depression inventory (p < .01), Epworth sleepiness scale (p = .03), Pittsburg sleep quality index (p < .01), more spontaneous arousals in NPSG, and more alcohol consumption than non-GERD patients. There was no association between presence of GERD, SAS-related variables, and body mass index (BMI). GERD was significantly associated with poor sleep quality (adjusted OR, 3.5; 95% CI, 1.3–9.3) and depressed mood (adjusted OR, 2.8; 95% CI, 1.5–5.3).

Conclusion

Poor subjective sleep and depressive symptoms are associated with the presence of GERD with no association between SAS, BMI and GERD. In managing patients with GERD, psychiatric and sleep symptoms need to be evaluated and appropriately treated.     

The effects of intraduodenal nutrient infusion on serum CCK,LES pressure,and gastroesophageal reflux

Background Fats cause reflux symptoms in many patients and cholecystokinin (CCK) may play a role. This study was designed to evaluate the effects of intraduodenal nutrient infusion on serum CCK levels, lower esophageal sphincter (LES) pressure, and gastroesophageal reflux (GER). Methods Twenty‐four asymptomatic volunteers were studied. A Dent sleeve catheter assessed LES function while an impedance‐pH catheter measured reflux events. Participants were randomized to fat (F), carbohydrate (C) or protein (P) infusion. Serum CCK and LES pressures were measured at baseline and after nutrient infusion. Key Results Baseline LES pressures and CCK levels were similar in all three groups. A significant linear decrease was found in LES pressure during F, but not C or P, infusion (P = 0.004). A significant interaction effect was noted between the infusion groups and CCK levels (P = 0.002). A significant linear increase was noted in CCK levels during F but not during C or P infusion (P = 0.02). A significant inverse correlation was found between CCK levels and LES pressure (ρ = ?0.43; P = 0.04). Esophageal acid exposure was significantly increased in the F infusion group (median; interquartile range: 1.10%; 0.25–4.7%) compared to both the C (0.03%; 0.00–0.39%) and P infusion (0.03%; 0.00–0.39%) groups (P = 0.04). Conclusions & Inferences Intraduodenal F infusion was associated with an increase in CCK levels, while P and C were not. LES pressure decreased significantly after fat infusion and reflux events were more frequent. Fat‐induced CCK release is another mechanism that contributes to GER.