糖尿病肾病患者伴发抑郁症状综合治疗的临床观察

将伴发抑郁症状的204例糖尿病肾病患者分为5组,分别予以谷维素（对照组）、圣·约翰草提取物片（900mg／d口服、分3次,药物组）、圣·约翰草提取物片＋心理治疗（药物＋心理组）、圣·约翰草提取物片＋物理疗法（药物＋物理组）及圣·约翰草提取物片＋心理＋物理（综合治疗组）治疗,以汉密尔顿抑郁量表（HAMD）减分率评定疗效。治疗12周后,5组患者HAND减分率分别为13％、47％、55％、60％和86％,综合治疗组疗效最优（χ2=47．331,P=0．000）,且糖化血红蛋白、尿微量白蛋白排泄率（UAER）降低最明显（F值分别为15．754和74．025,均P=0．000）。提示综合治疗能显著改善抑郁症状,控制血糖,改善UAER。

Comparison of different regimens in treatment of depressive disorder in diabetic patients with nephropathy

Two hundred and four patients with diabetic nephropathy and depressive disorder were randomly assigned to the control group (40 cases), St.John's Wort extract (SWE) group(40 cases) ,SWE +psychotherapy group ( 40 cases), SWE + physicotherapy group ( 40 cases ) and SWE + psychotherapy +physicotherapy group (44 cases), all patients were treated for 12 weeks.The therapeutic effects were evaluated with Hamilton Rating Scale for Depression-17 (HAMD-17).The percentage reduction in HAMD scores in SWE + psychotherapy + physicotherapy group was the highest ( 86% ), and those for SWE, SWE +psychotherapy, SWE + physicotherapy and control groups were 47%, 55%, 60% and 13%, respectively (x2 =47.331, P =0.000).After 12 weeks of treatment, glycosylated hemoglobin(HbA1c) and urinary albumin excretion rate (UAER) were reduced in all 4 treatment groups compared with the control group.The levels of HbA1 c and UAER in SWE + psychotherapy + physicotherapy group were significantly lower than those in others ( F = 15.754,74.025, all P = 0.000).St.John' s Wort extract with psychotherapy and physicotherapy can efficiently improve the depressive disorder in type 2 diabetic patients with nephropathy, as well as control blood glucose and reduce UAER of patients.