米氮平治疗伴发抑郁的皮质下动脉硬化性脑病疗效分析

目的观察抗抑郁治疗对皮质下动脉硬化性脑病伴发抑郁患者的抑郁症状、神经功能缺损及日常生活能力的改善情况。方法 110例患者随机分为米氮平组(n=38),阿米替林组(n=36),对照组(n=36),各组均行常规神经营养药物和促智药物治疗。米氮平组同时口服米氮平30mg/次,1次/晚;阿米替林组同时口服阿米替林25mg/次,分早晚2次口服,最大剂量为100mg/d,总疗程均为12～24周,治疗期间不合并其他抗抑郁或精神障碍药,治疗前、治疗后1、2、4、8、12周及6个月,分别采用汉密顿抑郁量表评定患者的抑郁症状。于治疗前及治疗后12周、6个月进行神经功能缺损和日常生活能力评定。并于6个月对各组患者并发症及预后进行评定。结果①米氮平组在治疗第1、2、4、8、12周和6个月时,汉密顿抑郁量表得分均明显低于治疗前及对照组(P<0.05),阿米替林组在治疗后第2、4、8、12周及6个月时,汉密顿抑郁量表得分低于治疗前及对照组(P<0.05)。②米氮平组及阿米替林组在治疗后12周、6个月时,神经功能缺损评分均明显低于治疗前及对照组(P<0.05),日常生活能力得分明显高于治疗前及对照组(P<0.05)。③治疗期间米氮平导致口干、便秘、视力模糊、恶心、呕吐、心电图异常、脑卒中、心血管事件的发生率明显少于阿米替林治疗组(P<0.05)。④各组治疗后并发症及预后比较:对照组肺部感染、尿路感染、脑卒中、心血管事件的发生率高于米氮平治疗组、阿米替林治疗组(P<0.05),其死亡率也明显增高(P<0.05)。结论米氮平能有效改善皮质下动脉硬化性脑病伴抑郁的症状,副作用少,安全可靠。

Effect of mirtazapine on patients with subcortical arteriosclerotic encephalopathy (SAE) accompanied by depression

Objective To observe the ameliorating effect of mirtazapine on depressive symptoms,neurological impairment and activity of daily living in patients with subcortical arteriosclerotic encephalopathy (SAE) accompanied by depression.Methods 110 Patients were randomly divided into mirtazapine group (n=38),amitriptylint group (n=36)and control group (n=36).Patients in all groups received routine treatment by intaking drugs of neurotrophy and nootropics.Meanwhile,Patients in mirtazapine group took mirtazapine pills orally for 30mg each time,once per night;Patients in mitriptyline group took amitriptyline for 25mg each time,twice a day in the morning and at night respectively with the maximal dose of 100 mg per day,and the whole progress were 12～24 weeks without intaking other drugs against depression or mental disorder.The depressive symptoms of patients were measured with Hamilton rating scale for depression(HAMD) before treatment and 1,2,4,8,12 weeks as well as 6 months after treatment.The incidence condition of adverse reaction in mirtazapine group and amitriptyline group during curative period was recorded.At the 6th month of treatment,the complications and prognosis of patients in all groups were evaluated.Results ①At the 1st,2nd,4th,8th,12th weeks and the 6th month of treatment,HAMD score was obviously lower in mirtazapine group,compared with pretherapy and control group(P<0.05),at the 2nd,4th,8th,12th weeks and the 6th months of treatment,it was obviously lower in amitriptyline group,compared with pretherapy and control group(P<0.01).②Scores of neurological impairment in mirtazapine group and amitriptyline group at the 12 th week and 6th month of treatment were significantly lower than those before treatment and those of control group(P<0.05),and scores of daily living activity were obviously higher than those before treatment and those of control group(P<0.05).③Adverse effect(including dry mouth,constipation,blurred vision,nausea,vomit,electrocardiographic abnormality,retention of urine,and so on) in mirtazapine group were significantly lower than those in amitriptyline group(P<0.05).④Comparision of complications and prognosis among groups:incidences of pulmonary infection,urinary tract infection,stroke and cardiovascular disease in control group were higher than those in the other two groups (P<0.05),and its mortality rate also increased significantly (P<0.05).Conclusion Mirtazapine therapy can significantly ameliorate the symptoms of SAE accompanied by depression,and it is safer with fewer side effects.