应用QIDS评估抗抑郁剂早期起效对预后预测的效果

目的探讨抗抑郁剂早期起效对预后的预测作用。方法 133例抑郁发作患者被随机分入四种抗抑郁剂治疗组(西酞普兰、艾司西酞普兰、舍曲林、帕罗西汀组),分别在基线期、治疗2周末及8周末使用16项抑郁症状快速自评量表(QIDS-SR16)对患者症状进行评估,计算2周末灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)。结果治疗2周末,各治疗组均有较高比例患者满足早期起效标准(西酞普兰组50%;艾司西酞普兰组52%;帕罗西汀组51.16%;舍曲林组53.85%),各组间差异无统计学意义(P=0.781);各药物组阳性预测值(PPV)均较高,阴性预测值(NPV)偏低(西酞普兰组0.77,0.38;艾司西酞普兰组1.00,0.25;帕罗西汀组0.91,0.24;舍曲林组0.90,0.28)。结论进一步证实SSRIs类抗抑郁药在2周内起效;早期起效对预后估计比较灵敏,但早期未起效对预后判断欠佳。

Study of early onset of action in depression to predict outcome

Objective To explore prediction of early onset of action for depressive patients. Methods 133 patients with de-pressive episode enrolled to be randomized in four antidepressants treatment groups(Citalopram,Escitalopram,Sertraline Paroxetine) The depressive sympotoms were measured by the Quick Inventory of Depressive Symptomatology(QIDS - 16)in baseline,the end of the 2nd and 8th week. The outcome measures include. Sensitivity,Specificity,Positive Predictive Value(PPV),Negative Predictive Value(NPV)at the end of two weeks of treatment. Results After two weeks of treatment,patients have high rate to meet the standard of onset of action in each group(Citalopram 50% ;Escitalopram 52% ;Paroxetine 51. 16% ;Sertraline 53. 85% ). There were no sig-nificance among different groups(P = 0. 781). The high score of PPV in each group,but lower scores of NPV were seen in different groups(Citalopram 0. 77,0. 38;Escitalopram 1. 00,0. 25;Paroxetine 0. 91,0. 24;Sertraline 0. 90,0. 28). Conclusion The find-ings supported the early onset of action of the new type of the antidepressants further. Adapting the quick inventory depressive scale to confirm the early onset of action can predict the response of patients.