米氮平对伴糖尿病的抑郁障碍患者空腹血糖的影响

目的探讨米氮平对伴2型糖尿病的抑郁障碍患者空腹血糖(FBG)的影响。方法将87例伴糖尿病的中度抑郁障碍患者随机分为3组(各29例):米氮平组(30～45 mg.d-1)、舍曲林组(150～200 mg.d-1)和心理治疗组(以认知治疗为主,每周1～2次),治疗观察期均为12 wk。3组患者于治疗前及治疗后wk 4、8、12末测定FBG进行比较。结果米氮平组、舍曲林组、心理治疗组分别脱落3例、3例、1例。米氮平组与舍曲林组或心理治疗组比较,FBG均数均有显著差异(P<0.05,P<0.01),而舍曲林组与心理治疗组间无显著差异(P>0.05);3组wk 4末FBG与基线比较无显著差异(P>0.05),而wk 8或wk 12末与基线相比均有非常显著差异(均P<0.01)。wk 4、8末3组间FBG异常升高率无显著差异(P=0.996、P=0.631),wk 12末3组间FBG异常升高率均有显著差异(P=0.018),且其总体频率的95%置信区间为1.5%～2.0%。结论米氮平治疗伴2型糖尿病的中度抑郁障碍患者可出现有临床意义的FBG异常升高,且其发生可能存在一定的时间趋势。

Effects of mirtazapine on fasting blood glucose of depressive disorder with type 2 diabetes

AIM To explore the effects of mirtazapine on fasting blood glucose(FBG)of depressive patients with type 2 diabetes.METHODS Total 78 moderate depressive patients with type 2 diabetes were randomly divided into three groups:mirtazapine(30-45 mg·d-1)group,sertraline(150-200 mg·d-1)group,and psychotherapy(cognitive therapy once or twice a week)group,29 for each.Each group have a 12-week treatment.The FBG were measured at baseline and at wk 4,8 and 12 of the treatment for comparison.RESULTS The mirtazapine,sertraline and psychotherapy group had 3,3 or 1 drop-our case,respectively.The FBG of the mirtazapine group had statistical difference compared with the sertraline group and the psychotherapy group(P < 0.05,P < 0.01)respectively,while there was no difference between the sertraline group and the psychotherapy group(P > 0.05).The FBG of the three groups had no statistical difference between at baseline and at wk 4(P > 0.05),while there was statistical difference in FBG between at baseline and at wk 8 or 12(P < 0.01).The abnormally increased rates of FBG among the three groups had no statistical difference at week 4 or 8(P = 0.996 or P = 0.631),while it was statistical different among the three groups at week 12(P = 0.018),and the 95% confidence interval of the population rate is 1.5% to 2.0%.CONCLUSION The abnormal rise of FBG with clinical significance can occur among moderate depressive patients with type 2 diabetes who were treated by mirtazapine.The abnormally increased rate of FBG may have a time tendency.