小剂量抗抑郁药治疗难治性肠易激综合征

目的探讨小剂量抗抑郁药治疗难治性肠易激综合征(irritablebowelsyndrome,IBS)的疗效。方法采用自身对照随访研究,选择符合罗马标准Ⅱ的难治性非便秘型肠易激综合征患者46例,给予小剂量氟西汀(10mg/d)、帕罗西汀(10mg/d)或多虑平(45mg/d)等抗抑郁药中的一种治疗,疗程9～12周;采用症状性焦虑、症状严重程度指数、生活质量及精神症状积分进行临床终效评价。结果46例患者均完成了抗抑郁药治疗和第1个单元随访,在第1随访单元结束时患者的临床症状均有明显改善(P<0.01);症状的严重程度指数(3.4±1.5vs1.8±0.84)和频率指数(3.8±1.60vs2.0±0.76)均有显著降低(P<0.01);与基线相比,在症状性焦虑量表中躯体性焦虑(16.04±1.65vs10.83±1.64,P<0.001)、认知性焦虑(18.78±2.12vs11.17±1.89,P<0.001)、担心(15.80±1.76vs10.78±1.85,P<0.001)和逃避(15.47±1.53vs10.16±1.59,P<0.001)的积分显著降低。患者的生活质量明显改善(P<0.05),其中焦虑不安、躯体意念、担心健康、社会功能及总体健康评价改善最为明显(P<0.01)。根据SCL-90,患者总的精神状态明显改善(P<0.01)。结论小剂量抗抑郁药治疗难治性IBS是合理的,疗效显著,其作用机制值得进一步研究。

Treatment of refractory irritable bowel syndrome with subclinical dosage of antidepressants

OBJECTIVE: To investigate the effect of antidepressant on irritable bowel syndrome (IBS). METHODS: A self-control and follow-up study on subclinical dosage of antidepressants therapy (fluoxetine 10 mg/d, paroxetine 10 mg/d or doxepin 45 mg/d) for 9-12 wks in 46 patients with refractory IBS symptoms according to Rome II criteria was performed, the clinical outcomes were evaluated by scales changes of symptom-related-anxiety, severity index of symptom, and quality of life specific of IBS, as well as general psychiatric health by SCL-90 during treatment and follow-up periods. RESULTS: All 46 cases completed therapy and first follow-up unit (12 wks after treatment) (FFU), at the end of FFU, clinical symptoms in all patients were improved (P < 0.01). Comparison of the scores of symptom-related-anxiety, index of symptom, and quality of life specific of IBS at the end of FFU with that at basal level, indexes of the severity (3.4 +/- 1.5 vs 1.8 +/- 0.84) and frequency (3.8 +/- 1.60 vs 2.0 +/- 0.76) of symptoms were subsided significantly (P < 0.01, respectively); the scores of symptom-anxiety questionnaire including body anxiety (16.04 +/- 1.65 vs 10.83 +/- 1.64, P < 0.001), cognitive anxiety (18.78 +/- 2.12 vs 11.17 +/- 1.89, P < 0.001), fear (15.80 +/- 1.76 vs 10.78 +/- 1.85, P < 0.001) and avoiding (15.47 +/- 1.53 vs 10.16 +/- 1.59, P < 0.001) were also subsided significantly. In the meantime, IBS-QoL improved significantly (P < 0.05), dysphoria, body image, interference with activity, health worry, social reaction and overall scores were improved significantly (P < 0.01, respectively). The status of general psychiatric health was also improved significantly (P < 0.01). CONCLUSIONS: Treatment of refractory IBS with subclinical dosage antidepressant is rational and effective, However a further study on its mechanisms is suggested.