5-羟色胺1A受体激动剂枸橼酸坦度螺酮对癫痫后抑郁与焦虑的疗效研究

目的观察5-羟色胺1A(5-TH1A)受体激动剂橼酸坦度螺酮对癫痫合并抑郁与焦虑治疗的疗效。方法收集山西医科大学第一临床医院及山西医科大学第三医院神经内科2012年11月至2013年11月门诊及住院的癫痫合并焦虑、抑郁的患者131例,分为治疗组(88例)和对照组(43例)。治疗组在常规口服抗癫痫药物的基础上加服坦度螺酮,每次10 mg,每天3次;对照组服用常规抗癫痫药物,疗程8周。两组分别在使用5-TH1A受体激动剂治疗前和治疗后2周、4周与8周进行汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评定抑郁、焦虑情况。同时记录每组患者癫痫发作次数的改变。采用SPSS 17.0统计软件包进行统计。HAMA及HAMD评分以均数±标准差(x珋±s)表示,比较采用配对t检验;癫痫发作次数为非正态分布数据,用中位数(四分位数间距)[M(P25,P75)]表示,组间比较采用Mann-Whitney U检验;两组间疗效比较采用χ2检验,P0.05为差异有统计学意义。结果 (1)治疗4周后,治疗组与治疗前比较,HAMD评分(t=19.23,P0.05)与HAMA评分(t=13.55,P0.05)均明显下降;治疗组与对照组比较,治疗后HAMD评分(t=-5.506,P0.05)与HAMA评分(t=-2.491,P0.05)均显著减低。(2)与对照组比较,治疗组随访8周后发作次数明显减少,差异有统计学意义(U=-3.92,P0.05)。(3)两组未见严重不良反应。结论 5-HT1A受体激动剂枸橼酸坦度螺酮可全面改善癫痫合并焦虑抑郁障碍的所有症状,减少癫痫的发作,提高疗效。

Study on the effect of tandospirone citrate epileptic patients with depression and anxiety

Objective To investigate the effect of tandospirone citrate [ 5-hydroxy tryptamine （5- TH1A） receptor agonist] on epileptic patients with depression and anxiety. Methods One hundred and thirty-one epileptic patients with depression and anxiety were treated as the subjects of the study. The patients were from the department of neurology of the First Clinical Hospital of Shanxi Medical University and the Third Hospital of Shanxi Medical University during the period from November 2012 to November 2013. The subjects were divided into two groups with 88 patients in the treatment group and 43 patients in the control group. The patients in the treatment group would take 10 mg tandospirone each time, three times a day, in addition to the conventional anti-epileptic drugs while the patients in the control group just took conventional anti-epileptic drugs. The degree of depression and anxiety of the patients in both groups was assessed with Hamilton depression scale （HAMD）and Hamilton anxiety scale （HAMA）before the treatment and in the second, the forth and the eighth week after the treatment. Meanwhile, the changes of the number of epileptic seizures were recorded in both groups during the whole study. The results would be analyzed with the use of the software SPSS 17.0. The scores of HAMA and HAMD would be illustrated by x^-±s. Paired-sample t test would be utilized in the present study and the significance level is 0. 05. The number of seizures would be illustrated by M （P25, P75 ）. Mann-Whitney U test would be adopted to compare the two groups and the significance level is 0. 05. The effects of the treatment between the groups would be analyzed by utilizing Chi square test（Х^2 ） at the significance level of 0. 05. Results Four weeks after the treatment of tandospirone citrate, the scores of HAMD （ t = 19. 23, P 〈 0. 05 ） and HAMA of the treatment group were significantly decreased when compared with those before the treatment （ t = 13.55, P 〈 0. 05 ）. Meanwhile, those scores of the treatment group were significantly reduced when compared with the scores of control group（t = -5. 506, P 〈 0. 05 ; t = - 2. 491, P 〈 0. 05 ）. At the end of the eighth week, the frequency of epileptic seizures of treatment group were significantly decreased when compared with that of control group （ U = - 3.92, P 〈 0. 05）. Additionally, serious adverse reaction was not observed in both groups. Conclusion The 5-HT1A receptor agonist（tandospirone）can improve the symptoms of epilepsy combined with depression and anxiety overall and reduce the frequency of epileptic seizures.