选择性5-羟色胺再摄取抑制剂合并银杏叶提取物对老年抑郁障碍患者脑血流及疗效的影响
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摘要
目的:探讨选择性5-羟色胺再摄取抑制剂(SSRIs)合并银杏叶提取物(EGb)对老年抑郁障碍患者脑血流及疗效的影响。方法:84例老年抑郁障碍患者随机分成联合治疗组(44例,SSRIs+EGb)和单药治疗组(40例,SSRIs);观察20周。治疗前后行脑血管多普勒(TCD)检查两侧大脑前动脉(ACA)、大脑中动脉(MCA)及基底动脉(BA)血流速度,并与33名正常对照者(正常对照组)比较;联合治疗组及单药治疗组治疗前、治疗2周、10周、20周末给予17项汉密尔顿抑郁量表(HAMD-17)评估,并比较两组疗效。结果:治疗前联合治疗组及单药治疗组ACA、MCA及BA血流速度较正常对照组明显减慢(P <0. 05或P <0. 01)。经20周治疗,联合治疗组ACA、MCA及BA及单药治疗组ACA血流流速较治疗前显著增快(P <0. 05或P <0. 01);联合治疗组在治疗10周和20周HAMD评分明显低于单药治疗组,减分率明显高于单药治疗组;治疗10周联合治疗组总有效率显著高于单药治疗组(P <0. 05或P <0. 01)。结论:EGb可有效改善脑动脉血流,对治疗老年抑郁障碍有增效作用。
Objective: To investigate the therapeutic effect and influence on the cerebral blood flow( CBF) of selective serotonin reuptake inhibitors antidepressants( SSRIs) combined with ginkgo biloba extract( EGb) in geriatric depression patients. Method: Totally 84 elderly depression patients were randomly divided into the combined group( 44 cases,SSRIs + EGb) and the monotherapy group( 40 cases,SSRIs),and treated for 20 weeks. Before and after treatment,the blood flow velocity of both anterior cerebral arteries( ACA),middle cerebral arteries( MCA),and basal arteries( BA) were examined by cerebral vascular Doppler( TCD)and compared with 33 normal controls( normal control group). All the patients were evaluated by 17 items Hamilton depression scale( HAMD-17) before treatment,the end of 2 ed week,10 th week,and 20 th week after treatment;,and the therapeutic effect of the combined group and the monotherapy group were compared.Results: Before treatment,the blood flow rate of ACA,MCA and BA in the combined group and the monotherapy group were significantly slower than that of the normal control group( P < 0. 05 or P < 0. 01). After 20 weeks of treatment,the blood flow rate of ACA,MCA and BA in the combined group and ACA in the monotherapy group were significantly higher than that before treatment( P < 0. 05 or P < 0. 01). After 10 and 20 weeks of treatment,the HAMD scores in the combined group were significantly lower than those of the monotherapy group,and the score reduction rate was significantly higher than that of the monotherapy group. The total efficacy of 10 weeks after treatment in the combined group was significantly higher than that of the monotherapy group( P <0. 05 or P < 0. 01). Conclusion: EGb can effectively improve the cerebral artery blood flow and has a synergistic effect on the treatment of depression in the elderly.
Objective: To investigate the therapeutic effect and influence on the cerebral blood flow( CBF) of selective serotonin reuptake inhibitors antidepressants( SSRIs) combined with ginkgo biloba extract( EGb) in geriatric depression patients. Method: Totally 84 elderly depression patients were randomly divided into the combined group( 44 cases,SSRIs + EGb) and the monotherapy group( 40 cases,SSRIs),and treated for 20 weeks. Before and after treatment,the blood flow velocity of both anterior cerebral arteries( ACA),middle cerebral arteries( MCA),and basal arteries( BA) were examined by cerebral vascular Doppler( TCD)and compared with 33 normal controls( normal control group). All the patients were evaluated by 17 items Hamilton depression scale( HAMD-17) before treatment,the end of 2 ed week,10 th week,and 20 th week after treatment;,and the therapeutic effect of the combined group and the monotherapy group were compared.Results: Before treatment,the blood flow rate of ACA,MCA and BA in the combined group and the monotherapy group were significantly slower than that of the normal control group( P < 0. 05 or P < 0. 01). After 20 weeks of treatment,the blood flow rate of ACA,MCA and BA in the combined group and ACA in the monotherapy group were significantly higher than that before treatment( P < 0. 05 or P < 0. 01). After 10 and 20 weeks of treatment,the HAMD scores in the combined group were significantly lower than those of the monotherapy group,and the score reduction rate was significantly higher than that of the monotherapy group. The total efficacy of 10 weeks after treatment in the combined group was significantly higher than that of the monotherapy group( P <0. 05 or P < 0. 01). Conclusion: EGb can effectively improve the cerebral artery blood flow and has a synergistic effect on the treatment of depression in the elderly.
引文
[1]王丽.老年抑郁症的临床分析[J].中国中医药咨讯,2011,3(6):92-93.
[2]蒲俊材,周新雨,张玉清,等.比较SSRIs与SNRIs治疗老年抑郁症疗效和安全性的meta分析[J].中国神经精神疾病杂志,2015,41(12):750-755.
[3]谭庆荣.老年期抑郁的特点及治疗[J].中华精神科杂志,2013,46(3):180-181.
[4] Vakilian A,Iranmanesh F. Assessment of cerebrovascular reactivity during major depression and after remission of disease[J]. Ann Indian Acad Neurol,2010,13(1):52-56.
[5]胡春凤,李武,李龙飞,等.发作期抑郁症患者脑动脉血流速度与注意力、执行功能关系[J].中国神经精神疾病杂志,2016,11(42):647-651.
[6] Lawrence NS,Williams AM,Surguladze S,et al. Subcortical and ventral prefrontal cortical neural responses to facial expressions distinguish patients with bipolar disorder and major depression[J]. Biol Psychiatry,2004,15(4):578-587.
[7]马永盛,马洪胜.银杏叶提取物联合西酞普兰治疗老年抑郁症的研究[J].中国实用医药,2010,10(5):51-52.
[8]郭克锋,郭珊,闰凯麟.帕罗西汀加银杏叶提取物治疗抑郁症的疗效[J].中国行为医学科学,2006,8(15):704-706.
[9]陈斌华,齐若兵,苏雪倩,等.银杏叶制剂合并西酞普兰治疗血管性抑郁的对照研究[J].浙江中医药大学学报,2011,35(4):513-515.
[10] Qin XS,Jin KH,Ding BK,et al. Effects of extract of Ginkgo biloba with venlafaxine on brain injury in a rat model of depression[J]. Chin Med(J Engl),2005,118(5):391-397.
[2]蒲俊材,周新雨,张玉清,等.比较SSRIs与SNRIs治疗老年抑郁症疗效和安全性的meta分析[J].中国神经精神疾病杂志,2015,41(12):750-755.
[3]谭庆荣.老年期抑郁的特点及治疗[J].中华精神科杂志,2013,46(3):180-181.
[4] Vakilian A,Iranmanesh F. Assessment of cerebrovascular reactivity during major depression and after remission of disease[J]. Ann Indian Acad Neurol,2010,13(1):52-56.
[5]胡春凤,李武,李龙飞,等.发作期抑郁症患者脑动脉血流速度与注意力、执行功能关系[J].中国神经精神疾病杂志,2016,11(42):647-651.
[6] Lawrence NS,Williams AM,Surguladze S,et al. Subcortical and ventral prefrontal cortical neural responses to facial expressions distinguish patients with bipolar disorder and major depression[J]. Biol Psychiatry,2004,15(4):578-587.
[7]马永盛,马洪胜.银杏叶提取物联合西酞普兰治疗老年抑郁症的研究[J].中国实用医药,2010,10(5):51-52.
[8]郭克锋,郭珊,闰凯麟.帕罗西汀加银杏叶提取物治疗抑郁症的疗效[J].中国行为医学科学,2006,8(15):704-706.
[9]陈斌华,齐若兵,苏雪倩,等.银杏叶制剂合并西酞普兰治疗血管性抑郁的对照研究[J].浙江中医药大学学报,2011,35(4):513-515.
[10] Qin XS,Jin KH,Ding BK,et al. Effects of extract of Ginkgo biloba with venlafaxine on brain injury in a rat model of depression[J]. Chin Med(J Engl),2005,118(5):391-397.