抗抑郁治疗对帕金森病伴抑郁患者情绪和认知功能改善作用的比较-东南大学学报医学版

抗抑郁治疗对帕金森病伴抑郁患者情绪和认知功能改善作用的比较

单位：1. 贵州医科大学附属医院精神科, 贵州贵阳 550001;
2. 蒲江县人民医院, 四川蒲江 611600

分类号：R749.4;R742

出版年·卷·期（页码）：2020·39·第五期（583-589）

摘要：

目的:比较不同的抗抑郁治疗方式对帕金森病伴抑郁(dPD)患者情绪和认知功能改善的作用,探索治疗dPD的有效方式。方法:连续选取原发性帕金森病(PD)患者328例,通过17项汉密尔顿抑郁量表(HAMD)-17对PD患者是否伴有抑郁症状进行筛查,将符合条件的dPD患者131例纳入实验组,最终完成实验的为118例。受试者被随机分为常规治疗组(A组,n=29)、常规治疗+艾司西酞普兰组(B组, n=29)、常规治疗+普拉克索组(C组, n=31)以及常规治疗+经颅磁刺激治疗组(D组, n=29)4组,治疗2、4周后通过HAMD-17评分及减分率来评价其抗抑郁治疗的效果,并通过事件相关电位来评价不同治疗方法对dPD患者认知功能的影响。结果:本研究dPD的患病率为53.4%。通过比较各组HAMD减分率,治疗总有效率A组为34.48%,B组为93.10%,C组为87.09%,D组为75.86%。艾司西酞普兰、普拉克索、经颅磁刺激治疗有效率均优于常规抗PD治疗,其中艾司西酞普兰疗效最佳,差异具有统计学意义(P<0.05)。治疗时间与不同治疗方法之间的交互效应有统计学意义(P<0.05),治疗第2周及第4周后各组HAMD评分相较于治疗前均降低,差异均有统计学意义(P<0.05)。治疗第2周时C组HAMD降分最多,与各组间比较差异均有统计学意义(P<0.05);治疗第4周时B组HAMD降分最多,与各组间比较差异均有统计学意义(P<0.05);治疗后B、C、D组事件相关电位中P₃₀₀潜伏期较治疗前降低、波幅增加,差异均有统计学意义(P<0.05),而A组P₃₀₀相较治疗前差异无统计学意义(P>0.05)。治疗后各组PDQ-39评分均较治疗前降低,差异均有统计学意义(P<0.05)。结论:dPD发生率较高,艾司西酞普兰、普拉克索、高频经颅磁刺激治疗对dPD的情绪和认知功能改善都有较好的疗效,艾司西酞普兰抗抑郁、改善认知疗效最佳。

Objective: To compare the effects of different antidepressant therapies on emotional and cognitive improvement in patients with Parkinson disease(PD) complicated with depression, and to explore effective strategies to treat PD patients with depression. Methods: A total of 328 patients with idiopathic PD were consecutively selected. The 17-item Hamilton Depression Scale(HAMD-17) was used to screen whether patients with PD exhibited depressive symptoms, and 131 patients with PD accompanied with depression were enrolled into the experimental group, 118 patients were eventually completed. The subjects were randomly divided into 4 groups: routine treatment group(group A, n=29), routine treatment+escitalopram group(group B, n=29), routine treatment+pramipexole group(group C, n=31) and(routine treatment+transcranial magnetic stimulation (TMS) group(group D,n=29). After 2 and 4 weeks of treatments, the efficacy of antidepressant treatment was evaluated by using the method of HAMD-17 score and reduction rate, and the effects of different treatment methods on cognitive function of PD patients with depression were evaluated by the event related potentials. Results: The prevalence of PD associated with depression was 53.4%. By comparing the reduction rates of HAMD scores in each group,the effective rate was 34.48% in group A, 93.10% in Group B, 87.09% in Group C and 75.86% in Group D. The efficacy of escitalopram, pramipexole and TMS was better than that of conventional anti PD therapy, among which the escitalopram was the best, and the differences were statistically significant(P<0.05). The interaction effect between treatment time and different treatment methods was statistically significant(P<0.05).The scores of HAMD in each group after the 2nd and 4th week of treatment were significantly lower than those before treatment, the differences were statistically significant(P<0.05). At the 2nd week of treatment, the HAMD score of group C decreased the most. Compared with other groups, the difference were significant(P<0.05). At the 4th week of treatment, the HAMD scores of group B decreased the most. Compared with other groups, the difference were significant(P<0.05). After treatment, the incubation period of P300 in the group B, group C and group D was lower than that before treatment, and the amplitude increased,the differences were statistically significant (P<0.05). While there was no statistically significant difference on P300 in group A. The PDQ-39 score of each group after treatment was lower than that before treatment, the differences were statistically significant(P<0.05). Conclusion: The incidence of PD accompanied with depression was higher, and escitalopram, pramipexole and high frequency TMS have good effects on emotional and cognitive function improvements, while escitalopram has the best effect on antidepressant therapy and the cognitive improvement.

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