目的 探討奧氮平聯(lián)合艾司西酞普蘭治療老年女性難治性抑郁癥的臨床療效。方法 選取2012年6月—2014年12月北京市順義區(qū)精神病醫(yī)院門診和住院部收治的女性患者83例,隨機(jī)分為對(duì)照組(41人)和治療組(42人)。對(duì)照組開始口服草酸艾司西酞普蘭片5 mg/d,2～4周內(nèi)增加至10～20 mg/d。治療組在對(duì)照組的基礎(chǔ)上口服奧氮平片2.5 mg/次,每晚1次,2～4周內(nèi)增加至3.75～5 mg/次,每晚1次。兩組均連續(xù)治療12周。應(yīng)用漢密爾頓抑郁評(píng)定量表(HAMD)和漢密爾頓焦慮量表(HAMA)評(píng)定療效,同時(shí)對(duì)血糖(GLU),血脂指標(biāo)總膽固醇(CHOL)、三酰甘油(TG)、低密度脂蛋白(LDL)和高密度脂蛋白(HDL)和體質(zhì)量指數(shù)(BMI)進(jìn)行比較,并且應(yīng)用副反應(yīng)量表(TESS)評(píng)定不良反應(yīng)。結(jié)果 治療組總有效率(65.9%)明顯高于對(duì)照組的總有效率(42.5%),兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05);治療4、6、8、12周,兩組的HAMD評(píng)分均較同組治療前顯著改善,且差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05、0.01);且治療6、8、12周,治療組的HAMD評(píng)分均較對(duì)照組同期顯著改善,且差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05、0.01)。治療4、6、8、12周,對(duì)照組的HAMA評(píng)分均較同組治療前顯著改善,且差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05、0.01);治療2、4、6、8、12周,治療組的HAMA評(píng)分均較同組治療前顯著改善,且差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05、0.01);治療2、6、12周,兩組的觀察指標(biāo)GLU、CHOL、TG、HDL、LDL、BMI較治療前差異均無(wú)統(tǒng)計(jì)學(xué)意義,且治療組較對(duì)照組同期各觀察指標(biāo)差異也無(wú)統(tǒng)計(jì)學(xué)意義;兩組不良反應(yīng)發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 奧氮平聯(lián)合艾司西酞普蘭治療老年女性難治性抑郁癥有較好療效,且安全性較高,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effects of olanzapine combined with escitalopram in treatment of older women with refractory depression. Methods The patients (83 cases) with refractory depression in Beijing Shunyi District Mental Hospital from June 2012 to December 2014 were randomly divided into control (41 cases) and treatment (42 cases) groups. The patients in the control group were po administered with Escitalopram Oxalate Tablets 5 mg/d. After 2-4 weeks, the dosage was gradually increased to 10-20 mg/d. On the basis of control group, the patients in the treatment group were po administered with Olanzapine Tablets 2.5 mg/d in the evening. After 2-4 weeks, the dosage was gradually increased to 3.75-5 mg/d in the evening. Two groups were treated for 12 weeks. Hamihon depression scale (HAMD) and Hamiton anxiety scale (HAMA) were assessed, and glucose (GLU), lipid indexes total cholesterol chol (CHOL), triacylglycerol (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), and body mass index (BMI) were compared, and treatment-emergent signs and symptoms (TESS) were used to assess adverse reactions. Results The clinical efficacy in treatment group (65.9%) was higher than that in control group (42.5%) with significant difference (P < 0.05). After treatment for 4, 6, 8, and 12 weeks, HAMD scores of two groups were improved more than those before treatment, and the difference was significant (P < 0.05, 0.01); After treatment for 6, 8, and 12 weeks, HAMD scores of treatment group were improved more than those of control group with significant difference (P < 0.05). After treatment for 4, 6, 8, and 12 weeks, HAMA scores of control group were improved more than those before treatment, and the difference was significant (P < 0.05, 0.01); After treatment for 2, 4, 6, 8, and 12 weeks, HAMA scores of treatment group were improved more than those before treatment with significant difference (P < 0.05, 0.01). After treatment for 2, 6, and 12 weeks, there was no significant difference in GLU, CHOL, TG, HDL, LDL, and BMI of two groups, compared with those before treatment. And there was no significant difference in these obvervational indexes of treatment group, compared with those in control group at the same period. The incidence of adverse events of two groups was not statistically significant. Conclusion Olanzapine combined with escitalopram has good effect in treatment of older women with refractory depression, and is safer, which has a certain clinical application value.