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目的 探讨米氮平对早醒抑郁症患者睡眠脑电图(PSG)及临床疗效的影响.方法 应用PSG对22例早醒病人、22例对照者进行检测.早醒病人米氮平治疗6周后复测PSG,在米氮平治疗前、治疗2周及6周后应用汉密尔顿抑郁量表(HAMD)评定患者的抑郁症状及早醒症状,比较治疗前后PSG指标与HAMD及早醒评分的变化.结果 与对照组比较,早醒组在PSG指标方面存在诸多异常.早醒组经过6周的米氮平治疗,PSG显示睡眠潜伏期缩短[(16.9±6.6) min],睡眠效率提高[(85.4±6.7)％],觉醒时间缩短[ (27.7±10.4)min],睡眠维持率提高[(87.9±5.3)％],慢性睡眠第一阶段(S1)百分比降低[(9.7±4.1)％],慢性睡眠第二阶段(S2)百分比提高[( 148.0±30.7)％],快动眼睡眠(REM)密度降低[(56.1±3.8)％]；差异有显著性(P＜0.05).HAMD及早醒治疗后评分明显低于治疗前,差异具有显著性,(P＜0.001).相关分析显示HAMD及早醒的评分与PSG指标变化率无显著相关性(P＞0.05).结论 REM睡眠潜伏期缩短,REM睡眠时间延长,REM活动度和密度增加可能是抑郁症早醒的生物学标志之一,PSG变化与疗效无显著相关性.

Objective To investigate influence of mirtazapine on polysomnograpy (PSG) of depression dysphylaxia patient and treatment effect.Methods 22 dysphylaxia patients and 22 healthy contrast persons were detected by PSG.The group of dysphylaxia patients were re-detected PSG 6 weeks later after treatment by Mirtazapine.In order to evaluate the patient' symptoms of depression and early awakening,the scale of HAMD was utilized at the time before and after 2 weeks,6 weeks treatment by mirtazapine.To compare changes of PSG index,HAMD scores and dysphylaxia scores before and after treatment.Results Compared with healthy controls,there existed much deviation with dysphylaxia patients on PSG index.6 weeks after mirtazapine treatment,the PSG showed the sleeping latency had shortened to ( 16.9 ± 6.6) min,sleep efficiency had improved ( 85.4 ± 6.7 ) ％,awake time had shortened (27.7 ± 10.4)min,sleep maintenance rate had risen (87.9 ±5.3)％,decrease (9.7±4.1 )％ of the S1 sleeping stage percentage,S2 had increased ( 148.0 ±30.7)％,REM density had decreased (56.1 ±3.8)％.the difference was significant (P＜0.05).The scores of HAMD and early awakening after treatment were significantly lower than before treatment,the difference was significant (P＜0.01 ).Correlation analysis showed there was no significant correlation between the HAMD,dysphylaxia reduced rate and changes of PSG all indicators(P ＞ 0.05 ).Conclusion It may be one of the biological markers for dysphylaxi in shortened of REM sleep latency,prolonged of REM sleep time and increased of REM activity and density.There is no correlation between post-treatment changes of PSG.