摘要目的 研究文拉法新和瑞波西汀对经五羟色安回吸收抑制剂(SSRIs)治疗达不到完全缓解的抑郁症患者的疗效和副反应.方法 收集经SSRIs治疗8周达不到完全缓解的抑郁症患者117例,随机分成3组,分别给予文拉法新、瑞波西汀和继续维持原药和原剂量继续治疗8周.于患者入组前和入组后1,2,4,6,8周末用汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)评定疗效和副反应,并于入组前和入组治疗后4、8周末检查血压、血糖、血常规、尿常规和心电图.结果 文拉法新组和瑞波西汀组患者在治疗4周末[分别为(18.8±5.5)分和(19.3±5.8)分]、8周末[分别为(12.7±3.3)分和(14.5±3.7)分]HAMD量表的评分显著低于原药组[4周末(22.7±6.2)分,8周末(19.3±6.0)分]( F =3.93,6.79,P <0.05).治疗8周末,文拉法新组HAMD量表的评分显著低于瑞波西汀组( F =6.79,P <0.05).文拉法新和原药组患者治疗2周后[分别为(24.5±6.3)分和(24.3±7.1)分]HAMD评分较治疗前[分别为(28.2±9.5)分和(28.5±9.7)分]有显著下降( t =2.7,2.1,P <0.05),瑞波西汀组患者治疗4周末才显著下降( t =4.8,P <0.01).治疗结束时文拉法新和瑞波西汀组患者的认知障碍[分别为(4.8±2.3)分和(4.1±1.9)分]、迟缓[分别为(4.4±1.9)分和(3.4±1.7)分]和绝望感[分别为(1.7±0.8)分和(1.5±0.7)分]因子减分显著高于原药组[分别为(2.5±1.4)分、(1.9±1.3)分和(1.0±0.4)分]( F =5.49,10.35,6.47,P <0.05或<0.01);文拉法新组迟缓因子减分[(4.4±1.9)分]显著高于瑞波西汀组[(3.4±1.7)分]( F =10.35,P <0.05).文拉法新、瑞波西汀和原药组疗效比较差异有显著性(χ2＝9.8,P <0.05);文拉法新与瑞波西汀组疗效比较差异无显著性(χ2＝1.6,P ＞0.05),但显著优于原药组(χ2＝8.9,P <0.01);瑞波西汀与原药组比较差异无显著性(χ2＝3.7,P ＞0.05).3组副反应的发生率差异无显著性(χ2＝2.3,P ＞0.05).结论 文拉法新对SSRIs治疗达不到完全缓解的抑郁症患者有较好疗效,特别是对伴有迟滞的抑郁症患者疗效更好;文拉法新的起效时间快于瑞波西汀.

abstractsObjective The purpose of this study was to access the efficacy of Venlafaxine and Reboxitine on treatment of depressive patients who had not responded to selective serotonin reuptake inhibitors for eight weeks. Methods 117 cases depressive patients who had not responded to selective serotonin reuptake inhibitors for eight weeks were divided into three Venlafaxine group(n =41),Reboxitine group(n =39),Original medicine group(n =37) by randomly and were treated by corresponding drugs for 8 weeks. The therapeutic response and safety were evaluated by scale of HAMD and TESS at before and after treatment the end of 1,2,4,8 week. Results The score of HAMD in Venlafaxine and Reboxitine groups were significantly lower than Original medicine group at the end of 4,8 weeks after treatment and the score of HAMD in Venlafaxine group were significantly lower than Reboxitine group at the end of 8 weeks after treatment. The score of HAMD in Venlafaxine and Original medicine groups were marked descendanter than before treatment from after treatment second weekend(P <0.01),while reboxitine group did not marked descent until the 4th weekend after treatment. The reduce score of factors in cognition,retardition and desperation of Venlafaxine and Reboxitine groups were significantly higher than Original medicine group at the end of treatment. The curative effect of Venlafaxine group were supper than Original medicine group. The side reaction of three groups were not difference. Conclusions There are obviously curative effect using Venlafaxine to treat the depressive patients who had not responded to selective serotonin reuptake inhibitors. The time of initial effect in Venlafaxine were rapider than Reboxitine group.