文拉法辛联合喹硫平治疗重度抑郁症急性期的效果及对患者血清BDNF、Cor表达的影响

石奇嵩

【摘要】 目的：探讨文拉法辛联合喹硫平治疗重度抑郁症急性期患者的效果及对血清BDNF、Cor表达的影响。方法：选取自2019年3月-2020年4月本院收治的68例重度抑郁症急性期患者，按照随机数字表法分为两组，各34例。对照组给予文拉法辛治疗，观察组给予文拉法辛联合喹硫平。比较两组治疗前后抑郁状态评分、血清BDNF与Cor表达水平及不良反应发生情况。结果：治疗后，两组MADRS评分、HAMD-17评分均低于治疗前，且观察组均低于对照组（P<0.05）;治疗后，两组血清BDNF、Cor表达水平均优于治疗前，且观察组血清BDNF表达水平高于对照组，Cor表达水平低于对照组（P<0.05）;两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论：文拉法辛联合喹硫平治疗可明显减轻重度抑郁症急性期患者的抑郁状态，并可上调血清BDNF表达，下调Cor表达，安全有效。

【关键词】 文拉法辛 喹硫平 重度抑郁症 急性期 皮质醇

Effect of Venlafaxine Combined with Quetiapine in the Treatment of Acute Stage of Major Depression and Its Effect on the Expression of Serum BDNF and Cor/SHI Qisong. //Medical Innovation of China， 2021， 18（13）： -142

[Abstract] Objective： To investigate the effect of Venlafaxine combined with Quetiapine in the treatment of acute phase of major depression patients and its effect on the expression of serum BDNF and Cor. Method： A total of 68 patients with acute phase of major depression were selected from March 2019 to April 2020， and divided into two groups according to random number table method， 34 cases in each group. The control group was given Venlafaxine treatment， while the observation group was given Venlafaxine combined with Quetiapine treatment. The depressive state scores， serum BDNF and Cor expression levels before and after treatment， and adverse reactions were compared between the two groups. Result： After treatment， the MADRS score and HAMD-17 score in both groups were lower than before treatment， and the observation group were lower than those of the control group （P<0.05）. After treatment， the serum BDNF and Cor expression levels of both groups were better than before treatment， and the serum BDNF expression level of observation group was higher than that of control group， and the Cor expression level of observation group was lower than that of control group （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusion： The treatment of Venlafaxine combined with Quetiapine can alleviate the depressive state in patients with acute phase of major depression， and can up regulate serum BDNF expression， down regulate Cor expression， which is safe and effective.

[Key words] Venlafaxine Quetiapine Major depression Acute phase Cor

First-authors address： Heilongjiang Nongken Neuropsychiatric Hospital， Jiamusi 154007， China

doi：10.3969/j.issn.1674-4985.2021.13.034

抑郁症为常见的一种精神疾病，其在中国的发病率约为6.00%，目前已确诊的病例数约3 000万[1]。情绪低落、思维迟缓为抑郁症的常见临床表现，重度患者会出现自杀念头与行为，自杀率达10%～15%，给社会带来极大负担[2]。抗抑郁药物治疗为当前该病的主要疗法，文拉法辛为5-羟色胺（5-HT）与去甲肾上腺素再摄取抑制剂（ANRIS），具有双通道抗抑郁作用，但对重度抑郁症的疗效欠佳[3]。喹硫平为非典型抗精神病药物，可与多种神经递质受体作用，并保护神经中枢系统。研究发现，脑源性神经营养因子（BDNF）的表达下调会引起情感调节相关脑区-海馬神经元结构的改变，并参与抑郁症的发生，而上调其表达，可对抑郁症的情绪、行为、学习障碍发挥缓解作用，即可减轻抑郁样行为[4]。此外，皮质醇（Cor）高表达可损伤海马、蓝斑等部位，引起注意和记忆缺损，情感和行为障碍[5]。……