症状群因子的早期改善对米氮平治疗抑郁症患者疗效的预测研究

被引：9

作者：

程文桃

林文盛

林力

莫夸耀

戴可荣

李凌恩

陈彬

林涌超

罗兰珠

卢大力

机构：

[1] 福州市,福州神经精神病防治院精神科

来源：

中华行为医学与脑科学杂志 | 2015年 / 24卷 / 04期

关键词：

抑郁症; 米氮平; 预测因素; 疗效; ROC分析;

D O I：

暂无

中图分类号：

R749.4 [情感性精神病];

学科分类号：

100204 [神经病学];

摘要：

目的验证米氮平治疗抑郁症早期起效的特点, 全面比较17项-汉密尔顿抑郁量表(HDRS-17)各因子的早期改善对4周后疗效的预测效能。方法 82例抑郁症患者接受米氮平治疗, 开放性观察4周, 以HDRS-17评价疗效。将量表条目分为情绪(F1)、精神性焦虑(F2)和躯体性焦虑(F3)3个因子, 以受试者操作特征曲线(ROC)下面积AUC评估第1、2周(记为AUC1、AUC2)时各因子减分率对第4周达到治疗有效和临床缓解的预测值。结果治疗2周后, 67例(81.7%)患者早期起效, 18例(22.0%)有效;4周后分别有57例(69.5%)和33例(40.2%)达到有效和临床缓解。ROC分析:(1)HDRS-17总分可有效预测终点达治疗有效和临床缓解, 且第2周的预测效能均优于第1周, 分别为:AUC1=0.69, AUC2=0.87, Z=5.547, P<0.01和AUC1=0.65, AUC2=0.74, Z=3.475, P<0.01;大部分因子均有良好的预测效能(0.5<AUC<0.9, P<0.05);(2)与HDRS-17总分比较, 只有F1的预测效能与之差异无统计学意义(P>0.05);(3)各因子间比较, 第2周时F1的预测效能优于F2、F3(P<0.05);(4)在敏感性、阴性预测值和准确率上, F1、F2和F3的预测值依次降低, 但特异性均较低。结论米氮平治疗抑郁症有早期起效的特点, HDRS-17各因子的早期改善可预测米氮平后4周后的疗效, 且F1具有更好的预测价值。

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