王策,
霍平欣,
王昊,
李媛媛^,,
严保平,
杨淼
河北省精神卫生中心 河北省重大精神与行为障碍疾病研究重点实验室 河北大学第六临床医学院，河北 保定 071000

基金项目: 河北省卫生健康委科研基金项目（20210184）


详细信息 作者简介: 王 策（1983-），男，主治医师。E-mail：6333231@qq.com






通讯作者: 李媛媛，副主任医师。E-mail：754538597@qq.com 中图分类号: R749


摘要:目的评价度洛西汀联合丁螺环酮对伴认知功能损害的躯体形式障碍（SD）患者焦虑症状及认知功能的改善效果及安全性。方法纳入符合《国际疾病分类第10版》（ICD-10）躯体形式障碍诊断标准且蒙特利尔认知评估量表（MOCA）评分＜26分者86例，随机分为联合治疗组（度洛西汀+丁螺环酮，n=42）及单药治疗组（度洛西汀，n=44），两组基线情况仅在年龄均值方面差异具有统计学意义（P=0.03）。治疗周期为8周。采用汉密尔顿焦虑量表（HAMA）评估焦虑症状，MOCA量表评估认知功能，记录不良反应发生情况。结果联合治疗组脱落3例；单药治疗组脱落7例。联合治疗组HAMA量表总分下降较为明显，与单药治疗组相比差异有统计学意义（F=4.56，P=0.04）；联合治疗组躯体性焦虑因子评分下降亦较为明显，与单药治疗组相比差异有统计学意义（F=6.61，P=0.01）；认知功能方面，治疗前两组间各维度的认知功能差异均无统计学意义；治疗后在视空间与执行能力（t=2.27，P=0.03）、注意力（t=2.24，P=0.03）及抽象能力（t=2.81，P=0.01） 3个维度，联合治疗组改善较单药治疗组更显著，差异均有统计学意义；联合治疗组有6例出现不良反应，单药治疗组有5例出现不良反应，组间差异无统计学意义（χ²=0.16，P=0.76）。结论度洛西汀联合丁螺环酮治疗躯体形式障碍的疗效优于单药治疗，能有效改善焦虑症状及提高患者的认知功能，且不增加不良反应，联合治疗可以作为治疗躯体形式障碍的一种推广模式。
关键词: 度洛西汀/
丁螺环酮/
躯体形式障碍/
疗效


Abstract:ObjectiveTo evaluate the efficacy and safety of duloxetine combined with buspirone in patients of somatoform disorders with cognitive impairment.MethodsThis was an 8-weeks randomized control study. Totally 86 patients with somatoform disorders, who met the definition and criteria of the ICD-10 and had a score＜26 on the Montreal cognitive assessment scale, were recruited. All patients were randomly divided into duloxetine combined with buspirone treatment group (n=42) and duloxetine control group (n=44), the difference in baseline conditions between the two groups was statistically significant only in terms of mean age (P=0.03). The anxiety symptoms were assessed by the Hamilton anxiety scale (HAMA), the cognitive function was assessed by the Montreal cognitive assessment scale (MOCA), and the treatment emergent symptoms were recorded.ResultsThere were 42 patients in the treatment group with 3 dropped out, and 44 patients in the control group with 7 dropped out. Statistical analysis revealed that the total score of HAMA in the treatment group was significantly lower than that in the control group (F=4.56, P=0.04), and the score of somatic anxiety factor in the treatment group was significantly lower than that in the control group (F=6.61, P=0.01). For cognitive function, there was no significant difference between the groups before treatment. After treatment, the improvements in visual space and executive ability (t=2.27, P=0.03), attention (t=2.24, P=0.03) and abstract ability (t=2.81, P=0.01) were more significant in the treatment group. There were 6 cases of adverse reactions in the treatment group and 5 cases in the control group, with no significant difference (χ²=0.16, P=0.76).ConclusionDuloxetine combined with buspirone is more effective than duloxetine monotherapy in the treatment of somatoform disorders, improving anxiety symptoms and cognitive function without increasing adverse reactions. Therefore, duloxetine combined with buspirone can be used as a promotion model for the treatment of somatoform disorders.
Keywords:duloxetine/
buspirone/
somatoform disorders/
efficacy

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