西酞普兰与阿普唑仑治疗广泛性焦虑症对照研究
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[摘要] 目的：探讨西酞普兰治疗广泛性焦虑症的临床疗效。方法：将66例广泛性焦虑症患者随机分为两组，西酞普兰组34例，阿普唑仑组32例。西酞普兰组治疗剂量40～60 mg/d，阿普唑仑组为2.4～3.6 mg/d，观察时间均为6周。治疗前与治疗第1、2、4、6周末采用HAMA、SAS、TESS评定临床疗效和副反应。结果：两组疗效相当，差异无统计学意义(P>0.05)；阿普唑仑组起效时间快，但远期疗效差于西酞普兰组；西酞普兰组副反应明显少于阿普唑仑组(P<0.05)。结论：西酞普兰治疗广泛性焦虑疗效肯定，依从性好。
[关键词] 西酞普兰；阿普唑仑；焦虑症；对照研究
[中图分类号] R971 [文献标识码]B[文章编号]1674-4721(2011)08(b)-068-02
Control study of citalopram and alprazolam in treatment of generalized anxiety disorder
MA Yaping
The Fourth People's Hospital of Nanyang City, Henan Province, Nanyang 473083, China
[Abstract] Objective: To investigate the clinical effects of citalopram in the treatment of generalized anxiety disorder. Methods: 66 patients with generalized anxiety disorder were randomly divided into two groups, with 34 patients for the citalopram group and 32 patients for the alprazolam group. The therapeutic dose was 40-60 mg/d for the citalopram group and 2.4-3.6 mg/d for the alprazolam group. The observation time was 6 weeks for both groups. The clinical effects and side effects before and 1, 2, 4, 6 weeks after treatment were assessed using HAMA, SAS and TESS. Results: Clinical effects of the two groups were similar, with no significant difference (P>0.05). The alprazolam group had faster action but much worse long-term effects than the citalopram group. The citalopram group had significantly less side effects than the alprazolam group (P<0.05). Conclusion: Citalopram has good clinical effects and compliance in the treatment of generalized anxiety disorder.
[Key words] Citalopram; Alprazolam; Anxiety disorder; Control study
西酞普兰属于选择性5-羟色胺(5-HT)再摄取抑制剂中选择性最强、药物相互作用最少的新一代抗抑郁剂[1-2]，其不良反应主要与5-HT有关，反应轻微，可自行消失。国外曾报道[3]西酞普兰用于焦虑障碍治疗取得很好的疗效。笔者用西酞普兰和阿普唑仑进行对照研究，现报道如下：
1 资料与方法
1.1 一般资料
选取2010年2～12月在本院住院的66例广泛性焦虑症患者为研究对象。入组患者均符合以下标准：①符合中国精神障碍分类与诊断标准第三版(CCMD-3)广泛性焦虑症诊断标准；②排除伴有严重躯体疾病者；③汉密顿焦虑量表(HAMA)≥14分；④伴有消极自杀观念、精神活性物质依赖者。随机将入组患者分为两组，其中西酞普兰组34例，男16例，女18例，平均病程(3.0±2.4)年；阿普唑仑组32例，平均病程(2.9±1.9)年。两组以上一般资料差异均无统计学意义(P>0.05)。
1.2 方法
两组患者均使用安慰剂1周，西酞普兰组起始剂量为10 mg/d，1周内加至40 mg/d，最大剂量加至60 mg/d；阿普唑仑组起始剂量为0.4 mg/d，1周内加至2.0～3.6 mg/d。疗程均为6周。两组按HAMA减分率评定疗效，减分率≥75%为痊愈，50%≤减分率<75%为显著进步，25%≤减分率<50%为有效，减分率<25%为无效，HAMA在入组时和治疗的1、2、4、6周各评定1次，6周末采用HAMA和SAS评定疗效，TESS评定不良反应 ......
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