本文選題：西酞普蘭 + 阿爾茨海默病��； 參考：《青島大學》2017年碩士論文

【摘要】：目的本研究是觀察西酞普蘭治療阿爾茨海默病患者的精神行為癥狀、認知功能的療效和安全性,其次觀察看護者在壓力方面的改變。方法從2015年4月至2016年2月在青島市精神衛(wèi)生中心收集80例中度(根據(jù)臨床癡呆評定量表,CDR)阿爾茨海默病并伴有精神行為癥狀的患者,并將其隨機分為治療組和對照組,每組各40例。治療組給予西酞普蘭10-30mg/d治療,以10mg/d為起始劑量,根據(jù)患者對藥物的反應性及耐受性逐漸加量至最高劑量30mg/d,對照組給予同劑量的安慰劑,兩組均口服鹽酸美金剛10mg bid,療程12周。用簡易精神狀態(tài)檢查(MMSE)測量認知功能損害,神經(jīng)精神科問卷(NPI)測量精神行為癥狀及看護者壓力,每位患者每月常規(guī)復查血常規(guī)、尿常規(guī)、生化、心電圖、腦電圖,以檢測服藥對機體的影響,副反應量表(TESS)評定有無不良反應,比較兩組患者的療效和安全。結(jié)果1、治療組和對照組經(jīng)治療12周后,在激越/攻擊、情感淡漠/漠不關(guān)心、抑郁/心境惡劣和焦慮四項比較有顯著差異(P0.05),治療組經(jīng)治療后減分率較高的為激越/攻擊、抑郁/心境惡劣和焦慮這三項減分率分別為:40.80%、30.89%、35.27%。2、對照組激越/攻擊減分率為30.34%,減分率小于治療組(30.34%40.80%)。3、兩組在看護者壓力的改變及NPI總分改變也有顯著差異(P0.05),其余癥狀改善無顯著性(P0.05)。4、治療組和對照組在MMSE測評中有顯著差異(P0.05)。5、兩組TESS量表未見明顯差異(P0.05),對照組有兩名患者口干,1名患者因力比多能增加退出研究,治療組2名患者每天服用西酞普蘭30mg/d而出現(xiàn)QTc間期延長,其中1名退出研究。兩組因不良反應皆退出1名。結(jié)論1、西酞普蘭合并鹽酸美金剛可以改善精神行為癥狀,主要是激越/攻擊、情感淡漠/漠不關(guān)心、抑郁/心境惡劣和焦慮這四個臨床癥狀,在激越/攻擊、抑郁/心境惡劣和焦慮這三個臨床癥狀治療效果顯著,西酞普蘭聯(lián)合鹽酸美金剛比單用鹽酸美金剛在改善激越/攻擊癥狀效果更為顯著。2、與單用鹽酸美金剛相比,西酞普蘭聯(lián)合鹽酸美金剛在降低看護者壓力和NPI總分的更為有效,但整體臨床改善療效可能有限。3、西酞普蘭合并鹽酸美金剛比單用鹽酸美金剛更好的改善認知功能。4、西酞普蘭耐受性好,半衰期長,無明顯的抗腎上腺素能及抗膽堿能作用,對細胞色素P450作用小,不良反應小,適合老年人使用,有望成為治療癡呆患者精神行為癥狀的主要藥物。意義研究表明西酞普蘭輔助治療阿爾茨海默病患者精神行為癥狀有潛在功效。有望成為改善阿爾茨海默病精神行為癥狀的主要藥物。
[Abstract]:Objective to observe the efficacy and safety of citalopram in the treatment of mental and behavioral symptoms, cognitive function and stress in patients with Alzheimer's disease. Methods from April 2015 to February 2016, 80 patients with moderate Alzheimer's disease associated with psychobehavioral symptoms were collected from Qingdao Mental Health Center and were randomly divided into treatment group and control group. There were 40 cases in each group. The treatment group was treated with citalopram 10-30mg/d at the initial dose of 10mg/d. According to the response and tolerance of the patients to the drug, the dosage was gradually increased to the maximum dose of 30 mg / d. The control group was given the same dose of placebo. Both groups were given orally 10mg bidbidin hydrochloride for 12 weeks. MMSE was used to measure cognitive impairment, NPI (neuropsychiatric questionnaire) was used to measure mental and behavioral symptoms and stress of caregivers. Blood routine examination, urine routine examination, biochemistry, electrocardiogram, electroencephalogram (EEG) were performed in each patient. The efficacy and safety of the two groups were compared by examining the effect of taking medicine on the body and evaluating the adverse reactions by using the side effects scale (TESS). Results 1. After 12 weeks of treatment, there were significant differences between the treatment group and the control group in terms of agitation / aggression, apathy / indifference, depression / bad mood and anxiety (P 0.05). The three subtraction rates of depression / mood disorder and anxiety were respectively: 40.80,30.89 and 35.27.2, respectively. In the control group, the reduction rate of agitation / aggression was 30.34, which was lower than that of the treatment group (30.34.80). There was also a significant difference between the two groups in the changes of stress and NPI scores in the carers (P0.05), and the other symptoms in the control group (P < 0.05). There was no significant difference between the treatment group and the control group in the MMSE test. There was no significant difference in Tess scale between the two groups (P 0.05). Two patients in the treatment group received citalopram 30mg/d daily with prolonged QTC intervals, one of whom withdrew from the study. Both groups dropped out of 1 because of adverse reactions. Conclusion 1 citalopram combined with MJ can improve the symptoms of mental behavior, such as agitation / aggression, apathy / indifference, depression / bad mood and anxiety. The clinical symptoms of depression / mood disorder and anxiety were significantly effective. Citalopram combined with methadramide hydrochloride was more effective in improving agitation / aggression symptoms than that of MJ hydrochloride alone, compared with meadronium hydrochloride alone. Citalopram combined with methadine hydrochloride was more effective in reducing stress and NPI scores in caregivers. However, the overall clinical improvement effect may be limited. Citalopram combined with methadramide hydrochloride can improve cognitive function better than meadronium hydrochloride alone. Citalopram has good tolerance, long half-life and no obvious antiadrenergic and anticholinergic effects. It has little effect on cytochrome P450, less adverse reaction, and is suitable for the elderly. It is expected to be the main drug for the treatment of mental and behavioral symptoms of dementia patients. Significant studies have shown that citalopram adjuvant treatment of Alzheimer's disease patients with mental behavior symptoms have potential efficacy. It is expected to be a major drug for improving symptoms of mental behavior in Alzheimer's disease.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.16

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