南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (07): 1012-.

• • 上一篇    下一篇

艾司西酞普兰干预干扰素治疗慢性丙型病毒性肝炎引发的精神症状

齐明华,周斌,苏梅蕾,潘集阳,张浩,张艳茹,张健,李威,王俊洁,周元平   

  • 出版日期:2013-07-20 发布日期:2013-07-20

Escitalopram for intervention of psychiatric adverse events during peginterferon-alfa-2a and ribavirin treatment for chronic hepatitis C

  • Online:2013-07-20 Published:2013-07-20

摘要: 目的旨在评估引起这些精神心理症状的易感因素并分析艾司西酞普兰干预这些症状的效果。方法59例慢性丙型病毒
性肝炎患者,经聚乙二醇干扰素联合利巴韦林的抗病毒治疗,12周时由精神科医师使用DSM-IV标准进行评估,并指导患者使
用SCL-90量表自评。对于符合重度抑郁标准者进行艾司西酞普兰干预治疗,在用药后4周,8周时再次行SCL-90测评。结果
中重度抑郁的易感因素有:男性,1b基因型,感染途径为静脉药瘾。干扰素相关中重度抑郁的发病率为32.2%。其他精神症状,
如:敌对、焦虑、人际关系敏感各因子的发生率为分别为19.7%,9.2%,5.26%。使用艾司西酞普兰治疗后4 周及8 周,患者的
SCL-90总分,敌对、焦虑、抑郁、人际关系敏感各因子得分显著下降。结论干扰素引发的精神症状在我国丙型肝炎的患者中发
生率较高,应做常规的精神症状评估,特别注意对静脉药瘾感染人群的评估,及时使用艾司西酞普兰对于干扰素引发的精神症
状有较好的疗效。

Abstract: Objective To evaluate the risk factors of psychiatric adverse events associated with PEG interferon and ribavirin
treatment for chronic hepatitis C and assess the efficacy of escitalopram intervention for these adverse effects. Methods
Fifty-nine patients with chronic hepatitis C undergoing interferon-based treatment for 12 weeks were assessed for major
depression using DSM-IV and SCL-90, and the patients identified to have major depression received escitalopram treatment
for intervention. SCL-90 was used to assess the psychological condition of the patients at the forth and eighth weeks of
escitalopram treatment. Results A male gender, 1b genotype, and intravenous infection are all risk factors of major depression.
The morbidity rate of interferon-based depression was 32.2% with rates of hostility, anxiety, depression and sensitivity of
19.7%, 9.2%, and 5.26%, respectively. The total score of SCL-90 and scores for hostility, anxiety, depression and sensitivity all
significantly declined after escitalopram treatment in the 19 patients with major depression. Conclusions Psychological
symptoms are common in HCV patients receiving interferon treatment, for whom regular psychological assessment is
essential especially for those patients with drug abuse. Prompt use of escitalopram is recommended for effective control of
major depression or other psychological symptoms in these patients.