【作者】 李倩；

【导师】 孙月吉；

【作者基本信息】 大连医科大学 ， 精神病与精神卫生， 2008， 硕士

【摘要】 目的观察n-3不饱和脂肪酸(n-3PUFA)辅助赛乐特治疗自杀未遂的抑郁症患者的临床效果。对象和方法本研究收集2005年8月至2006年12月在大连市金州区中心医院和吉林市精神病医院就诊的39例自杀未遂的抑郁症患者为研究对象。采取随机双盲的方法,应用n-3PUFA对39例自杀未遂的抑郁症患者进行辅助治疗,疗程为3个月,其中21例为n-3PUFA组,18例为安慰剂组。所有患者都接受了标准抗抑郁药物治疗(赛乐特20mg/d)。所有病例都在治疗前、治疗1.5个月和治疗3个月的时点上,抽取5ml静脉血,进行红细胞膜脂肪酸水平测定,同时采用汉密尔顿抑郁量表,贝克抑郁自评问卷及贝克自杀意图量表进行心理评估。采用SPSS12.0软件包,进行了t检验、χ2检验、方差分析和Pearson相关分析。结果1. 39例自杀未遂抑郁症患者抑郁得分与脂肪酸的相关分析。汉密尔顿抑郁量表得分与AA和AA/EPA呈正相关(P<0.05)。2.治疗前、治疗1.5个月和治疗3个月三时点,n-3PUFA组和安慰剂组比较。(1)抑郁状况:两组在治疗前后的三个时点汉密尔顿抑郁量表和贝克抑郁自评问卷得分之间差异无统计学意义(P>0.05)。(2)自杀意念情况:两组在治疗前后的三个时点贝克自杀意图量表得分之间差异无统计学意义(P>0.05)。(3)红细胞膜脂肪酸水平:治疗前,两组之间差异无统计学意义(P>0.05);治疗1.5个月,n-3PUFA组与安慰剂组在20:5 n-3(EPA), 22:6 n-3(DHA), n-3%和n-6/n-3上的差异具有统计学意义(P<0.05);治疗3个月,n-3PUFA组和安慰剂组在20:5 n-3(EPA), 22:6 n-3(DHA), n-3%和n-6/n-3的差异具有统计学意义(P<0.05)。3.治疗前后各种指标自身比较。(1)抑郁状况在汉密尔顿抑郁量表和贝克抑郁自评问卷得分上,n-3PUFA组及安慰剂组在治疗前、治疗1.5个月和治疗3个月三个时间点自身比较,差异均具有统计学意义(P<0.05)。(2)红细胞膜脂肪酸水平n-3PUFA组治疗前后红细胞膜脂肪酸水平的自身比较,三组之间在20:5 n-3(EPA), 22:5 (n=3), 22:6 n-3(DHA), n-3%和n-6/n-3上的差异具有统计学意义(P<0.05);安慰剂组治疗前后红细胞膜脂肪酸水平的自身比较,三组之间的差异无统计学意义(P>0.05)。结论1. 39例自杀未遂抑郁症患者抑郁得分越高,AA和AA/EPA越高。2. n-3PUFA组和安慰剂组抑郁症状改善是同等的。3. n-3PUFA组和安慰剂组自杀意念降低程度是同等的。4.自杀未遂抑郁症患者赛乐特治疗中,n-3PUFA没有辅助作用。更多还原

【Abstract】 Objective: To find supplementary effects of n-3 polyunsaturated fatty acids to Paroxetine for depression of suicide attempters.Objects and Methods:We had drawn out 39 attempted suicide patients who suffering from depression from Dalian Jinzhou District Central Hospital and Jilin psychiatric hospital during August 2005 to December 2006. 21 cases were given n-3PUFA to intervention by 3 months with random and double blind method, and 18 cases were served as control. During the intervention period, 39 attempted suicide patients had received fixed dose of antidepressant (Paroxetine 20mg/d). In the same time, HRSD (Hamilton Depression Rating Scale), BDI (Beck’s depression inventory) and SIS (the Suicide Intent Scale) were evaluated respectively at baseline, then 1.5 and 3 months. Blood samples were collected from 39 attempted suicide patients at above 3 time points to fatty acid analysis.Data was input in the computer, SPSS12.0 software was used to t test, Chi-square, one-way ANOVA and Pearson correlation.Results: Firstly, how correlation existed between the depressed scores of 39 suicide attempters and the fatty acids level. Scores of HRSD positively correlated with AA, AA/EPA. Secondly, Comparison between n-3 PUFA intervention group and control group at 3 time points.①Depressive state There were no significant differences between n-3 PUFA intervention group and control group on scores of HRSD and BDI at 3 time points (P>0.05).②Suicide ideation There were no significant differences between n-3 PUFA intervention group and control group on scores of SIS at 3 time points(P>0.05).③PUFA levels of erythrocyte membrane There were no significant differences between n-3 PUFA intervention and control group at baseline (P>0.05); There were significant differences between n-3 PUFA intervention group and control group on 20:5 n-3(EPA), 22:6n-3(DHA), n-3% and n-6/n-3 at 1.5 and 3 months point (P<0.05). Thirdly, Self- comparison among the 3 points of time before and after intervention.①Depressive state Some significant differences were found on scores of HRSD and BDI in any one of n-3 PUFA intervention group and control group to self-comparison among 3 points of time (P<0.05).②PUFA levels of erythrocyte membrane In n-3 PUFA intervention group, some significant differences existed in 20:5 n-3(EPA), 22:5 (n=3), 22:6n-3(DHA), n-3% and n-6/n-3 at self-comparison among 3 time points (P<0.05); In the control group, no significant differences were found on PUFA levels of erythrocyte membrane at self-comparison of 3 time points (P>0.05).Conclusions:①Depressed scores of 39 suicide attempters with depression are higher, AA and AA/EPA are higher.②Improving depression is equal between n-3 PUFA intervention group and control group.③Reducing suicide ideation is equal between n-3 PUFA intervention group and control group.④There are no supplementary effects of n-3 PUFA to Paroxetine for depression of suicide attempters.更多还原