摘要
目的：探讨舍曲林对恶性肿瘤患者执行功能及生活质量的影响，为更好地治疗晚期肿瘤提供参考。方法122例确诊的Ⅲ期或Ⅳ期恶性肿瘤患者经过医院焦虑抑郁量表（HAD）评估后分入抑郁组（n=86）或非抑郁组（n=36）。所有对象接受对症支持治疗的同时，抑郁组患者口服盐酸舍曲林25～75mg/d抗抑郁治疗，治疗周期为12周。在基线及12周末采用汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）评估焦虑抑郁程度，采用0～10视觉等级模拟（VAS）法进行疼痛评估，用威斯康星卡片分类试验（WSCT）评价执行功能，用健康状况调查表（SF-36）评估生活质量。结果基线时抑郁组与非抑郁组相比，焦虑抑郁程度、执行功能及生活质量下降方面均具有统计学差异。经过抗抑郁治疗，抑郁组焦虑抑郁程度改善，但仍显著高于非抑郁组。WSCT分析表明治疗后抑郁组错误总数平均改善（12.1±4.5）分，而非抑郁组却恶化（-2.3±3.8）分。抑郁组成绩的改善得益于持续错误数的改善[（10.8±3.7）vs（-2.4±3.5）]，而非抑郁组成绩恶化的主要原因为非持续错误数显著增加[（-8.1±4.7）vs（1.7±4.2）]，差异均达到统计学意义（P＜0.05）。SF-36分析发现基线时抑郁组与非抑郁组相比，生理功能（PF）、生理职能（RP）、躯体疼痛（BP）、总体健康（GH）、活力（VT）、社会功能（SF）、情感职能（RE）及精神健康（MH）各维度均明显下降，差异具有统计学意义（P＜0.01）。经过治疗，抑郁组VT、SF、RE、MH改善程度显著高于非抑郁组，分别为[（19.4±10.8）vs（-8.2±7.9）、（28.8±13.5）vs（-11.3±11.0）、（14.9±11.3）vs（-8.6±8.8）、（25.4±10.5） vs（-4.7±6.3）]，差异均具有统计学意义（P＜0.05）。多元回归分析表明HAMA、HAMD、疼痛评分、肿瘤分期与生活质量各个维度均存在显著的相关性。结论抑郁是导致晚期肿瘤患者生活质量和执行功能下降和的重要原因，舍曲林可减轻患者的抑郁症状，改善执行功能障碍，提高生活质量。研究结果对于指导临床实践有一定意义。
Objective To investigate the effects of antidepressant Sertraline on executive function and quality of life in patients with late-advanced cancer for a better therapy choice. Methods 122 patients with a diagnosis of stage III or stage IV cancer were recruited and assigned to depressed group （DG, n=86） or non-depressed group （NG, n=36） after assessed by Hospital anxiety and depression questionnaire （HAD）. All subjects were given supportive treatment, meanwhile the patients in DG received additional antidepressant treatment using Selective Serotonin Reuptake Inhibitor （SSRI）, Sertraline （25~75mg/d） for a 12-week follow-up period. A battery of neuropsychological tests were performed at the baseline and the endpoint using Hamilton anxiety scale （HAMA） and Hamilton depression scale （HAMD） for anxiety and depression, Wisconsin card sorting test （WCST） for executive function and Short form 36 （SF-36） for quality of life. A 0-10 grade Visual analogue scale was used to estimate the level of cancer-related pain. Results At the baseline, there were significant differences in total scores of HAMD and HAMA, performance of WCST and SF-36 domains. After antidepressant treatment the level of depression and anxiety decreased significantly in DG, but was still significantly higher than NG. The low executive function enhanced in DG, reflected by the improvement （12.1±4.5） of Total Errors （TE） due to the improved Perseverative Errors as compared to NG[（10.8±3.7） vs（-2.4 ± 3.5）], meanwhile a worsening executive function was found in TE in NG （-2.3±3.8） due to the increase of Non-perseverative Errors （NPE） compared with DG[（-8.1± 4.7）vs（1.7 ± 4.2）]. These differences were all statitical （P〈0.05）. The dimensions of SF-36 in physical functioning （PF）, role limitations-physical （RP）, bodily pain （BP）, general health （GH）, vitality （VT）, social functioning （SF）, role limitations-emotional （RE） and mental health （MH） were decreased significantly at the baseline in depressed group compared to NG （P〈0.01）. After 12-week Sertraline treatment, the improvement in DG in factors VT, SF, RE and MH were more powerful than in NG [（19.4±10.8）vs（-8.2±7.9）, （28.8±13.5）vs（-11.3±11.0）, （14.9±11.3）vs（-8.6±8.8） and （25.4±10.5）vs（-4.7±6.3）, all P 〈 0.05]. Multiple regression analysis indicated that HAMA, HAMD and VAS scores and tumor stage were significantly correlated to any one dimension of quality of life. Conclusion Depression is an important reason leading to the decline of quality of life and executive function in patients with advanced cancer. Antidepressant Sertraline can improve the executive function and quality of life which may be helpful for the clinical practice of cancer treatment.
出处
《中国医药科学》
2014年第3期12-17,共6页
China Medicine And Pharmacy
基金
浙江省卫生厅科研基金(N20110317)
关键词
肿瘤
抑郁
舍曲林
执行功能
生活质量
Cancer
Depression
Sertraline
Executive function
Quality of life
