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

摘要

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.%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.