坦度螺酮治疗功能性消化不良合并焦虑的临床观察

摘要

目的：观察坦度螺酮治疗功能性消化不良（functional dyspepsia， FD）合并焦虑状态患者的疗效和安全性。方法2012年3月至2013年12月北京协和医院消化内科门诊就诊的31例FD合并焦虑状态患者，既往常规治疗无效，口服坦度螺酮10 mg／次，3次／d，治疗4周，比较治疗前、治疗2周及治疗4周时 FD症状积分；比较治疗前和治疗4周时Zung焦虑、抑郁自评量表（ Zung anxiety and depression self－rating scales， SAS、 SDS ）评分，汉密尔顿焦虑、抑郁量表（Hamilton anxiety and depression scales， HAMA、 HAMD）评分，生活质量（SF－36）评分，液体营养餐负荷试验的变化，分析评价疗效，同时观察记录不良反应。结果治疗前、治疗2周、4周时总体症状积分分别为10．45±5．66、8．48±5．96、7．39±5．46，治疗2周、4周时均较治疗前明显下降（P＝0．002，0．020）；餐后饱胀不适和早饱两个单项症状积分在治疗2周、4周时较治疗前明显下降，差异有统计学意义（P均＜0．05）。 SAS、 HAMA及HAMD评分治疗4周较治疗前下降（P＝0．028，0．002，0．000）。生活质量（SF－36）评分中生理功能、躯体疼痛、总体健康状况分数在治疗4周时有改善（P＝0．033，0．022，0．041）。液体营养餐负荷试验阈值饮入量和饱足饮入量治疗前后差异无统计学意义（P＝0．285，0．532）。治疗期间有5例（16．1％）患者出现皮疹、瘙痒等不良反应，其中1例因不良反应停药。结论坦度螺酮治疗功能性消化不良合并焦虑患者安全有效，可以作为常规治疗无效时的一个选择。%Objective To observe the efficacy and safety of tandospirone in treating patients with func-tional dyspepsia ( FD) co-morbid with anxiety.Methods Thirty-one patients diagnosed with FD co-morbid with anxiety and failed to respond to routine therapy were recruited from the outpatient clinic of gastroenterology in Pe-king Union Medical College Hospital during the period of March 2012 to December 2013.The patients were trea-ted with tandospirone citrate tablets 10 mg thrice a day for 4 weeks.FD symptom scores before treatment, after 2-week treatment and after 4-week treatment were compared.The Zung anxiety and depression self-rating scales ( SAS and SDS ) , Hamilton anxiety and depression scales ( HAMA and HAMD ) , quality of life questionnaire ( SF-36) , and liquid nutrient load test results after 4-week treatments were compared with those before treatment to evaluate the efficacy of tandospirone treatment.Adverse reactions were recorded.Results The total symptom scores 2 weeks and 4 weeks after treatment were 8.48 ±5.96 and 7.39 ±5.463, both significantly lower than that prior to treatment (10.45 ±5.66; P=0.002, 0.020).Compared with before treatment, the discomfort after meal and early satiety symptom scores decreased significantly after 2-week and 4-week treatment (all P<0.05). The SAS, HAMA and HAMD scores declined significantly after 4-week treatment compared with pre-treatment score (P=0.028, 0.002, 0.000).SF-36 indicated significantly improved physiological function, body pain and total health condition after 4-week treatment (P=0.033, 0.022, 0.041).The threshold volume and satiety vol-ume in liquid nutrient load test showed no significant change after treatment (P=0.285, 0.532).During treat-ment, there were adverse reactions in 5 patients (16.1%, e.g.rash and pruritus) and one case withdrew from the therapy.Conclusion Tandospirone is effective and safe in treating functional dyspepsia patients with anxie-ty, offering an option when routine therapy fails.