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中国临床药理学与治疗学 ›› 2020, Vol. 25 ›› Issue (4): 440-446.doi: 10.12092/j.issn.1009-2501.2020.04.014

• 药物治疗学 • 上一篇    下一篇

选择性5-羟色胺再摄取抑制剂类抗抑郁药舍曲林对产后抑郁患者眼表功能影响

葛 薇,盛文燕,许琦彬,李秋实,苏铃雅,吴双庆   

  1. 浙江省中西医结合医院眼科,杭州 310003,浙江
  • 收稿日期:2020-01-13 修回日期:2020-03-02 出版日期:2020-04-26 发布日期:2020-05-12
  • 通讯作者: 吴双庆,女,副主任医师,硕士生导师,研究方向: 眼科学。 Tel: 0571-56108710 E-mail: shuangqingwu@zju.ed.cn
  • 作者简介:葛薇,女,硕士,主治医师,研究方向: 眼科学。 Tel: 0571-56108710 E-mail: v.v.anna@163com
  • 基金资助:
    杭州市医药卫生科技项目(0020190136);杭州市农业与社会发展科研项目(20170533B70)

Effects of SSRI antidepressant sertraline on ocular surface function in patients with postpartum depression

GE Wei, SHENG Wenyan, XU Qibing, LI Qiushi, SU Lingya, WU Shuangqing   

  1. Department of Ophthalmology, Zhejiang Integrated Traditional and Western Medicine, Hangzhou 310003, Zhejiang, China
  • Received:2020-01-13 Revised:2020-03-02 Online:2020-04-26 Published:2020-05-12

摘要: 目的:研究选择性5-羟色胺再摄取抑制剂(SSRI)抗抑郁药舍曲林对产后抑郁患者眼表功能的影响。方法:本研究为前瞻性自身对照研究。43例诊断为产后抑郁首次需要服用舍曲林的患者在进行用药前及用药2个月后进行汉密尔顿抑郁量表(Hamilton depression scale,HAMD)调查、眼表指数评分问卷(ocular surface disease index,OSDI)调查,泪膜破裂时间(tear break up time,TBUT)、泪液分泌实验I(Schirmer I test,SIT)、角膜染色试验(fluorescent test,FL)以及泪液渗透压(tear osmolarity)、泪液炎症因子白细胞介素-6(interleukin- 6,IL-6)、 泪液金属基质蛋白酶-9(matrix metalloproteinases-9,MMP-9)的检测。比较用药前后各项干眼指标的变化。结果:用药后2个月,HAMD评分明显降低,差异均具有统计学意义(P<0.01)。药物治疗有效性与干眼无相关性(t=0.119,P>0.05),用药2个月后,OSDI评分升高,TBUT时间明显缩短、泪液分泌减少,FL评分增高,泪液渗透压升高,差异均具有统计学意义(P<0.01、P<0.01、P<0.05、P<0.01、P<0.01)。IL-6、MMP-9在用药后2个月,表达水平增加,差异均具有统计学意义(P<0.01、P<0.01)。泪液渗透压和IL-6之间呈正相关(r=0.472,P<0.01),泪液渗透压和MMP-9之间呈正相关(r=0.403,P<0.01),泪液渗透压与TBUT呈负相关(r=-0.536,P<0.01),泪液渗透压与FL无相关性(r=0.143,P>0.05),证明干眼发生时泪液渗透压升高、泪液炎症因子及泪液金属基质蛋白酶表达水平增加。结论:舍曲林能有效缓解和治愈产后抑郁,但是长期服用可以造成眼表功能的损害,导致干眼的发生率上升。

关键词: 舍曲林, 产后抑郁, 干眼, 泪液渗透压

Abstract: AIM: To investigate the effect of SSRI antidepressant sertraline on ocular surface function in patients with postpartum depression.METHODS: This was a prospective case-control study. Forty-three patients diagnosed as postpartum depression receiving sertraline for the first time were investigated with the HAMD, OSDI, TBUT, SIT, FL, tear osmolarity and IL-6, MMP-9 before medication and 2 months after medication. The changes of dry eye indexes before and after medication were compared.RESULTS:After 2 months of medication, HAMD score was significantly decreased, with statistically significant differences (P<0.01). There was no correlation between efficacy of medication and dry eye (t=0.119, P>0.05). After 2 months of medication, OSDI score increased, TBUT time shortened significantly, tear secretion decreased, FL score increased, tear osmolarity increased. The differences were statistically significant (P<0.01, P<0.01, P<0.05, P<0.01, P<0.01, P<0.01, P<0.01, respectively). The expression level of IL-6 and MMP-9 increased significantly 2 months after medication, with statistically significant differences (P<0.01 and P<0.01, respectively). There was a positive correlation between tear osmolarity and IL-6 (r=0.472, P<0.01), a positive correlation between tear osmolarity and MMP-9 (r=0.403, P<0.01), a negative correlation between tear osmolarity and BUT (r=-0.536, P<0.01), and no correlation between tear osmolarity and FL (r=0.143, P>0.05), which indicated that tear osmolarity, tear inflammatory factor and tear metalloproteinase expression level increased when dry eye occurred. CONCLUSION:Sertraline can effectively relieve and cure postpartum depression, but long-term administration can cause damage to ocular surface function, leading to an increase in the incidence of dry eye.

Key words: sertraline, postpartum depression, dry eye, tear osmolarity

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