| Objective To discuss influencing mechanism of antidepressants to bonemineral density and bone metabolism of patients with depression.Method Patientsmeeting the diagnostic criteria of depression in Diagnostic and Statistical Manual ofmental disorders,4th edition, DSM-IV are selected from the psychological departmentin Guiyang Medical College. Meanwhile, SCID (structured clinical interview researchedition for DSM-IV-TR disorders) is used to screen and exclude enrolled patients withschizophrenia depressive disorder caused by organic diseases, substance dependenceand the like. Based on the HAMD (Hamilton Depression Scale), patients with themarking criterion greater than or equals to17are determined to be enrolled patientswith depression; the patients are randomly divided into four groups of a sertralinegroup with31patients, a citalopram group with33patients, a venlafaxine group with30patients, and a reboxetine group with31patients. Respectively, at the beginningthat the patients are enrolled, and after a year of treatment, the severity of thedepression is evaluated by using HAMD, the contents of serum5-HT, OPG, CXT-1,TNF-α, osteoprotegerin, cell nucleus receptor activator of NF-KB ligand are measuredby adopting ELSA method, and the bone mineral densities of the femoral neck andlumbar vertebra L1-L4are measured by using dual energy X-ray absorptiometry.Result (1) clinical symptoms:1) compared with the patients before the treatment, theHAMD score of each group is obviously reduced after a year of anti-depressiontreatment,(P＜0.05);2) compared with the control group, the HAMD scores of thedrug groups are obviously reduced,(P＜0.05), the drug groups are pairwise compared,（P＞0.05), and the specific trend is that sertraline group, citalopram group,venlafaxine group and reboxetine group are greater than the control group.(2) The change of bone mineral density,1) compared with the patients before the treatment, the bone mineral densities of the femoral neck and L1-L4of the patients inthe sertraline group, the citalopram group, and the venlafaxine group are reduced afterthe a year of anti-depression treatment,(P＜0.05)，and the bone mineral densities ofthe femoral neck and L1-L4of the patients in the reboxetine group and the controlgroup have no obvious change,(P＞0.05);2) compared with the control group, thereduction degrees of the bone mineral densities of the femoral neck and L1-L4of thepatients in the sertraline group and the citalopram group are increased obviously,（P＜0.05）, and the reduction degrees of the bone mineral densities of the femoral neckand L1-L4of the patients in the venlafaxine group and the reboxetine group have noobvious change,（P＞0.05）; compared with the sertraline group, the reductiondegrees of the bone mineral densities of the femoral neck and L1-L4of the patients invenlafaxine group, the reboxetine group and the control group are reduced obviously,（P＜0.05）, and the reduction degrees of the bone mineral densities of the femoralneck and L1-L4of the patients in the citalopram group have no obvious change,(P＞0.05）; compared with the citalopram group, the reduction degrees of the bone mineraldensities of the femoral neck and L1-L4of the patients in the venlafaxine group andthe reboxetine group are reduced obviously,（P＜0.05）; compared with thevenlafaxine group, the reduction degrees of the bone mineral densities of the femoralneck and L1-L4of the patients in the reboxetine group have no obvious change （P＞0.05）; the specific downtrend is that the sertraline group and the citalopram group aregreater than the citalopram group, the reboxetine group and the control group.(3) The change of bone metabolism biochemical criterion level after a year ofanti-depression treatment:1, the concentration of serum5-HT,1) compared with thepatients before the treatment, the concentrations of the serum5-HT of the sertralinegroup, the citalopram group, the venlafaxine group and the reboxetine group areincreased,（P＜0.05）, and the concentration of serum5-HT of the control group hasno obvious change,（P＞0.05）;2) compared with the control group, theconcentrations of the serum5-HT of the patients in the drug groups are increasedobviously,（P＜0.05）; the drug groups are pairwise compared,（P＞0.05）, and thespecific increasing trend is that the sertraline group is greater than the citalopram group, the citalopram group is greater than the venlafaxine group, the venlafaxinegroup is greater than the reboxetine group, and the reboxetine group is greater than thecontrol group;2, the concentration of serum BGP,1) compared with the patientsbefore the treatment, the concentrations of serum BGP of the patients in the sertralinegroup and the citalopram group are reduced,（P＜0.05）, the concentrations of serumBGP of the patients in the venlafaxine group and the reboxetine group have noobvious change,（P＞0.05）, and the concentrations of serum BGP of the patients inthe control group are increased,（P＜0.05）;2) compared with the control group, thereduction degrees of the concentrations of serum BGP of the patients in the sertralinegroup, the citalopram group, the venlafaxine group and the reboxetine group areincreased obviously （P＜0.05）; compared with the sertraline group, the reductiondegrees of the concentrations of serum BGP of the patients in the venlafaxine groupand the reboxetine group are reduced obviously,（P＜0.05）, and the reductiondegrees of the concentrations of serum BGP of the patients in the citalopram grouphave no obvious change,（P＞0.05）；compared with citalopram group, the reductiondegrees of the concentrations of serum BGP of the patients in the venlafaxine groupand the reboxetine group are reduced obviously,（P＜0.05）; compared with thevenlafaxine group, the reduction degrees of the concentrations of serum BGP of thepatients in the reboxetine group have no obvious change,（P＞0.05）; the specificdowntrend is that the sertraline group and the citalopram are greater than thevenlafaxine group and the reboxetine group, and the venlafaxine group and thereboxetine group are greater than the control group;3, the concentration of serumTNF-α,1) compared with the patients before the treatment, the concentrations ofserum TNF-α of the patients in the sertraline, the citalopram group, the venlafaxinegroup, the reboxetine group and the control group are reduced obviously,（P＜0.05）;2) compared with the control group, the reduction degrees of the concentrations ofserum TNF-α of the patients in the sertraline group and the citalopram group areincreased obviously,（P＜0.05）， and the reduction degrees of the concentrations ofserum TNF-α of the patients in the venlafaxine group and the reboxetine group have no obvious change,（P＞0.05）; compared with the sertraline group, the reductiondegrees of the concentrations of serum TNF-α of the patients in the citalopram group,the venlafaxine and the reboxetine group are reduced obviously,（P＜0.05）;compared with the citalopram group, the reduction degrees of the concentrations ofserum TNF-α of the patients in the venlafaxine group and the reboxetine group arereduced obviously,（P＜0.05）; compared with the venlafaxine group, the reductiondegrees of the concentrations of serum TNF-α of the patients in the reboxetine grouphave no obvious change,（P＞0.05）; the specific downtrend is that the sertralinegroup is greater than the citalopram, and the citalopram group is greater than thevenlafaxine group, the reboxetine group and the contro group;4the concentration ofserum CTX-I,1) compared with the patients before the treatment, the concentrationsof the serum CTX-I of the patients in the sertraline group, the citalopram group andthe venlafaxine are increased,（P＜0.05）, the concentrations of the serum CTX-I ofthe patients in the reboxetine group and the control group have no obvious change,（P＞0.05）; compared with the control group, the increasing degrees of theconcentrations of the serum CTX-I of the patients in the sertraline group, thecitalopram and the venlafaxine are increased obviously,（P＜0.05）， and theincreasing degrees of the concentrations of the serum CTX-I of the patients in thereboxetine group have no obvious change,（P＞0.05）; compared with the sertralinegroup, the increasing degrees of the concentrations of the serum CTX-I of the patientsin venlafaxine group and the the reboxetine group are reduced obviously,（P＜0.05）,and the increasing degrees of the concentrations of the serum CTX-I of the patients inthe citalopram group have no obvious change,（P＞0.05）; compared with thecitalopram group, the increasing degrees of the concentrations of the serum CTX-I ofthe patients in the venlafaxine group and the reboxetine group are reduced obviously,（P＜0.05）; compared with the venlafaxine group, the increasing degrees of theconcentrations of the serum CTX-I of the patients in the reboxetine group have noobvious change,（P＞0.05）; the specific increasing trend is that the sertraline groupand the citalopram are greater than the venlafaxine group, the venlafaxine is greaterthan the reboxetine group and the control group;5the concentration of serum OPG,1) compared with the patients before the treatment, the concentrations of serum OPG ofthe patients in the sertraline, the citalopram group and the venlafaxine are reduced,（P＜0.05）, and the concentrations of serum OPG of the patients in the reboxetinegroup and the control group have no obvious change,（P＞0.05）;2) compared withthe control group, the reduction degrees of the concentrations of serum OPG of thepatients in the sertraline group, the citalopram group and the venlafaxine group areincreased obviously,（P＜0.05）, and the reduction degrees of the concentrations ofserum OPG of the patients in the reboxetine group have no obvious change,（P＞0.05）; compared with the sertraline group, the reduction degrees of the concentrationsof serum OPG of the patients in the citalopram group, the venlafaxine group and thereboxetine group are reduced obviously（P＜0.05）; compared with the citalopram, thereduction degrees of the concentrations of serum OPG of the patients in thevenlafaxine group have no obvious change,（P＞0.05）, and the reduction degrees ofthe concentrations of serum OPG of the patients in the reboxetine group and thecontrol group are reduced obviously,（P＜0.05）; compared with the venlafaxinegroup, the reduction degrees of the concentrations of serum OPG of the patients in thereboxetine group are reduced obviously,（P＜0.05）; the specific downtrend is thatthe sertraline group is greater than the citalopram group and the venlafaxine group,the citalopram group and the venlafaxine group are greater than the reboxetine groupand the control group;6the concentration of serum RANKL,1) compared with thepatients before the treatment, the concentrations of serum RANKL of the patients inthe sertraline group, the citalopram group, the venlafaxine group, the reboxetine groupand the control group have no obvious change,（P＞0.05）;2)compared with thecontrol group, the concentrations of serum RANKL of the patients in drug groupshave no obvious change,（P＞0.05）, and the drug groups are pairwise compared,（P＞0.05）.Conclusion (1) After a year of anti-depression treatment, different types ofantidepressants of sertraline, citalopram, venlafaxine and reboxetine can reduce theHAMD scores of the patients to indicate that the anti-depression treatment iseffective.(2) After a year of anti-depression treatment, sertraline, citalopram and venlafaxine can lower the bone mineral densities of the femoral neck and L1-L4; the degree is that the sertraline group and the citalopram group are greater than the venlafaxine group and the reboxetine group.(3) The antidepressants can affect the bone mineral densities of the patients by increasing the concentrations of serum5-HT and CTX-I, and lowering the concentrations of serum BGP and OPG of the patients with depression. |
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