To Evaluate The Efficacy Of Anti-depressant And Therapeutic Mechanism On Patients Suffered Superior Mesenteric Artery Syndrome With Depression

Background and Objectives Superior mesenteric artery syndrome (SMAS) is a relatively rare disease clinically, It was first described by Von Rokitansky in 1842, but people are interested in SMAS until 1927 Wilkie reported 75 cases and became debating question. Many cause can lead to SMAS, including congenital factors,acquired factors and inducing factors, Patients suffered SMAS with psychological factor are often ignored, The diagnosis is usually established by using the upper gastrointestinal contrast x-ray study, It is reported recently years in china to use CDFI to detect the angle between superior mesenteric artery(SMA) and aorta(AO), and rarely reported to detect cortisol (Cor) concentration of patients suffered SMAS; Treatment of SMAS varies from conservative and postural therapy to operative therapy, Anti-depressant therapy on SMAS is rarely reported, Although the incidence of SMAS is lower, it can affect serious complication of functional gastrointestinal disorders, so it is important to make diagnosis and treatment early. CDFI can demonstrate directly and clearly the angle between SMA and AO, and the horizontal segment of duodenum across included angle, and CDFI can know the thickness of fatty tissue around SMA, and observe dynamically changes of enteric inner diameter and flowing condition of enteric content, mostly important, CDFI not only demonstrate anatomy of SMA and AO with 2Dacross section but also fix quantity aorto-mesenteric angle and changes of hemodynamics, determining duodenum obstruction by SMA and stegnosis degree of aorto-mesenteric angle, at the same time, eliminating duodenum extrinsic oncothlipsis ( paries posterior gastricus, pancreatic tumor, tumor of gallbladder, paraaortic lymphadenectasis,abdominal aneurysm and so on),duodenum intrinsic obstruction (duodenum intrinsic tumor,biliary calculus entering enteric cavity and corpus alienum and so on) and congenital intestinal tract dysfunction leading to duodenum obstruction are very valuable.Recently years, many research found exterior and interior that psychological factors can revoke weight loss and emaciation leading to SMAS, Patients usually suffer from long-term stress of chronic event, Long-term stress affect much psychological stress, demonstrating psychological abnormality, for example depression, anxiety. lead to neuroendocrine change. Hypothalamic-pituitary-adrenal axis (HPAA) is a very important endocrine axis, many researches demonstrate that patients with depression have hyperfimction of HPAA, Adrenocorticotrophic hormone (ACTH) and Cor concentration increasing in blood are their character, centers of superior accommodation of stress reaction of HPAA are hippcocampus, hippcocampus is important ingredient of limbic system, accommodating emotion, learning, memory and behavior, Continue stress revoke hypercortisol working lemporal lobe of cerebrum long time(hippcocampus) , decrease brain-derived neurotrophic factor(BDNF), make nerve cell of hippcocampus CA3 taper cellular layer survive decreasing, low hippcocampus nerve cause 5-HT decreasing, 5-HT concentration is associate with emotion.Methods (1) 45 cases of SMAS come from outwards and inwards of digestive medicine from August in 2004 to July in 2006, the first affiliated hospital Zhengzhou university, selecting randomly 30 cases as anti- depressant group, 15 cases as control group, they take part in the trial voluntarily, All patients use HAMD score, CDFI examining the angle between SMA and AO, radio-immunity detecting cortisol concentration in pre- cure and post- cure both groups. (2) Anti- depressant group receive paroxetine treatment for 8 weeks, control group receive conventional treatment for 8 weeks, The score of HAMD and digestive symptom and changes of included angle evaluate therapeutic effect. (3) The data is analysized by statistical software SPSS 10.0, x|-±s and t-test are used to analysize the difference between different groups, a=0.05 is considered as statistically significant value.Results 1. The HAMD scales score of control group has no obvious differencein pre-cure and post-cure (P>0.05); The HAMD scales score of anti-depressant is 22.10+4.74, which is significantly higher than (12.53 + 5.46) post-cure (P<0.01).2. The angle between SMA and AO of control group has no obvious difference in pre-cure and post-cure (P>0.05); The angle between SMA and AO of post-cure in anti-depressant group is 28.29 + 5.45, which is much bigger than (15.24 + 4.57) pre-cure (P<0.01).3. Cortisone concentration of control group has no obvious difference in pre-cure and post-cure (P>0.05); cortisone concentration of light anti-depressant group is 147.95±44.97ng/ml,which is higher than (131.85±25.37ng/ml) than pre-cure (P<0.05), middle anti-depressant group is 309.80±17.12ng/ml, which is significantly higher than (220.70±24.99ng/ml) post-cure (P<0.01).4. The score of digestive symptom has no obvious difference in pre-cure both groups, the digestive symptom score of control group is 7.53 +4.41 in post-cure, which is higher than (4.75+4.32) anti-depressant group (P<0.05).Evaluating therapeutic effect to Anti-depressant: Anti-depressant group carry out the HAMD scales score in pre-cure and post-cure, the scores of HAMD exceeding 75 percent has 4 cases, 9 cases between 50 percent and 75 percent, 11 cases between 25 percent and 50 percent, total therapeutic effective rate is 80 percent (24/30). Conclusion 1. The HAMD scale score is higher in patients suffered superiormesenteric artery syndrome with depression and anxiety, which suggests that psychological factor maybe play key role in superior mesenteric artery syndrome2. CDFI can detect the angle between SMA and AO, and diagnose SMAS, less painful and simple and easy3.Patients suffered superior mesenteric artery syndrome with psychological abnormity are hyperfunction of HPA axis, and appear the changes of endocrine, which suggests that the changes of hormone maybe play key role in superior mesenteric artery syndrome, to treat to provide new idea4. Anti-depressant drug (paroxetine) may alter compression of superior mesenteric artery syndrome, improve clinical symptom and quality of life, which suggests anti-depressant therapy play key role in treatment of superior mesenteric artery syndrome with depression...