| Objective:To research whether there is correlation between depression and bone mineral density in elderly patients with depression,and identify the effect of duloxetine on bone mineral density and bone metabolism in elderly patients with depression.To provide valuable and meaningful experimental data for clinical medication of senile depression.Method:Combined with a grade III level B psychiatric hospital and three psychiatry departments of three grade III level A general hospitals.A total of 120 elderly patients aged between 65 and 75 years from May 2016 to October who were diagnosed with depressive disorder and met the diagnostic criteria for DSM-IV depression were selected.The 120 patients were randomly divided into duloxetine treatment group and Seculin treatment group.According to the HAMD-17 and SDS scores,each group was divided into mild,moderate and severe groups.Both groups were given corresponding treatment for 12 weeks,HAMD-17 and SDS scores were scored at the end of the 2,4,12 week;1 to 4 lumbar vertebrae,lumbar right femur trochanter,right femoral neck and WARD BMD and T vaule were measured at before treatment and after 12 weeks of treatment.Serum calcium,serum phosphorus,serum alkaline phosphatase(ALP),serum parathyroid hormone(PTH)and 25 hydroxyvitamin D(25(OH)D)were determined simultaneously.The overall health status was evaluated by SF-36 before and after treatment,and the adverse reactions were observed by TESS.Multivariate analysis of variance,chi square test and T test were used to analyze the treatment results.To research whether there is correlation between depression and bone mineral density in elderly patients with depression,and determine the effect of duloxetine on bone mineral density and bone metabolism in elderly patients with depression.Research results:(?)The relationship between varying degrees of depression and bone mineral densityBefore treatment the depression degree of patients were negatively correlated with BMD of femoral neck.With the increase of depression degree,the BMD of patients decreased gradually,and there were statistical significance between the groups(P<0.05).(?)The effects of different drugs on bone mineral density and bone metabolism1.changes of BMD in four regions before and after treatment with different drugs:?The 1-4 lumbar vertebrae,right femoral neck,right femoral greater trochanter,and Ward triangle region were measured before treatment and at the end of 12 weeks of treatment respectively.The BMD values of these four sites showed:two groups of different parts of the BMD values showed no significant differences before treatment;The bone mineral density difference of duloxetine group of L1-L4 vertebral body and greater trochanter of femur was smaller than that of sertraline group before and after the treatment,the differences were statistically significant(P<0.05?0.01);?Before and after treatment the two groups in different degrees of depression of L1-L4 vertebral body BMD comparative analysis found in patients with moderate depression,the effects of bone mineral density of duloxetine group were less than that of sertraline group,the differences were statistically significant(P<0.05);?Analysis of variance using a randomized block design,comparative analysis the differences of BMD(dąs,points)in treatment(drugs)and group(variation between the degree of depression)before and after treatment found that;statistically significant changes in the L1-L4 vertebral and femoral trochanter(P=0.001<0.05),but there were no significant differences in the changes in femoral neck and WARD triangle site(P=0.933,0.665>0.05).2.The changes of T value in four major parts before and after treatment with different drugs:?The T values of the 1-4 lumbar vertebrae,right femoral neck,right femoral greater trochanter,and Ward triangle region were measured before treatment and at the end of the 12 weeks of treatment respectively,in these 4 cases found:two groups of different parts of the T values showed no significant differences before treatment;two groups of different parts of the T value comparison analysis showed that the degree of duloxetine group of L1-L4 vertebral body,femoral trochanter and WARD triangle T values were lower than those of sertraline group before and after treatment,with statistical significance(P<0.01).?Before and after treatment the two groups in different degrees of depression of L1-L4 vertebrae and femur trochanter T difference comparative analysis found that the effect of duloxetine group on T value was smaller than that of sertraline group,and the differences between mild and moderate group in L1-L4 vertebral body were statistically significant(P<0.05).In the greater trochanter of femur,the differences of moderate groups were statistically significant(P<0.05);?Using random block design variance analysis,the changes of T value difference(D + s,score)before and after treatment between treatment(drug)variation and area(depression degree)was compared and analyzed,the results showed:the changes in L1-L4 vertebral body,greater trochanter and WARD triangle were statistically significant(P<0.05),but there were no significant differences in the femoral neck(P=0.168>0.05).3.Changes of serum markers related to bone metabolism before and after treatment with different drugs:Detection of serum and bone metabolism index,duloxetine and Seculin treatment will lead to blood phosphorus,ALP and PTH increased and decreased serum calcium,25 hydroxyvitamin D,before and after the treatment t test in groups had statistically significant difference(P<0.01).Comparing the differences between the two groups before and after treatment,the effects of serum calcium,phosphorus,ALP,PTH and 25 hydroxyvitamin D in duloxetine group were smaller than those in sertraline group,and the differences of t test were statistically significant(P<0.05?0.01).(?)The effect of different drugs on the efficacy and adverse reactions of senile depression1.HAMD changes:accept paired t test,the HAMD scores of two groups before and after treatment significantly improved,the differences were statistically significant(P<0.01).Using repeated measures ANOVA,there were no significant differences in HAMD scores between the two groups before treatment,at the 4th and 12th weekend(P>0.05).At the end of the 2 weeks' treatment,the HAMD scores of duloxetine group were lower than those of sertraline group,the differences were statistically significant(P<0.05).2.SDS changes:Using paired t test,the SDS scores of two groups before and aftertreatment were significantly improved,the differences were statistically significant(P<0.01).By repeated measures ANOVA,there were no significant differences in SDS scores between the two groups before treatment,at the 4th and 12th weekend(P>0.05).At the end of the second weekend treatment,the SDS scores of duloxetine group were lower than those of sertraline group,the differences were statistically significant(P<0.05).3.Adverse reactions:The incidence of adverse reactions in duloxetine group and sertraline group were 36 cases and 34 cases respectively,the incidence rates were 61%and 60%,chi square test found that the differences between the two groups were not statistically significant(P>0.05).The incidence of constipation in duloxetine group was higher than that in sertraline group,the differences were statistically significant(P<0.05).The incidence of diarrhea was lower than that of sertraline group,the differences were statistically significant(P<0.05).(?)Effects of different medications on the overall health status of elderly patients with depression1.Before treatment,the SF-36 scale scores of the two groups were not statistically significant(P>0.05).By paired t test,before and after treatment SF-36 scores comparison between the the two groups showed that duloxetine group in body pain,general health,vitality,social function,emotional function and mental health scores were higher than those of sertraline group,the differences were statistically significant(P<0.05);The scores of general health,life vitality,social function,emotional function and mental health of the sertraline group were also increased,and the differences were statistically significant(P<0.05).2.Comparison of SF-36 scale scores between the two groups before and after treatment showed that duloxetine group in physical pain,overall health,vitality,emotional function and mental health and other aspects of the difference were significantly greater than the sertraline group,the differences were all statistically significant(P<0.05).Research conclusion:1.With the increase degree of depression,the bone mineral density of the femoral neck showed a decreasing trend in the elderly patients with depression.2.Duloxetine has less effect on bone mineral density than senile sertraline in the treatment of senile depression.3.Both Duloxetine and Seculin in the treatment of senile depression may lead to the increase of serum phosphorus,PTH and LAP,and the decrease of serum calcium and 25 hydroxy vitamin D,but the effect of duloxetine was less than that of Seculin.4.Duloxetine and sertraline were effective in the treatment of senile depression,with mild adverse reactions.Duloxetine was more effective than sertraline,but 4 weeks later,the efficacy of the two drugs was comparable.5.Through the overall health survey,in the overall health,vitality,emotional function and mental health and other aspects of duloxetine,the promotion effect is significantly greater than sertraline,also the patient's physical pain improved more significantly.In conclusion,duloxetine should be used as the first choice for the treatment of senile depression. |
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