目的 探讨喹硫平联合伏硫西汀治疗难治性抑郁症的临床疗效。方法 选取2018年11月-2019年10月在天津市安定医院治疗的难治性抑郁症患者159例，随机分为对照组（81例）和治疗组（78例）。对照组口服氢溴酸伏硫西汀片，初始剂量为10 mg/d，1~2周后加至20 mg/d。治疗组在对照组的基础上口服富马酸喹硫平片，初始剂量为0.1 g/d，1~2周后增加到0.2 g/d。两组患者均连续治疗8周。观察两组患者临床疗效，同时比较治疗前后两组患者汉密尔顿抑郁量表（HAMD）评分、重复成套神经心理状态测验（RBANS）评分，及血清白细胞介素-6（IL-6）、IL-8、肿瘤坏死因子-α（TNF-α）和干扰素-γ（IFN-γ）水平。结果 治疗后，对照组临床有效率为72.84%，显著低于治疗组的85.90%，两组比较差异有统计学意义（P<0.05）。治疗后，两组HAMD在第2、4、8周末均明显下降（P<0.05），且治疗组在第4、8周末评分降低更明显（P<0.05）。治疗后，两组RBANS评分在第4、8周末均显著升高（P<0.05），且治疗组在第4、8周末均显著高于对照组（P<0.05）。治疗后，两组患者IL-6、IL-8、TNF-α、IFN-γ水平显著降低（P<0.05），且治疗组水平显著低于对照组（P<0.05）。结论 伏硫西汀联合喹硫平治疗难治性抑郁症起效快，可提高患者认知功能，安全性高。

Objective To investigate the clinical efficacy of quetiapine combined with vortioxetine in treatment of refractory depression. Methods Patients (159 cases) with refractory depression in Tianjin Anding Hospital from November 2018 to October 2019 were randomly divided into control (81 cases) and treatment (78 cases) groups. Patients in the control group were po administered with Vortioxetine Hydrobromide Tablets, the initial dose was 10 mg/d, and then increased to 20 mg/d after 1-2 weeks. Patients in the treatment group were po administered with Quetiapine Fumarate Tablets on the basis of the control group, the initial dose was 0.1 g/d, and then increased to 0.2 g/d after 1-2 weeks. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacy was evaluated, and the HAMD scores, RBANS scores, and the serum level of IL-6, IL-8, TNF-α and IFN-γ in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 72.84%, which was significantly lower than 85.90% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the HAMD scores in two groups were significantly decreased (P < 0.05) at the end of the 2nd, 4th and 8th week, and which in the treatment group were significantly lower than that in the control group at the end of the 4th and 8th week (P < 0.05). After treatment, the RBANS scores in two groups were significantly increased (P < 0.05) at the end of the 4th and 8th week, and which in the treatment group were significantly higher than that in the control group at the end of the 4th and 8th week (P < 0.05). After treatment, the serum levels of IL-6, IL-8, TNF-α and IFN-γ in two groups were significantly decreased (P < 0.05), and which in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Quetiapine combined with vortioxetine in treatment of refractory depression has a fast onset, can improve the cognitive function and has high safety.

R971

苏州市科技局指导性项目（SYSD2018165）