Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
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jalali
1390
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2011
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online
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fulltext
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دوکسپین موثرتر از نورتریپتیلین و دارونما در درمان سندرم روده تحریکپذیر با غلبه اسهال: کارآزمایی بالینی شاهد دار تصادفی سه سوکور با دارونما
Doxepin is more effective than nortriptyline and placebo for the treatment of diarrhea-predominant irritable bowel syndrome: a randomized triple-blind placebo-controlled trial
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<p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span lang="FA" style="font-size: 10pt">زمینه و
هدف</span></strong><span lang="FA" style="font-size: 10pt">:</span><span lang="FA" style="font-size: 10pt"> </span><span lang="AR-SA" style="font-size: 10pt">درمان جاری سندرم روده تحریکپذیر
غالباً ناامیدکننده است. چندین مطالعه شاهد دار مزایای داروهای ضد افسردگی سه
حلقهای را برای سندرم روده تحریکپذیر بهویژه هنگامی که درد غالب است به اثبات
رساندهاند اما اثربخشی ضد افسردگیها در سندرم روده تحریکپذیر مورد اختلافنظر
است. هدف از این مطالعه مقایسه اثر دو داروی دوکسپین و نورتریپتیلین بر درمان
سندرم روده تحریکپذیر با غلبه اسهال بود. </span><strong><em><span lang="FA" style="font-size: 10pt"><br></span></em></strong></p><p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span lang="FA" style="font-size: 10pt">روش
بررسی:</span><em><span lang="FA" style="font-size: 10pt"> </span></em></strong><span lang="AR-SA" style="font-size: 10pt">75 بیمار با تشخیص سندرم روده تحریکپذیر بر اساس معیارهای </span><span style="font-size: 7pt">R</span><span style="font-size: 8pt">ome </span><span style="font-size: 7pt">III</span><span lang="AR-SA" style="font-size: 10pt"> به مدت دو ماه
تحت درمان قرار گرفتند. بیماران به طور تصادفی به یکی از سه گروه تحت درمان با دوکسپین،
نورتریپتیلین یا دارونما وارد شدند. یکماه و دو ماه پس از درمان مورد ارزیابی
بالینی قرارگرفتند و علایم و عوارض دارویی در پرسشنامه ثبت شد. جمع امتیازات برابر
تعداد علایم موجود برای هر بیمار در نظر گرفته شد که بین صفر تا شش بود.</span><span lang="AR-SA" style="font-size: 11pt"> <br></span></p><p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><span lang="AR-SA" style="font-size: 11pt"></span><strong><span lang="FA" style="font-size: 10pt">یافتهها:</span></strong><span lang="FA" style="font-size: 10pt"> </span><span lang="AR-SA" style="font-size: 10pt">میزان بهبودی درد شکم و نفخ در گروه دوکسپین به طور معنیدار
بیشتر از نورتریپتیلین و دارونما بود (به ترتیب 001/0</span><span style="font-size: 7pt">P=</span><span lang="AR-SA" style="font-size: 10pt"> و 012/0</span><span style="font-size: 7pt">P=</span><span lang="AR-SA" style="font-size: 10pt">).میزان بهبودی اسهال در گروه نورتریپتیلین
به طور معنیدار بیشتر بود (018/0</span><span style="font-size: 7pt">P=</span><span lang="AR-SA" style="font-size: 10pt">). میانگین میزان بهبودی بیماران دو ماه پس از درمان در گروه
دوکسپین 56/2، در گروه نورتریپتیلین 2 و در گروه دارونما 6/0 بود (05/0</span><span style="font-size: 7pt">P<</span><span lang="AR-SA" style="font-size: 10pt">). </span><strong><em><span lang="FA" style="font-size: 10pt"><br></span></em></strong></p><p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span lang="FA" style="font-size: 10pt">نتیجهگیری:</span><em><span lang="FA" style="font-size: 10pt"> </span></em></strong><span lang="AR-SA" style="font-size: 10pt">دوکسپین یا نورتریپتیلین در درمان
سندرم روده تحریکپذیر با غلبه اسهال در دوره درمانی دو ماه سودمند است. همچنین
داروی دوکسپین نسبت به نورتریپتیلین اثربخشی بهتری در درمان سندرم روده تحریکپذیر
با غلبه اسهال دارد. با این حال، مطالعات مقایسهای بزرگتر توصیه میشود. </span></p>
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<!--stripped--> <strong>Background</strong><strong>:</strong> The current treatment
of IBS is often unsatisfactory and frustrating. Several
controlled trials have demonstrated benefits of tricyclic antidepressants for irritable
bowel syndrome, especially when pain is a prominent symptom but the efficacy of
antidepressants in irritable bowel syndrome is controversial. The aim of this
study was to compare the effect of doxepin and nortriptyline on
diarrhea-predominant irritable bowel syndrome.<br><strong>Methods</strong><strong>:</strong> Seventy-five patients with IBS according to Rome
III criteria were treated for two months. The
patients were randomly assigned to one of three groups treated with doxepin,
nortriptyline or placebo. Subjects were assessed clinically one month and two
months after treatment. The symptoms and adverse effects of the drugs were
recorded in the questionnaire. The total score was considered as the number of
the symptoms for each patient, which ranged between zero and six.<br><strong>Results</strong><strong>:</strong> Improvements in abdominal pain and bloating in the doxepin group were
significantly higher than the nortriptyline or the placebo groups (P=0.001
and P=0.012, respectively).
However, improvement in diarrhea in patients on nortriptyline was significantly
higher than the other groups (P=0.018). The average
improvement of symptoms in the patients after two months of treatment in
doxepin, nortriptyline and placebo groups, respectively were 2.56,
2 and 0.6 (P<0.05).<br><strong>Conclusion:</strong> Both
doxepin and nortriptyline are effective for the treatment of
diarrhea-predominant irritable bowel syndrome in a period of two months but doxepin
seems to be more efficacious than nortriptyline in this regard. However, larger
comparative trials are suggested.</p>
دوکسپین،نورتریپتیلین،سندرم روده تحریکپذیر
Irritable bowel syndrome,doxepin,nortriptyline
352
358
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-221&slc_lang=fa&sid=1
Ghadir
MR
محمدرضا
قدیر