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柴胡安心胶囊治疗轻中度抑郁症的临床疗效及影响因素分析
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| 篇名： | 柴胡安心胶囊治疗轻中度抑郁症的临床疗效及影响因素分析 |
| TITLE： | Clinical efficacy and influencing factors of Chaihu anxin capsules in the treatment of mild-to-moderate depression |
| 摘要： | 目的 评价柴胡安心胶囊治疗轻中度抑郁症的临床疗效，分析其疗效的影响因素，并构建列线图预测模型。方法回顾性纳入2023年5月1日至2025年3月10日于河北医科大学第一医院就诊的轻中度抑郁症患者，根据用药方案分为柴胡安心胶囊组和米那普仑组，采用倾向性评分匹配（PSM）平衡组间基线差异，比较两种药物治疗8周后的疗效，包括治疗8周后24项汉密尔顿抑郁量表（HAMD-24）评分和变化值、汉密尔顿焦虑量表（HAMA）评分和变化值、治疗反应率。根据是否发生治疗反应，将柴胡安心胶囊组分为治疗反应亚组和无治疗反应亚组，采用单因素及多因素Logistic回归分析筛选影响患者发生治疗反应的独立因素，并以此构建列线图预测模型；通过受试者工作特征（ROC）曲线、校准曲线及决策曲线分析等评估模型的预测效能。结果PSM前，共纳入297例患者，包括柴胡安心胶囊组196例患者，米那普仑组101例患者。PSM后，柴胡安心胶囊组与米那普仑组各纳入44例患者。PSM后，柴胡安心胶囊组患者治疗8周后的HAMD-24评分和HAMA评分，以及米那普仑组患者治疗8周后的HAMD-24评分均显著低于基线值（P＜0.05）；柴胡安心胶囊组患者的HAMA评分变化值显著高于米那普仑组（P＝0.04）。多因素Logistic回归分析显示，年龄、总胆红素及基线HAMD-24评分为影响患者发生治疗反应的独立因素（P＜0.05）。构建的列线图预测模型的ROC曲线下面积为0.72（95%置信区间：0.637～0.799），校正Brier评分为0.143（95%置信区间：0.112～0.176）；在临床阈值概率8%～37%之间，与“全部干预”和“全部不干预”策略相比，该列线图预测模型可获得更高的净获益。结论柴胡安心胶囊改善轻中度抑郁症的疗效与米那普仑相当，且在改善焦虑症状方面具有一定优势；年龄、总胆红素及基线HAMD-24评分是影响柴胡安心胶囊治疗反应的独立因素，据此构建的列线图预测模型具有良好的区分度、校准度及临床适用性。 |
| ABSTRACT： | OBJECTIVE To evaluate the clinical efficacy of Chaihu anxin capsules in the treatment of mild-to-moderate depression， analyze the influencing factors of its efficacy, construct a nomogram prediction model.METHODS Patients with mild-to-moderate depression treated at The First Hospital of Hebei Medical University from May 1， 2023 to March 10， 2025 were retrospectively included and categorized into Chaihu anxin capsules group and milnacipran group according to treatment regimen. Propensity score matching （PSM） was used to balance baseline characteristics， and treatment efficacy was compared after 8 weeks， including 24 Hamilton Depression Scale （HAMD-24） scores and changes， Hamilton Anxiety Scale （HAMA） scores and changes， and treatment response rate after 8 weeks of treatment. Patients receiving Chaihu anxin capsules were further classified as responders or non-responders based on the occurrence of treatment response. Univariate and multivariate Logistic regression analyses were conducted to identify the influencing factors of treatment response， and a nomogram model was constructed to predict the probability of treatment response， its predictive performance was evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis.RESULTS A total of 297 patients were included before PSM， including 196 patients in the Chaihu anxin capsules group and 101 patients in the milnacipran group. After PSM， each group included 44 patients. After PSM， the HAMD-24 scores and HAMA scores at 8 weeks after treatment in the Chaihu anxin capsules group， as well as the HAMD-24 scores in the milnacipran group， were significantly lower than their respective baseline values （ P ＜0.05）； the change in HAMA score in the Chaihu anxin capsules group was significantly greater than that in the milnacipran group （ P ＝0.04）. Multivariable Logistic regression identified age， total bilirubin， and baseline HAMD-24 score as independent predictors of treatment response （ P ＜0.05）. The area under the ROC curve of the constructed nomogram prediction model was 0.72 （95% confidence interval： 0.637-0.799）， and the corrected Brier score was 0.143 （95% confidence interval： 0.112-0.176）； compared with the “all intervention” and “all non intervention” strategies， applying this nomogram prediction model could achieve higher net benefits within the threshold probability range of 8% to 37%.CONCLUSIONS The efficacy of Chaihu anxin capsules in improving mild-to-moderate depression is comparable to that of milnacipran， and it has certain advantages in improving anxiety symptoms； age， total bilirubin， and baseline HAMD-24 score are independent influencing factors for the treatment response of Chaihu anxin capsules. The nomogram prediction model constructed based on these factors has good discrimination， calibration， and clinical applicability. |
| 期刊： | 2026年第37卷第18期 |
| 作者： | 李雅青；郝玉佩；苑世朝；王文涛；周春华；韩艳丛；赵媛媛；张卓；付淑莲；于静 |
| AUTHORS： | LI Yaqing，HAO Yupei，YUAN Shizhao， WANG Wentao，ZHOU Chunhua，HAN Yancong，ZHAO Yuanyuan，ZHANG Zhuo，FU Shulian，YU Jing |
| 关键字： | 柴胡安心胶囊;米那普仑;抑郁症;列线图;预测模型;影响因素 |
| KEYWORDS： | Chaihu anxin capsules;milnacipran;Depression;nomogram;Prediction model;Influencing factors |
| 阅读数： | 1 次 |
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