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目的 验证米氮平治疗抑郁症早期起效的特点,全面比较17项-汉密尔顿抑郁量表(HDRS-17)各因子的早期改善对4周后疗效的预测效能.方法 82例抑郁症患者接受米氮平治疗,开放性观察4周,以HDRS-17评价疗效.将量表条目分为情绪(F1)、精神性焦虑(F2)和躯体性焦虑(F3)3个因子,以受试者操作特征曲线(ROC)下面积AUC评估第1、2周(记为AUC1、AUC2)时各因子减分率对第4周达到治疗有效和临床缓解的预测值.结果 治疗2周后,67例(81.7％)患者早期起效,18例(22.0％)有效;4周后分别有57例(69.5％)和33例(40.2％)达到有效和临床缓解.ROC分析:(1)HDRS-17总分可有效预测终点达治疗有效和临床缓解,且第2周的预测效能均优于第1周,分别为:AUC1=0.69,AUC2=0.87,Z=5.547,P＜0.01和AUC1=0.65,AUC2=0.74,Z=3.475,P＜0.01;大部分因子均有良好的预测效能(0.5＜AUC＜0.9,P＜0.05);(2)与HDRS-17总分比较,只有F1的预测效能与之差异无统计学意义(P＞0.05);(3)各因子间比较,第2周时F1的预测效能优于F2、F3 (P＜ 0.05);(4)在敏感性、阴性预测值和准确率上,F1、F2和F3的预测值依次降低,但特异性均较低.结论 米氮平治疗抑郁症有早期起效的特点,HDRS-17各因子的早期改善可预测米氮平后4周后的疗效,且F1具有更好的预测价值.“,”Objective To verify the notion that mirtazapine exerts early improvement (EI) in depression treatment,and further to evaluate reliability of EI on the symptom clusters of 17-item Hamilton Depression Rating Scale (HDRS-17) for predicting treatment outcomes.Methods The 4-week,open-label clinic trial included 82 eligible patients with depression.All received mirtazapine monotherapy.Efficacy was measured by HDRS-17,which was divided into 3 symptom clusters (mood,psychic anxiety,and somatic anxiety).By using the receiver operating characteristic (ROC) analysis,areas under ROC curve (AUC) were calculated to estimate the predictive values of EIs of HDRS-17 total score and its factors at week 1 and 2 (namely AUC1 and AUC2) for prognosticating treatment outcomes at week 4,and pair-wise comparisons between the AUCs were finally conducted.Results After 2-week treatment,67 (81.7％) patients gained early onset,and 18 (22.0％) gained early response.At endpoint,57 (69.5％) and 33 (40.2％) patients achieved treatment response and remission respectively.ROC analysis either on HDRS-17 total score or its factors showed reliable predictive effects (0.5＜AUC＜0.9,P＜0.05),including that:1) AUC for HDRS-17 total score gave the markedly higher values at week 2 than at week 1 (AUC1 =0.69,AUC2=0.87,Z=5.547,P＜0.01 for predicting later response and AUC1 =0.65,AUC2=0.74,Z=3.475,P＜0.01 for predicting later remission),2)only mood factor among the 3 factors denoted equal AUC values to that for HDRS-17 to-tal score,3)mood cluster was superior to the others because of its higher AUC values (P＜0.05),and 4)the clusters of mood,psychic anxiety and somatic anxiety presented declined values in turn in sensitivity,negative predictive value and accuracy,but low specificity.Conclusion Mirtazapine is confirmed to act an early onset in depression treatment.Three factors of HDRS-17 are reliably predictive of final outcomes (4-week),and F1 factor is bet