癔球症患者食管测压结果、心理特征分析及小剂量阿米替林的干预效果研究

摘要 目的：分析患者的食管测压结果、心理特征及小剂量阿米替林的干预效果。方法：选取2017年5月~2019年5月期间上海市静安区市北医院收治的癔球症患者137例（癔球症组）,另选取同期到上海市静安区市北医院体检的健康志愿者50例（非癔球症组）,比较两组食管测压结果、癔球症症状评分量表（GETS）评分、汉密尔顿抑郁量表-17（HAMD-17）评分、汉密尔顿焦虑量表-14（HAMA-14）评分。按随机数字表法将癔球症患者分为对照组（n=68）和研究组（n=69）,对照组给予常规治疗,研究组则在对照组的基础上联合小剂量阿米替林干预。比较对照组、研究组的临床疗效、不良反应。结果：癔球症组、非癔球症组患者食管上括约肌（UES）长度、UES残余压、食管下括约肌（LES）静息压、收缩前沿速度（CFV）、远端潜伏时间（DL）组间比较差异无统计学意义（P>0.05）;癔球症组患者UES静息压高于非癔球症组（P<0.05）。癔球症组患者GETS、HAMA-14、HAMD-17评分高于非癔球症组（P<0.05）。研究组治疗后的临床总有效率为84.06%（58/69）,高于对照组的66.18%（45/68）（P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论：相对于非癔球症患者,癔球症患者具有较高的UES静息压,癔球症症状及较为严重的不良情绪,采用小剂量阿米替林对癔球症进行干预可提高治疗有效率,用药安全性较好。     

Forensic analysis of eleven cyclic antidepressants in human biological samples using a new reversed-phase chromatographic column of 2 μm porous microspherical silica gel

A high-performance liquid chromatographic method has been developed for the forensic analysis of eleven frequently used cyclic antidepressant drugs (ADSs) (amitriptyline, amoxapine, clomipramine, desipramine, dosulepine, doxepin, imipramine, maprotiline, melitracen, mianserine and nortriptyline) using a recently developed reversed-phase column with 2 μm particles for the analysis of biological samples. The separation was carried out using two different C₈ reversed-phase columns (column 1: 100 mm × 4.6 mm I.D., particle size 2 μm, TSK gel Super-Octyl; column 2: 100 mm × 4.6 mm I.D., particle size 5 μm, Hypersil MOS-C₈) for comparison. The mobile phase was composed of methanol-20 mM KH₂PO₄ (pH 7) (60:40, v/v) and the flow-rate was 0.6 ml/min for both columns. The absorbance of the eluent was monitored at 254 nm. When the eleven drugs were determined, the sensitivity with the 2 μm particles was about five times greater than with the 5 μm particles. Retention times on column 1 were shorter than those on column 2. These results show that the new ODS column packing with a particle size of 2 μm gives higher sensitivity and a shorter analysis time than the conventional ODS column packing when applied to the analysis of biological samples.     

In Vivo Spectrophotometric Determination of Striatal Acetylcholinesterase Activity: The Modulation Induced by the Antidepressant Amitriptyline

A new technology called in vivo spectrophotometry was applied to the quantitative determination of the variations in local acetylcholinesterase (AChE) activities. Repeated measurements of the enzyme activities in the same live animal allowed the study of the in vivo inhibition of AChE by amitriptyline. Interactions between AChE and this tricyclic antidepressant were investigated at the striatal level in anesthetized rats. In this anesthetized model, AChE assays were shown to be stable for approximately 8 h. The dose-effect relationship was explored in the 2.5- to 50-mg/kg amitriptyline range. A reversible inhibition was observed after acute amitriptyline administration. The maximum of inhibition appeared between 90 and 210 min after the intoxication and reached up to 22% for the 50-mg/kg dose. The threshold dose was established as 8 mg/kg. Evidence for an indirect interaction between tricyclic antidepressant and AChE was demonstrated when the total integrity of the biological system was preserved.     

阿米替林对脊髓电刺激治疗幻肢痛疗效的影响

目的：本研究旨在探讨阿米替林干预对脊髓电刺激（SCS）治疗幻肢痛疗效的影响。方法：研究对象为2007年1月至2009年6月在我科行SCS置入术且符合入组标准并自愿参加研究的幻肢痛患者,共获7例。术后SCS均开启,阿米替林治疗在术后1个月时开始。疼痛、情绪、生活质量评估采用视觉模拟评分法（visual analogue scales,VAS法）,现时疼痛强度评分法（presentpain intensity。PPI）,综合性医院焦虑抑郁量表（The Hospital Anxiety and Depression Scale,HAD）,疼痛失能指数（Pain disability index,PDI）。结果：（1）开启SCS后患者的疼痛、抑郁焦虑情绪及生活质量均得到显著改善。（2）所有患者在使用阿米替林治疗以后疼痛、情绪及生活质量也显著改善。结论：阿米替林能显著提高SCS对幻肢痛的疗效。     

Solid-phase microextraction with capillary gas-liquid chromatography and nitrogen-phosphorus selective detection for the assay of antidepressant drugs in human plasma

Solid-phase microextraction (SPME) was tested as a sample preparation for the simultaneous assay of ten antidepressant drugs and metabolites (TADs) in human plasma. Aqueous NaOH (0.5 ml, 1 M) and chloramitriptyline (50 μl, 40 μg/ml) as internal standard (I.S.) were added to a 2-ml plasma sample. This mixture was extracted with a 100-μm polydimethylsiloxane SPME fiber (Supelco) for 10 min. After washing in water and methanol (50%) and subsequent drying at room temperature, desorption of the fiber was performed in the injection port of a gas chromatograph at 260°C for 1 min (HP 5890, DB-17 30 m×0.25 mm I.D., 0.25 μm capillary; 0.7 ml/min nitrogen; nitrogen-phosphorus selective detection). The recovery was found to be very low from plasma (0.3% to 0.8%) but considerably higher from water (about 15%). Therefore, the high protein binding of antidepressants appears to be the main limiting mechanism for a better extraction. However, the analytes were well separated and the calibrations were linear between 125 ng/ml and 2000 ng/ml. The limits of quantification were about 90 ng/ml for imipramine and desipramine, 125 ng/ml for amitriptyline, trimipramine, doxepine, nortriptyline and mianserine and about 200 ng/ml for maprotiline, clomipramine and desmethylclomipramine. The recovery was improved by increasing the extraction time. The influence of the concentrations of the sum of proteins and of α-acid glycoprotein on the peak-area ratios A_TAD/A_I.S. and on absolute peak areas was studied. Peak-area ratios increased with decreasing protein concentration but were found to be independent on α-acid glycoprotein. A simple model for the explanation of the effect is presented. Measures for the improvement of sensitivity are discussed. As presented in this paper, which first describes SPME for the analysis of drugs in plasma, SPME with a short extraction time can be of only very limited value for therapeutic drug monitoring. Lower concentrations than the limit of quantification are usually found at therapeutic doses. The method can be useful for toxicological analysis after the accidental or suicidal intake of higher doses. However, an about 10-fold improvement of the sensitivity of the method seems to be possible.     

Discovery of diphenyl amine based sodium channel blockers, effective against hNav1.2

The development of new therapies for chronic pain is an area of unmet medical need. Central to pathways of chronic pain is the upregulation of voltage-gated sodium channels. The use of tricyclic antidepressants, which also have sodium channel activity, in chronic pain therapy prompted us to develop novel compounds from this scaffold. Herein, we show that the tricyclic moiety is not needed for effective inhibition of the [³H]-BTX binding site and sodium currents of hNa_v1.2. Our lead compound 6, containing a diphenyl amine motif, demonstrated a 53% inhibitory block of Na_v1.2 currents at 10 μM, which is greater than 50% increase in current block in comparison to the amitriptyline standard. Altogether our study establishes that the tricyclic motif is unnecessary for hNa_v1.2 activity and modification of the amine portion is detrimental to sodium channel block.     

Validation of non-aqueous capillary electrophoresis for simultaneous determination of four tricyclic antidepressants in pharmaceutical formulations and plasma samples

We present the validation of a method using non-aqueous capillary electrophoresis (NACE) for quantitative analysis of four tricyclic antidepressants (TADs) in pharmaceutical formulations and plasma. The method presented high resolution allowing the separation of the TADs in 4.3 min at optimized conditions: 50 mM ammonium acetate, 1 M acetic acid in acetonitrile, capillary with 48 cm in length, 40 cm to the detector, and voltage of 30 kV. Acceptable precision (relative standard deviation R.S.D.14.1% from plasma samples) and linearity were achieved using the internal standard (IS) method. The limits of quantification determined for plasma, after liquid-liquid extraction (LLE), were between 30 and 50 ng ml-1. These values are beyond the plasmatic therapeutic concentration. Our results were found comparable or better than those described in the literature for high performance liquid chromatography (HPLC)-based methods.     

Amitriptyline-Mediated Inhibition of Neurite Outgrowth from Chick Embryonic Cerebral Explants Involves a Reduction in Adenylate Cyclase Activity

We have previously shown that amitriptyline, a tricyclic antidepressant, inhibited neurite outgrowth from chick embryonic cerebral explants, and that dibutyryl cyclic AMP, 3-isobutyl-1-methylxanthine, or theophylline can enhance neurite outgrowth from embryonic olfactory explants. In the present study, we examined the mechanism(s) underlying amitriptyline-mediated inhibition of neurite outgrowth by studying the effects of amitriptyline on adenylate cyclase activity and cyclic AMP levels. In cultured chick embryonic cerebral explants, dibutyryl cyclic AMP or theophylline, but not dibutyryl cyclic GMP, enhanced neurite outgrowth and partially reduced the inhibitory effects of amitriptyline on neurite outgrowth. Explants treated with amitriptyline for 2 days showed decreased cyclic AMP levels that significantly correlated with the degree of neurite outgrowth. Amitriptyline inhibited both basal and forskolin-stimulated adenylate cyclase activity in vitro, but only in the presence of GTP. Taken together, these data suggest that amitriptyline inhibits the activity of adenylate cyclase via a GTP-dependent mechanism, and that the subsequent decrease in cyclic AMP level may be involved in amitriptyline-mediated inhibition of neurite outgrowth.     

Effects of the suppression of acute herpetic pain by gabapentin and amitriptyline on the incidence of delayed postherpetic pain in mice

The inoculation of mice with herpes simplex virus type-1 (HSV-1) causes herpes zoster-like skin lesions and pain-related responses (tactile allodynia and mechanical hyperalgesia) from day 5 after inoculation. Skin lesions completely heal by day 15 after inoculation, but about half of mice with acute herpetic pain show pain-related responses long after the lesions heal. Using this mouse model, we examined the effects of repeated administration of gabapentin and amitriptyline on the acute herpetic pain and the incidence of postherpetic pain. Gabapentin and amitriptyline were administered three times daily from day 5 to 11 after inoculation. Postherpetic pain-related responses were assessed on day 30 after inoculation. Gabapentin (10-100 mg/kg) produced the dose-dependent inhibition of acute herpetic pain-related responses. This medication produced marked reduction in the incidence of delayed postherpetic pain and the dose of 100 mg/kg produced the complete inhibition. Amitriptyline (10 mg/kg) did not affect the acute pain-related responses in the initial 3- and 2-day periods and then gradually inhibited them. This dosage produced a substantial but non-significant decrease in the incidence of postherpetic pain-related responses. Amitriptyline (1 and 3 mg/kg) was without effects on acute herpetic and postherpetic pain-related responses. The results strongly support the idea that the severity of the acute herpetic pain is a risk factor of postherpetic neuralgia. It may be worth testing the effects of gabapentin on acute herpetic pain and the incidence of postherpetic neuralgia in human subjects.     

阿米替林对脊髓电刺激治疗幻肢痛疗效的影响

目的:本研究旨在探讨阿米替林干预对脊髓电刺激(SCS)治疗幻肢痛疗效的影响。方法:研究对象为2007年1月至2009年6月在我科行SCS置入术且符合入组标准并自愿参加研究的幻肢痛患者,共获7例。术后SCS均开启,阿米替林治疗在术后1个月时开始。疼痛、情绪、生活质量评估采用视觉模拟评分法(visualanaloguescales,VAS法),现时疼痛强度评分法(presentpainin-tensity,PPI),综合性医院焦虑抑郁量表(The Hospital Anxiety and Depression Scale,HAD),疼痛失能指数(Pain disability index,PDI)。结果:(1)开启SCS后患者的疼痛、抑郁焦虑情绪及生活质量均得到显著改善。(2)所有患者在使用阿米替林治疗以后疼痛、情绪及生活质量也显著改善。结论:阿米替林能显著提高SCS对幻肢痛的疗效。