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目的 比较单用SSRIs与SSRIs合并认知行为治疗(cognitive behavioral therapy,CBT)强迫障碍患者的临床疗效.方法 选取符合DSM-Ⅳ中强迫障碍诊断标准的门诊患者共80例,采用随机数字表法分为单用SSRIs治疗组(简称药物治疗组,n=40)和SSRIs合并CBT组(简称联合治疗组,n=40),分别于0、4、8、12、24、36、48周末采用Y-BOCS、HAMA等对患者进行盲法评定比较药物治疗和联合治疗的临床治疗效果,采用Logistic回归分析治疗效果的影响因素.结果 4周末联合治疗组f(20.0±6.4)分与(23.6±6.0)分]及药物治疗组[(20.8±7.0)分与(23.7±6.3)分]Y-BOCS总分均低于基线(t=4.05,P=0.000;t=3.46,P=0.001).2组患者Y-BOCS总分(F=3.986～7.104,P=0.009～0.049)和Y-BOCS强迫行为因子分(F=5.370～ 5.895,P=0.017～0.023)自8周末开始至48周末组间差异有统计学意义;2组患者Y-BOCS强迫思维因子分在48周末差异有统计学意义(F=5.523,P=0.021).Logistic回归分析显示,联合CBT、Y-BOCS总分4周末治疗是否有效对患者48周末的疗效有正性预测作用(OR=8.61、9.25,均P＜0.05).结论 药物联合CBT能有效缓解强迫障碍患者症状,且优于单纯药物治疗,尤其对强迫行为的改善更为突出,且接受CBT、4周末起效的患者在后续的治疗中能获得更好地改善.“,”Objective To compare the effect between the group of 5-selective serotonin reuptake inhibitor (SSRIs) treatment and the group of SSRIs combining cognitive behavioral therapy (CBT).Methods Eighty patients met the Diagnostic and Statistical Manual of Mental Disorders,Fourth edition criteria for obsessive-compulsive disorder were randomly designed to group of SSRIs (n=40),and combined therapy group (n=40).The Y-BOCS,HAMA,Global Assessment Function(GAF) were used to assess the efficacy blindly after 0,4,8,12,24,36,48 week treatment,influence factors of effect were evaluated using logistic regression analysis.Results At the end of 4th week,the Y-BOCS total score were lower than baseline in both groups (group of SSRIs:20.8±7.0 vs.23.7±6.3,t=3.46,P=0.001; group of combined therapy:20.0±6.4 vs.23.6±6.0,t=4.05,P=0.000).The comparision between groups showed that the Y-BOCS total scores and compulsion scores of two group had significant effects from 8th week to 48th week (Y-BOCS total scores:F=3.986-7.104,P=0.009-0.049 ; Y-BOCS compulsion scores:F=5.370-5.895,P=0.017-0.023),and the Y-BOCS obsession scores of two groups had a significant effect at the 48th week (F=5.523,P=0.021).Logistic regression analysis demonstrated that with CBT and the fourth week working had positid forecast on the prognosis of patients with long-term effect(OR=8.61,9.25,both P＜0.05).Conclusions SSRIs combining CBT could effectively alleviate symptons of obsessive-compulsive disorder,and better than single SSRIs group,especially for compulsive behavior.The patients with CBT response at the fourth week can get better improvement in the subsequent treatment.