经前情感障碍证卵巢类固醇激素发病机制探讨
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摘要
经前期综合征高发于育龄女性群体,严重影响患者情感及行为,造成人际关系紧张,严重类型为经前情感障碍症(Premenstrual Dysphoric Disorder,PMDD),尤以严重的精神类症状为主要表现,为中医典型的"情志病"之一。中西医对于PMDD发病机制的研究已经相当深入,但是因机制复杂至今阐释不清,但陆续有研究者注意到:该病显现于黄体期,消退于月经来潮,并且最早可追溯到青春期,而终于绝经期,卵巢类固醇激素水平的改变或与其存在莫大关系。此后,针对"激素发病说"的研究陆续开展,疾病相关性也逐渐被证实,但是从现象描述迈向本质阐明非一夕可成,具体研究到何种深度尚未可知。故欲立足国际前沿,把握关键科学问题,对激素发病机制相关研究系统整合分析,便于后续研究的相继开展。
Premenstrual syndrome occurs in women at childbearing age and affects the emotion and behavior of patients seriously, resulting in interpersonal tension. The serious type is premenstrual dysphoric disorder, especially severe psychotic symptoms. Chinese and Western medicine for the pathogenesis of PMDD has been deeply studied, but the mechanism is too complicated to explain clearly. More than one researcher have noticed that the disease is manifested in the luteal phase, subsided in menstrual cramps,which be traced back to adolescence, and finally menopausal, ovarian steroid hormone levels change or have a great relationship. Since then, the research on hormone diseases has been carried out one after another, and the disease-related diseases have also been gradually confirmed. However, it is not clear from the description of the phenomenon that the nature is elucidated. Therefore, based on the international forefront, this paper grasps the key scientific issues and systematically analyzes the relevant research systems on the pathogenesis of hormones, which facilitates subsequent research.
Premenstrual syndrome occurs in women at childbearing age and affects the emotion and behavior of patients seriously, resulting in interpersonal tension. The serious type is premenstrual dysphoric disorder, especially severe psychotic symptoms. Chinese and Western medicine for the pathogenesis of PMDD has been deeply studied, but the mechanism is too complicated to explain clearly. More than one researcher have noticed that the disease is manifested in the luteal phase, subsided in menstrual cramps,which be traced back to adolescence, and finally menopausal, ovarian steroid hormone levels change or have a great relationship. Since then, the research on hormone diseases has been carried out one after another, and the disease-related diseases have also been gradually confirmed. However, it is not clear from the description of the phenomenon that the nature is elucidated. Therefore, based on the international forefront, this paper grasps the key scientific issues and systematically analyzes the relevant research systems on the pathogenesis of hormones, which facilitates subsequent research.
引文
[1] Halbreich U,Borenstein J,Pearlstein T,et al.The prevalence,impairment,impact,and burden of premenstrual dysphoric disorder (PMS/PMDD)[J].Psychoneuroendocrinology,2003,28(3):1.
[2] Pilver CE,Libby DJ.Premenstrual dysphoric disorder as a correlate of suicidal ideation,plans,and attempts among a nationally representative sample[J].Social psychiatry and psychiatric epidemiology,2013,48(3):437-446
[3] Hong JP,Park S,Wang HR,et al.Prevalence,correlates,comorbidities,and suicidal tendencies of premenstrual dysphoric disorder in a nationwide sample of Korean women[J].Social psychiatry and psychiatric epidemiology,2012,47(12):1937-1945.
[4] Zachar P.A diagnostic and statistical manual of mental disorders history of premenstrual dysphoric disorder[J].The Journal of nervous and mental disease,2014,202(4):346-352.
[5] Janda C,Kues JN,Andersson G,et al.A symptom diary to assess severe premenstrual syndrome and premenstrual dysphoric disorder[J].Women & health,2017,57(7):837-854.
[6] Epperson CN.Making Strides to Simplify Diagnosis of Premenstrual Dysphoric Disorder[J].The American journal of psychiatry,2017,174(1):6-7.
[7] 高明周,高冬梅,刘晓琴,等.青春期经前期综合征病因病机及治疗的研究进展[J].中国中西医结合杂志,2016,36(2):251-255.
[8] 高明周,高冬梅,刘欢,等.青春期经前期综合征/经前情感障碍症流行病学研究进展[J].中华中医药杂志,2016,31(4):1361-1364.
[9] Andreano JM,Cahill L.Menstrual cycle modulation of medial temporal activity evoked by negative emotion[J].NeuroImage,2010,53:1286-1293.
[10] Goldstein JM,Jerram M,Abbs B,et al.Sex differences in stress response circuitry activation dependent on female hormonal cycle[J].J Neurosci,2010,30:431-438.
[11] 陈春萍,程大志,罗跃嘉.雌激素对情绪的影响:心理、神经、内分泌研究[J].中国科学:生命科学,2011,41(11):1049-1062.
[12] 侯艳娇.肝疏泄不及深层机制探索—经前期综合征肝气郁证脑区定位[D].济南:山东中医药大学,2014.
[13] 王德敬,郭晓艳,林乐军,等.PET-CT对肝气郁型经前期综合征患者郁怒症脑功能成像研究[J].辽宁中医杂志,2014,41(2):232-236.
[14] Baller Erica B,Shau-Ming Wei,Kohn Philip D,et al .Abnormalities of dorsolateral prefrontal function in women with premenstrual dysphoric disorder:a multimodal neuroimaging study[J].American Journal of Psychiatry,2013,170(3):305-314.
[15] Gingnell M,Bannbers E,Wikstr?m J,et al.Premenstrual dysphoric disorder and prefrontal reactivity during anticipation of emotional stimuli[J].European Neuropsychopharmacology,2013,23(11):1474-1483.
[16] Batra NA,Seres-Mailo J,Hanstock C,et al.Proton magnetic resonance spectroscopy measurement of brain glutamate levels in premenstrual dysphoric disorder[J].Biol Psychiatry,2008,63(12):1178-1184.
[17] Xenia Protopopescu,Oliver Tuescher A,C Honk Pan A,et al.Toward a functional neuroanatomy of premenstrual dysphoric disorder[J].Journalof Affective Disorders,2008,11 (108):87-94.
[18] 邵春娥,薛玲.白香丹胶囊对经前期综合征肝气逆证模型大鼠血清与不同脑区孕酮的影响[J].中医研究,2009,22(6):16-18.
[19] 李学智.雌性激素受体ER与PGR基因在经前期综合征模型动物下丘脑中的表达研究[D].济南:山东大学,2007.
[20] 赵斌.经前舒颗粒对PMS肝气郁证模型大鼠不同脑区雌激素受体表达的影响[D].济南:山东中医药大学,2009.
[21] 田振.雌激素膜受体GPR30在焦虑中的作用及机制研究[D].西安:第四军医大学,2016.
[22] Rubinow DR,Schmidt PJ.Gonadal steroid regulation of mood:the lessons of premenstrual syndrome[J].FrontNeuroendocrinol,2006,27:210-216.
[23] Wyatt KM,Dimmock PW,Ismail KM,et al.The effectiveness of GnRHa with and without ’add-back’ therapy in treating premenstrual syndrome:a meta analysis[J].Bjog An International Journal of Obstetrics & Gynaecology,2004,111(6):585.
[24] Schmidt PJ,NiemanLK,DanaceauMA,et al.Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J].N Engl J Med,1998,338:209-216.
[25] 牛聪慧.经前期综合征(重度,PMDD)证型分布及症状与女性激素间关系分析[D].济南:山东中医药大学,2014.
[26] 乔明琦,张惠云,于艳红,等.经前期综合征肝气逆证患者月经周期血清雌二醇、孕酮含量的动态变化[J].中医杂志,2006,47(4):295-297.
[27] 相宇.经轻胶囊治疗高雌激素导致的类经前期综合征的实验研究[D].成都:成都中医药大学,2004.
[28] Martinez PE,Rubinow DR,Nieman LK,et al.5ɑ-Reductase Inhibition Prevents the Luteal Phase Increase in Plasma Allopregnanolone Levels and Mitigates Symptoms in Women with Premenstrual Dysphoric Disorder[J].Neuropsychopharmacology Official Publication of the American College of Neuropsychopharmacology,2016,41(4):1093.
[29] Schmidt PJ,Martinez PE,Nieman LK,et al.Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression:Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable Levels[J].The American journal of psychiatry,2017,174(10):980-989.
[30] Schmidt PJ,Nieman LK,Danaceau MA,et al.Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J].New England Journal of Medicine,1998,338(4):209-216.
[31] Henshow C,Foreman D,Belcher J,et al.Can one induce premenstrual symptomatology in women with prior hysterectomy and bilateral oophorectomy?[J].Journal of Psychosomatic Obstetrics & Gynecology,1996,17(1):21-28.
[32] Segebladh B,Borgstr?m A,Nyberg S,et al.Evaluation of different add-back estradiol and progesterone treatments to gonadotropin-releasing hormone agonist treatment in patients with premenstrual dysphoric disorder[J].American Journal of Obstetrics & Gynecology,2009,201(2):1-8.
[33] Ko CH,Long CY,Yen CF,et al.Gonadotrophic hormone and reinforcement sensitivity systems in women with premenstrual dysphoric disorder[J].Psychiatry & Clinical Neurosciences,2014,68(11):785-794.
[34] Hengartner MP,Kruger THC,Geraedts K,et al.Negative affect is unrelated to fluctuations in hormone levels across the menstrual cycle:Evidence from a multisite observational study across two successive cycles[J].Journal of psychosomatic research,2017,99(3):21-27.
[35] Timby E,B?ckstr?m T,Nyberg S,et al.Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls-a pilot study[J].Psychopharmacology,2016,233(11):2109-2117.
[36] Dubey N,Hoffman JF,Schuebel K,et al.The ESC/E(Z) complex,an effector of response to ovarian steroids,manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder[J].Molecular psychiatry,2017,22(8):1172-1184.
[37] Nguyen TV,Reuter JM,Gaikwad NW,et al.The steroid metabolome in women with premenstrual dysphoric disorder during GnRH agonist-induced ovarian suppression:effects of estradiol and progesterone addback[J].Translational psychiatry,2017,7(8):e1193.
[38] Parry BL.For Women With PMDD,Acute Changes in Ovarian Steroids,But Not Enduring Higher Levels,Precipitate Symptoms[J].American Journal of Psychiatry,2017,174(10):917.
[39] 李乾.经前烦躁症的中医证候分布规律研究[D].济南:山东中医药大学,2012.
[40] 魏盛,乔明琦.肝主疏泄机制研究的进展、主要问题及其展望[J].陕西中医学院学报,2014,37(3):4-8.
[41] 石忠峰.“肝主疏泄与单胺类神经递质和性激素及其调节激素有关”假说新证据[D].济南:山东中医药大学,2002.
[42] 杨焕新,于艳红,吕晓敏,等.抑郁症肝气郁症患者面部表情及眼神的识别[J].中国中医基础医学杂志,2017,23(2):230-233.
[43] 高明周,王杰琼,安礼,等.基于体质人格的经前期综合征发病与干预探析[J].中国实验方剂学杂志,2016,22(13):223-228.
[44] 高明周,杨焕新,张震,等.人格、情绪与经前情感障碍证脑区机制探索[J].辽宁中医杂志,2016,43(5):932-936.
[45] 王莉眉.女性经前期综合征的中医证候(虚证)分布及相关体质调查[D].广州:广州中医药大学,2010.
[46] 喻琴,王红霞,宫建美,等.女大学生经前期综合征与D型人格的关系[J].中国心理卫生杂志,2017,31(4):333-336.
[47] 安晓妤,余跃生,姚瑞,等.医学专科女大学生经前期综合征与C型人格的关系[J].中国妇幼保健,2013,28(7):1079-1081.
[48] 黄丹,赵小淋,赵敏,等.医学院女大学生经前期综合征与人格特质的关系[J].中国健康心理学杂志,2018,26(1):68-73.
[2] Pilver CE,Libby DJ.Premenstrual dysphoric disorder as a correlate of suicidal ideation,plans,and attempts among a nationally representative sample[J].Social psychiatry and psychiatric epidemiology,2013,48(3):437-446
[3] Hong JP,Park S,Wang HR,et al.Prevalence,correlates,comorbidities,and suicidal tendencies of premenstrual dysphoric disorder in a nationwide sample of Korean women[J].Social psychiatry and psychiatric epidemiology,2012,47(12):1937-1945.
[4] Zachar P.A diagnostic and statistical manual of mental disorders history of premenstrual dysphoric disorder[J].The Journal of nervous and mental disease,2014,202(4):346-352.
[5] Janda C,Kues JN,Andersson G,et al.A symptom diary to assess severe premenstrual syndrome and premenstrual dysphoric disorder[J].Women & health,2017,57(7):837-854.
[6] Epperson CN.Making Strides to Simplify Diagnosis of Premenstrual Dysphoric Disorder[J].The American journal of psychiatry,2017,174(1):6-7.
[7] 高明周,高冬梅,刘晓琴,等.青春期经前期综合征病因病机及治疗的研究进展[J].中国中西医结合杂志,2016,36(2):251-255.
[8] 高明周,高冬梅,刘欢,等.青春期经前期综合征/经前情感障碍症流行病学研究进展[J].中华中医药杂志,2016,31(4):1361-1364.
[9] Andreano JM,Cahill L.Menstrual cycle modulation of medial temporal activity evoked by negative emotion[J].NeuroImage,2010,53:1286-1293.
[10] Goldstein JM,Jerram M,Abbs B,et al.Sex differences in stress response circuitry activation dependent on female hormonal cycle[J].J Neurosci,2010,30:431-438.
[11] 陈春萍,程大志,罗跃嘉.雌激素对情绪的影响:心理、神经、内分泌研究[J].中国科学:生命科学,2011,41(11):1049-1062.
[12] 侯艳娇.肝疏泄不及深层机制探索—经前期综合征肝气郁证脑区定位[D].济南:山东中医药大学,2014.
[13] 王德敬,郭晓艳,林乐军,等.PET-CT对肝气郁型经前期综合征患者郁怒症脑功能成像研究[J].辽宁中医杂志,2014,41(2):232-236.
[14] Baller Erica B,Shau-Ming Wei,Kohn Philip D,et al .Abnormalities of dorsolateral prefrontal function in women with premenstrual dysphoric disorder:a multimodal neuroimaging study[J].American Journal of Psychiatry,2013,170(3):305-314.
[15] Gingnell M,Bannbers E,Wikstr?m J,et al.Premenstrual dysphoric disorder and prefrontal reactivity during anticipation of emotional stimuli[J].European Neuropsychopharmacology,2013,23(11):1474-1483.
[16] Batra NA,Seres-Mailo J,Hanstock C,et al.Proton magnetic resonance spectroscopy measurement of brain glutamate levels in premenstrual dysphoric disorder[J].Biol Psychiatry,2008,63(12):1178-1184.
[17] Xenia Protopopescu,Oliver Tuescher A,C Honk Pan A,et al.Toward a functional neuroanatomy of premenstrual dysphoric disorder[J].Journalof Affective Disorders,2008,11 (108):87-94.
[18] 邵春娥,薛玲.白香丹胶囊对经前期综合征肝气逆证模型大鼠血清与不同脑区孕酮的影响[J].中医研究,2009,22(6):16-18.
[19] 李学智.雌性激素受体ER与PGR基因在经前期综合征模型动物下丘脑中的表达研究[D].济南:山东大学,2007.
[20] 赵斌.经前舒颗粒对PMS肝气郁证模型大鼠不同脑区雌激素受体表达的影响[D].济南:山东中医药大学,2009.
[21] 田振.雌激素膜受体GPR30在焦虑中的作用及机制研究[D].西安:第四军医大学,2016.
[22] Rubinow DR,Schmidt PJ.Gonadal steroid regulation of mood:the lessons of premenstrual syndrome[J].FrontNeuroendocrinol,2006,27:210-216.
[23] Wyatt KM,Dimmock PW,Ismail KM,et al.The effectiveness of GnRHa with and without ’add-back’ therapy in treating premenstrual syndrome:a meta analysis[J].Bjog An International Journal of Obstetrics & Gynaecology,2004,111(6):585.
[24] Schmidt PJ,NiemanLK,DanaceauMA,et al.Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J].N Engl J Med,1998,338:209-216.
[25] 牛聪慧.经前期综合征(重度,PMDD)证型分布及症状与女性激素间关系分析[D].济南:山东中医药大学,2014.
[26] 乔明琦,张惠云,于艳红,等.经前期综合征肝气逆证患者月经周期血清雌二醇、孕酮含量的动态变化[J].中医杂志,2006,47(4):295-297.
[27] 相宇.经轻胶囊治疗高雌激素导致的类经前期综合征的实验研究[D].成都:成都中医药大学,2004.
[28] Martinez PE,Rubinow DR,Nieman LK,et al.5ɑ-Reductase Inhibition Prevents the Luteal Phase Increase in Plasma Allopregnanolone Levels and Mitigates Symptoms in Women with Premenstrual Dysphoric Disorder[J].Neuropsychopharmacology Official Publication of the American College of Neuropsychopharmacology,2016,41(4):1093.
[29] Schmidt PJ,Martinez PE,Nieman LK,et al.Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression:Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable Levels[J].The American journal of psychiatry,2017,174(10):980-989.
[30] Schmidt PJ,Nieman LK,Danaceau MA,et al.Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J].New England Journal of Medicine,1998,338(4):209-216.
[31] Henshow C,Foreman D,Belcher J,et al.Can one induce premenstrual symptomatology in women with prior hysterectomy and bilateral oophorectomy?[J].Journal of Psychosomatic Obstetrics & Gynecology,1996,17(1):21-28.
[32] Segebladh B,Borgstr?m A,Nyberg S,et al.Evaluation of different add-back estradiol and progesterone treatments to gonadotropin-releasing hormone agonist treatment in patients with premenstrual dysphoric disorder[J].American Journal of Obstetrics & Gynecology,2009,201(2):1-8.
[33] Ko CH,Long CY,Yen CF,et al.Gonadotrophic hormone and reinforcement sensitivity systems in women with premenstrual dysphoric disorder[J].Psychiatry & Clinical Neurosciences,2014,68(11):785-794.
[34] Hengartner MP,Kruger THC,Geraedts K,et al.Negative affect is unrelated to fluctuations in hormone levels across the menstrual cycle:Evidence from a multisite observational study across two successive cycles[J].Journal of psychosomatic research,2017,99(3):21-27.
[35] Timby E,B?ckstr?m T,Nyberg S,et al.Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls-a pilot study[J].Psychopharmacology,2016,233(11):2109-2117.
[36] Dubey N,Hoffman JF,Schuebel K,et al.The ESC/E(Z) complex,an effector of response to ovarian steroids,manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder[J].Molecular psychiatry,2017,22(8):1172-1184.
[37] Nguyen TV,Reuter JM,Gaikwad NW,et al.The steroid metabolome in women with premenstrual dysphoric disorder during GnRH agonist-induced ovarian suppression:effects of estradiol and progesterone addback[J].Translational psychiatry,2017,7(8):e1193.
[38] Parry BL.For Women With PMDD,Acute Changes in Ovarian Steroids,But Not Enduring Higher Levels,Precipitate Symptoms[J].American Journal of Psychiatry,2017,174(10):917.
[39] 李乾.经前烦躁症的中医证候分布规律研究[D].济南:山东中医药大学,2012.
[40] 魏盛,乔明琦.肝主疏泄机制研究的进展、主要问题及其展望[J].陕西中医学院学报,2014,37(3):4-8.
[41] 石忠峰.“肝主疏泄与单胺类神经递质和性激素及其调节激素有关”假说新证据[D].济南:山东中医药大学,2002.
[42] 杨焕新,于艳红,吕晓敏,等.抑郁症肝气郁症患者面部表情及眼神的识别[J].中国中医基础医学杂志,2017,23(2):230-233.
[43] 高明周,王杰琼,安礼,等.基于体质人格的经前期综合征发病与干预探析[J].中国实验方剂学杂志,2016,22(13):223-228.
[44] 高明周,杨焕新,张震,等.人格、情绪与经前情感障碍证脑区机制探索[J].辽宁中医杂志,2016,43(5):932-936.
[45] 王莉眉.女性经前期综合征的中医证候(虚证)分布及相关体质调查[D].广州:广州中医药大学,2010.
[46] 喻琴,王红霞,宫建美,等.女大学生经前期综合征与D型人格的关系[J].中国心理卫生杂志,2017,31(4):333-336.
[47] 安晓妤,余跃生,姚瑞,等.医学专科女大学生经前期综合征与C型人格的关系[J].中国妇幼保健,2013,28(7):1079-1081.
[48] 黄丹,赵小淋,赵敏,等.医学院女大学生经前期综合征与人格特质的关系[J].中国健康心理学杂志,2018,26(1):68-73.