围绝经期抑郁发作患者治疗前后甲状腺激素水平
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摘要
目的:探讨围绝经期抑郁发作患者的甲状腺激素水平及其治疗前后的变化,了解焦虑、抑郁症状与甲状腺激素水平的相关性。方法:选取24项汉密顿抑郁量表(HAMD-24)评分≥20分的围绝经期抑郁发作患者133例(脱落34例,共完成99例),口服艾司西酞普兰治疗。于治疗基线、4周末、8周末行HAMD-24和汉密尔顿焦虑量表(HAMA-14)评分,并检测甲状腺激素水平。采用自身对照研究方法,比较治疗前后患者抑郁症状的评分变化,以及与甲状腺激素水平的相关性。结果:HAMD-24、HAMA-14评分在治疗4周末、8周末均较基线显著下降(F=1354.384,92.021;P<0.01);FT4水平逐渐下降(F=10.275,P<0.001),治疗基线与4周末、8周末比较均有显著性差异(P<0.001)。FT4水平与HAMD-24总分及焦虑/躯体化因子、HAMA-14总分及躯体性焦虑因子、精神性焦虑因子均呈显著正相关(r=0.135,0.312,0.362,0.320,0.360;P<0.01)。FT4与HAMD-24体重因子呈负相关(r=-0.281,P=0.005)。结论:血清FT4水平与围绝经期抑郁发作患者的抑郁和焦虑相关。
Objective:To explore the changes of blood thyroxine before and after treatment in perimenopausal depressed patients and study the correlations in anxiety,depression,symptoms and thyroid hormone levels.Methods:We recruited 133 perimenopausal depressed patients(34 cases lost)with Hamilton Depression Scale-24(HAMD-24)score≥20 points to take oral Escitalopram.The HAMD-24,HAMA-14 and thyroid hormone were assessed at the 4 th and 8 th week of treatment.A self-controlled study was conducted to compare the changes of depressive symptoms and analyze their correlation with thyroid hormone levels before and after treatment.Results:The scores of HAMD-24 and HAMA-14 were all significantly lower at 4 th and 8 th week than those at baseline(F=1354.384,92.021;P<0.01).The serum level of FT4 was decrease with time(F=10.275,P<0.001),and had significant difference between the baseline and 4 th,8 th(P<0.001).FT4 was significantly positively related to HAMD-24 scores,anxiety/somatization factor,HAMA-14 total score and physical anxiety factor(r=0.135,0.312,0.362,0.320,0.360;P<0.01),and significantly negatively related to the HAMD-24 weight factor(r=-0.281,P<0.01).Conclusion:There are significant correlations between the anxiety and depressive symptoms of perimenopausal depressed patients and the serum level of FT4.
Objective:To explore the changes of blood thyroxine before and after treatment in perimenopausal depressed patients and study the correlations in anxiety,depression,symptoms and thyroid hormone levels.Methods:We recruited 133 perimenopausal depressed patients(34 cases lost)with Hamilton Depression Scale-24(HAMD-24)score≥20 points to take oral Escitalopram.The HAMD-24,HAMA-14 and thyroid hormone were assessed at the 4 th and 8 th week of treatment.A self-controlled study was conducted to compare the changes of depressive symptoms and analyze their correlation with thyroid hormone levels before and after treatment.Results:The scores of HAMD-24 and HAMA-14 were all significantly lower at 4 th and 8 th week than those at baseline(F=1354.384,92.021;P<0.01).The serum level of FT4 was decrease with time(F=10.275,P<0.001),and had significant difference between the baseline and 4 th,8 th(P<0.001).FT4 was significantly positively related to HAMD-24 scores,anxiety/somatization factor,HAMA-14 total score and physical anxiety factor(r=0.135,0.312,0.362,0.320,0.360;P<0.01),and significantly negatively related to the HAMD-24 weight factor(r=-0.281,P<0.01).Conclusion:There are significant correlations between the anxiety and depressive symptoms of perimenopausal depressed patients and the serum level of FT4.
引文
[1]李继俊.妇产科内分泌治疗学[M].2版.北京:人民军医出版社,2012:99-110
[2]Bromberger J T,Matthews K A,Schott L L,et al.Depressive symptoms during the menopausal transition:The Study of Women's Health Across the Nation(SWAN)[J].J Affect Disord,2007,103(1-3):267-272
[3]Bromberger J T,Kravitz H M,Chang Y F,et al.Major depression during and after the menopausal transition:Study of Women's Health Across the Nation(SWAN)[J].Psychol Med,2011,41(9):1879-1888
[4]Freeman E W,Sammel M D,Lin H,et al.Associations of hormones and menopausal status with depressed mood in women with no history of depression[J].Arch Gen Psychiatry,2006,63(4):375-382
[5]Cohen L S,Soares C N,Vitonis A F,et al.Risk for new onset of depression during the menopausal transition:the Harvard study of moods and cycles[J].Arch Gen Psychiatry,2006,63(4):385-390
[6]Freeman E W.Associations of depression with the transition to menopause[J].Menopause,2010,17(4):823-827
[7]Richards M,Rubinow D R,Daly R C,et al.Premenstrual symptoms and perimenopausal depression[J].Am J Psychiatry,2006,163(1):133-137
[8]Parry B L.Perimenopausal depression[J].Am J Psychiatry,2008,165(1):23-27
[9]Nemeroff C B,Simon J S,Haggerty J J Jr,et al.Antithyroid antibodies in depressed patients[J].Am J Psychiatry,1985,142(7):840-843
[10]Zhang Li,Li Yue e,Yang Chao.A comparative study of the clinical features and thyroxine leveles between bipolar adolescent patients with different onset types[J].China Journal of Health Psychology,2017,25(08):1130-1134
[11]Ritchie M,Yeap B B.Thyroid hormone:Influences on mood and cognition in adults[J].Maturitas,2015,81(2):266-275
[12]Williams G R.Neurodevelopmental and neurophysiological actions of thyroid hormone[J].J Neuroendocrinol,2008,20(6):784-794
[13]Bauer M,Goetz T,Glenn T,et al.The thyroid-brain interaction in thyroid disorders and mood disorders[J].J Neuroendocrinol,2008,20(10):1101-1114
[14]Mowla A,Kalantarhormozi M R,Khazraee S.Clinical characteristics of patients with major depressive disorder with and without hypothyroidism:A comparative study[J].J Psychiatr Pract,2011,17(1):67-71
[15]Brownlie B E,Rae A M,Walshe J W,et al.Psychoses associated with thyrotoxicosis-'thyrotoxic psychosis.'Areport of 18cases,with statistical analysis of incidence[J].European Journal of Endocrinology,2000,142(5):438-444
[16]黄佳,苑成梅,李春波,等.甲状腺功能水平与抑郁症的相关性探索[J].上海精神医学,2010,22(4):220-223
[17]Kirkegaard C,Korner A,Faber J.Increased production of thyroxine and inappropriately elevated serum thyrotropin in levels in endogenous depression[J].Biol Psychiatry,1990,27(5):472-476
[18]Forman-Hoffman V,Philibert R A.Lower TSH and higher T4levels are associated with current depressive syndrome in young adults[J].Acta Psychiatr Scand,2006,114(2):132-139
[19]李强,亢万虎,王崴,等.抑郁症患者血清甲状腺激素水平变异分櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏析[J].西安交通大学学报(医学版),2004,25(5):494-501
[20]Berent D,Zboralski K,Orzechowska A,et al.Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder[J].Mol Biol Rep,2014,41(4):2419-2425
[21]Mohacsik P,Fuzesi T,Doleschall M,et al.Increased thyroid hormone activation accompanies the formation of thyroid hormone-dependent negative feedback in developing chicken hypothalamus[J].Endocrinology,2016,157(3):1211-1221
[22]Luo Y,Akama T,Okayama A,et al.A novel role for flotillincontaining lipid rafts in negative-feedback regulation of thyroid-specific gene expression by thyroglobulin[J].Thyroid,2016,26(11):1630-1639
[23]李鹤展,贾福军.甲状腺激素与抑郁症研究进展[J].国外医学精神病学分册,2003,30(1):21-23
[24]蒋珊.首发抑郁症、复发抑郁症患者血清甲状腺激素和性激素水平变化的对比研究[D].郑州:郑州大学,2013
[25]Ranjbar H,Radahmadi M,Reisi P,et al.Effects of electrical lesion of basolateral amygdala nucleus on rat anxiety-like behaviour under acute,sub-chronic,and chronic stresses[J].Clin Exp Pharmacol Physiol,2017,44(4):470-479
[2]Bromberger J T,Matthews K A,Schott L L,et al.Depressive symptoms during the menopausal transition:The Study of Women's Health Across the Nation(SWAN)[J].J Affect Disord,2007,103(1-3):267-272
[3]Bromberger J T,Kravitz H M,Chang Y F,et al.Major depression during and after the menopausal transition:Study of Women's Health Across the Nation(SWAN)[J].Psychol Med,2011,41(9):1879-1888
[4]Freeman E W,Sammel M D,Lin H,et al.Associations of hormones and menopausal status with depressed mood in women with no history of depression[J].Arch Gen Psychiatry,2006,63(4):375-382
[5]Cohen L S,Soares C N,Vitonis A F,et al.Risk for new onset of depression during the menopausal transition:the Harvard study of moods and cycles[J].Arch Gen Psychiatry,2006,63(4):385-390
[6]Freeman E W.Associations of depression with the transition to menopause[J].Menopause,2010,17(4):823-827
[7]Richards M,Rubinow D R,Daly R C,et al.Premenstrual symptoms and perimenopausal depression[J].Am J Psychiatry,2006,163(1):133-137
[8]Parry B L.Perimenopausal depression[J].Am J Psychiatry,2008,165(1):23-27
[9]Nemeroff C B,Simon J S,Haggerty J J Jr,et al.Antithyroid antibodies in depressed patients[J].Am J Psychiatry,1985,142(7):840-843
[10]Zhang Li,Li Yue e,Yang Chao.A comparative study of the clinical features and thyroxine leveles between bipolar adolescent patients with different onset types[J].China Journal of Health Psychology,2017,25(08):1130-1134
[11]Ritchie M,Yeap B B.Thyroid hormone:Influences on mood and cognition in adults[J].Maturitas,2015,81(2):266-275
[12]Williams G R.Neurodevelopmental and neurophysiological actions of thyroid hormone[J].J Neuroendocrinol,2008,20(6):784-794
[13]Bauer M,Goetz T,Glenn T,et al.The thyroid-brain interaction in thyroid disorders and mood disorders[J].J Neuroendocrinol,2008,20(10):1101-1114
[14]Mowla A,Kalantarhormozi M R,Khazraee S.Clinical characteristics of patients with major depressive disorder with and without hypothyroidism:A comparative study[J].J Psychiatr Pract,2011,17(1):67-71
[15]Brownlie B E,Rae A M,Walshe J W,et al.Psychoses associated with thyrotoxicosis-'thyrotoxic psychosis.'Areport of 18cases,with statistical analysis of incidence[J].European Journal of Endocrinology,2000,142(5):438-444
[16]黄佳,苑成梅,李春波,等.甲状腺功能水平与抑郁症的相关性探索[J].上海精神医学,2010,22(4):220-223
[17]Kirkegaard C,Korner A,Faber J.Increased production of thyroxine and inappropriately elevated serum thyrotropin in levels in endogenous depression[J].Biol Psychiatry,1990,27(5):472-476
[18]Forman-Hoffman V,Philibert R A.Lower TSH and higher T4levels are associated with current depressive syndrome in young adults[J].Acta Psychiatr Scand,2006,114(2):132-139
[19]李强,亢万虎,王崴,等.抑郁症患者血清甲状腺激素水平变异分櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏析[J].西安交通大学学报(医学版),2004,25(5):494-501
[20]Berent D,Zboralski K,Orzechowska A,et al.Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder[J].Mol Biol Rep,2014,41(4):2419-2425
[21]Mohacsik P,Fuzesi T,Doleschall M,et al.Increased thyroid hormone activation accompanies the formation of thyroid hormone-dependent negative feedback in developing chicken hypothalamus[J].Endocrinology,2016,157(3):1211-1221
[22]Luo Y,Akama T,Okayama A,et al.A novel role for flotillincontaining lipid rafts in negative-feedback regulation of thyroid-specific gene expression by thyroglobulin[J].Thyroid,2016,26(11):1630-1639
[23]李鹤展,贾福军.甲状腺激素与抑郁症研究进展[J].国外医学精神病学分册,2003,30(1):21-23
[24]蒋珊.首发抑郁症、复发抑郁症患者血清甲状腺激素和性激素水平变化的对比研究[D].郑州:郑州大学,2013
[25]Ranjbar H,Radahmadi M,Reisi P,et al.Effects of electrical lesion of basolateral amygdala nucleus on rat anxiety-like behaviour under acute,sub-chronic,and chronic stresses[J].Clin Exp Pharmacol Physiol,2017,44(4):470-479