围绝经期伴焦虑特征抑郁发作患者甲状腺激素水平
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摘要
目的:探讨围绝经期伴焦虑特征抑郁发作患者的甲状腺激素水平及其在治疗中的变化趋势,并分析甲状腺激素水平与焦虑特征的相关性。方法:收集处于围绝经期、且24项汉密顿抑郁量表(HAMD-24)评分≥20分的抑郁发作患者,用14项汉密尔顿焦虑量表(HAMA-14)评价其焦虑水平,HAMA-14总分>7分时判断为伴有焦虑特征。并收集和年龄、受教育年限相匹配的健康对照者。患者组口服可变剂量艾司西酞普兰治疗,并于基线、治疗4周末和8周末评估临床疗效(HAMD-24和HAMA-14),同时检测甲状腺激素水平。结果:共入组围绝经期抑郁发作患者133例,其中伴焦虑特征者81例(焦虑组,治疗8周末脱落19例),不伴焦虑特征者52例(无焦虑组,治疗8周末脱落15例);健康对照者40例。基线时,游离甲状腺素(FT4)水平在组间(P<0.01)及组内时点(P<0.01)有显著差异,分组和时间的交互作用显著(P<0.01)。基线时焦虑组血清FT4水平显著高于对照组(t=3.004,P<0.01);焦虑组和无焦虑组的血清FT4水平均随治疗时间逐渐下降,其中焦虑组组内各时点比较有显著性差异(F=14.736,P<0.001)。促甲状腺激素(TSH)水平在基线时组间效应显著(P<0.05),焦虑组显著低于对照组(t=-2.600,P<0.05),但组内时点及二者的交互效应均无统计学意义(P>0.05)。焦虑组血清FT4水平与HAMD中体重因子评分在基线时、4周末及8周末变化值均呈负相关(P<0.05),与HAMA-14总分、精神性焦虑评分在基线时均呈正相关(P<0.05),4周末及8周末的变化值分别与HAMA-14总分、躯体性焦虑分、精神性焦虑分的变化值呈正相关(P<0.05)。结论:血清FT4水平与围绝经期抑郁发作患者的焦虑症状显著相关,调节甲状腺激素水平可能是改善焦虑症状的潜在途径。
Objective:To explore the thyroid hormone levels of perimenopausal depressed patients with anxious characteristics before and after treatment,and further analyze the relationship of anxious symptoms with thyroid hormone levels.Methods:Perimenopausal depressed patients with Hamilton Depression Scale-24(HAMD-24)score≥20were recruited,HAMA-14 was used to assess anxiety level,and patients with anxious characteristics was defined as HAMA-14score>7.Health subjects with age and education matched were also recruited.Patients were treated with oral escitalopram for 8weeks and clinical symptoms were assessed at the baseline,4th and 8th week of treatment.Results:A total of 113 patients enrolled finally in the study were divided into anxiety group(81patients,19 cases lost)and without anxiety group(52patients,15 cases lost),and 40 health subjects were recruited.There were significant differences on the serum levels of FT4 within the group(F=5.668,P<0.01),among three groups(F=4.917,P<0.01)and group×time interaction effect(F=3.685,P<0.01).The serum level of FT4 of depressed patients with anxiety symptoms at baseline was significantly higher than those without anxious symptoms(t=3.004,P<0.01).The serum level of FT4 decreased gradually among depressed patients both with and without anxiety symptoms after the treatment,and there were significant differences on serum level of FT4 at each time point in anxiety group(F=14.736,P<0.001).There were significant differences on serum level of TSH at baseline among three groups(P=0.003),and the serum level of TSH was significantly lower in the anxiety group than that in the health group(t=-2.600,P<0.05).There was no statistical significance on within-subjects effects and the group×time interaction effect(P>0.05).Serum levels of FT4 and body mass factor scores were all negatively correlated at baseline,4th and 8th week of treatment(P<0.05).In the anxiety group,there were negative correlation between the serum level of FT4 and weight factor of HAMD-14 at baseline,4th and 8th week of treatment(P<0.05);there were positive correlations between the serum level of FT4 and total score of HAMA-14,somatic anxiety,mental anxiety at baseline,4th and 8th week respectively(P<0.05).Conclusion:There are significant correlations between anxiety symptoms of perimenopausal depressed patients and the serum level of FT4.It may be a potential way for improving anxiety symptoms to regulate thyroid hormone levels.
Objective:To explore the thyroid hormone levels of perimenopausal depressed patients with anxious characteristics before and after treatment,and further analyze the relationship of anxious symptoms with thyroid hormone levels.Methods:Perimenopausal depressed patients with Hamilton Depression Scale-24(HAMD-24)score≥20were recruited,HAMA-14 was used to assess anxiety level,and patients with anxious characteristics was defined as HAMA-14score>7.Health subjects with age and education matched were also recruited.Patients were treated with oral escitalopram for 8weeks and clinical symptoms were assessed at the baseline,4th and 8th week of treatment.Results:A total of 113 patients enrolled finally in the study were divided into anxiety group(81patients,19 cases lost)and without anxiety group(52patients,15 cases lost),and 40 health subjects were recruited.There were significant differences on the serum levels of FT4 within the group(F=5.668,P<0.01),among three groups(F=4.917,P<0.01)and group×time interaction effect(F=3.685,P<0.01).The serum level of FT4 of depressed patients with anxiety symptoms at baseline was significantly higher than those without anxious symptoms(t=3.004,P<0.01).The serum level of FT4 decreased gradually among depressed patients both with and without anxiety symptoms after the treatment,and there were significant differences on serum level of FT4 at each time point in anxiety group(F=14.736,P<0.001).There were significant differences on serum level of TSH at baseline among three groups(P=0.003),and the serum level of TSH was significantly lower in the anxiety group than that in the health group(t=-2.600,P<0.05).There was no statistical significance on within-subjects effects and the group×time interaction effect(P>0.05).Serum levels of FT4 and body mass factor scores were all negatively correlated at baseline,4th and 8th week of treatment(P<0.05).In the anxiety group,there were negative correlation between the serum level of FT4 and weight factor of HAMD-14 at baseline,4th and 8th week of treatment(P<0.05);there were positive correlations between the serum level of FT4 and total score of HAMA-14,somatic anxiety,mental anxiety at baseline,4th and 8th week respectively(P<0.05).Conclusion:There are significant correlations between anxiety symptoms of perimenopausal depressed patients and the serum level of FT4.It may be a potential way for improving anxiety symptoms to regulate thyroid hormone levels.
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]Miller L J,Girqis C,Gupta R.Depression and related disorders during the female reproductive cycle[J].Womens Health(Lond).,2009,5(5):577-587
[3]何志晖,张晓薇.麦小玲,等.围绝经期妇女抑郁症相关因素及预防策略[J].中国实用妇科与产科杂志,2007,23(12):935-937
[4]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
[5]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
[6]Miller L J,Girqis C,Gupta R.Depression and related disorders during the female reproductive cycle[J].Womens Health(Lond),2009,5(5):577-587
[7]Garlow S J,Dunlop B W,Ninan P T,et al.The combination of triiodothyronine(T3)and sertraline is not superior to sertraline monotherapy in the treatment of major depressive disorder[J].J Psychiatr Res,2012,46(11):1406-1413
[8]Rosenthal L J,Goldner W S,O'Reardon J P.T3augmentation in major depressive disorder:Safety considerations[J].Am J Psychiatry,2011,168(10):1035-1040
[9]Bauer M,Berman S M,Schlagenhauf F,et al.Regional cerebral glucose metabolism and anxiety symptoms in bipolar depression:Effects of levothyroxine[J].Psychiatry Res,2010,181(1):71-76
[10]宁宁,郑向红,封娟毅,等.围绝经期甲状腺功能减退症患者焦虑及抑郁情绪的临床研究[J].第三军医大学学报,2013,35(12):1308-1310
[11]Li Aisha.Comparison on the serum level of thyroid hormone in patients with refractory depression and single depression[J].China Journal of Health Psychology,2011,19(8):919-920
[12]张明园.精神科评定量表手册[M].2版.长沙:湖南科学技术出版社,1998:122-166
[13]Bellipanni G,D I Marzo F,Blasi F,et al.Effects of melatonin in perimenopausal and menopausal women:Our personal experience[J].Ann N Y Acad.2005,1057:393-402
[14]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
[15]Bocco B M,Werneck-de-Castro J P,Oliveira K C,et al.Type2deiodinase disruption in astrocytes results in anxiety-depressive-like behavior in male mice[J].Endocrinology.2016,157(9):3682-3695
[16]黄立芳,尹超群.心境障碍和甲状腺功能异常相关的研究进展[J].中国全科医学杂志,2016,19(10):1225-1228
[17]Delitala A P,Terracciano A,Fiorillo E,et al.Depressive symptoms,thyroid hormone and autoimmunity in a populationbased cohort from Sardinia[J].J Affect Disord,2016,191:82-87
[18]Gutiérrez-Mariscal M,de Gortari P,López-Rubalcava C,et al.Analysis of the anxiolytic-like effect of TRH and the response of amygdalar TRHergic neurons in anxiety[J].Psychoneuroendocrinology,2008,33(2):198-213
[19]Mohácsik P,Füzesi 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
[20]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
[21]Yang Yinhang,Sun Long,Liu Qingming.Neuroendocrine and clinical features in patients with depression[J].China Journal of Health Psychology,2015,23(6):814-816
[22]Guo T Y,Liu L J,Xu L Z,et al.Alterations of the daily rhythms of HPT axis induced by chronic unpredicted mild stress in rats[J].Endocrine.2015,48(2):637-643
[23]Duval F,Mokrani M C,Monreal-Ortiz JA,et al.Cortisol hypersecretion in unipolar major depression with melancholic and psychotic features:Dopaminergic,noradrenergic and thyroid correlates[J].Psychoneuroendocrinology,2006,31(7):876-888
[24]van de Ven A C,Muntjewerff J W,Netea-Maier R T,et al.Association between thyroid function,thyroid autoimmunity,and state and traitfactors of depression[J].Acta Psychiatr Scand,2012,126(5):377-384
[25]Jourdan C,Linseisen J,Meisinger C,et al.Associations between thyroid hormones and serum metabolite profiles in an euthyroid population[J].Metabolomics,2014,10(1):152-164
[26]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]Miller L J,Girqis C,Gupta R.Depression and related disorders during the female reproductive cycle[J].Womens Health(Lond).,2009,5(5):577-587
[3]何志晖,张晓薇.麦小玲,等.围绝经期妇女抑郁症相关因素及预防策略[J].中国实用妇科与产科杂志,2007,23(12):935-937
[4]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
[5]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
[6]Miller L J,Girqis C,Gupta R.Depression and related disorders during the female reproductive cycle[J].Womens Health(Lond),2009,5(5):577-587
[7]Garlow S J,Dunlop B W,Ninan P T,et al.The combination of triiodothyronine(T3)and sertraline is not superior to sertraline monotherapy in the treatment of major depressive disorder[J].J Psychiatr Res,2012,46(11):1406-1413
[8]Rosenthal L J,Goldner W S,O'Reardon J P.T3augmentation in major depressive disorder:Safety considerations[J].Am J Psychiatry,2011,168(10):1035-1040
[9]Bauer M,Berman S M,Schlagenhauf F,et al.Regional cerebral glucose metabolism and anxiety symptoms in bipolar depression:Effects of levothyroxine[J].Psychiatry Res,2010,181(1):71-76
[10]宁宁,郑向红,封娟毅,等.围绝经期甲状腺功能减退症患者焦虑及抑郁情绪的临床研究[J].第三军医大学学报,2013,35(12):1308-1310
[11]Li Aisha.Comparison on the serum level of thyroid hormone in patients with refractory depression and single depression[J].China Journal of Health Psychology,2011,19(8):919-920
[12]张明园.精神科评定量表手册[M].2版.长沙:湖南科学技术出版社,1998:122-166
[13]Bellipanni G,D I Marzo F,Blasi F,et al.Effects of melatonin in perimenopausal and menopausal women:Our personal experience[J].Ann N Y Acad.2005,1057:393-402
[14]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
[15]Bocco B M,Werneck-de-Castro J P,Oliveira K C,et al.Type2deiodinase disruption in astrocytes results in anxiety-depressive-like behavior in male mice[J].Endocrinology.2016,157(9):3682-3695
[16]黄立芳,尹超群.心境障碍和甲状腺功能异常相关的研究进展[J].中国全科医学杂志,2016,19(10):1225-1228
[17]Delitala A P,Terracciano A,Fiorillo E,et al.Depressive symptoms,thyroid hormone and autoimmunity in a populationbased cohort from Sardinia[J].J Affect Disord,2016,191:82-87
[18]Gutiérrez-Mariscal M,de Gortari P,López-Rubalcava C,et al.Analysis of the anxiolytic-like effect of TRH and the response of amygdalar TRHergic neurons in anxiety[J].Psychoneuroendocrinology,2008,33(2):198-213
[19]Mohácsik P,Füzesi 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
[20]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
[21]Yang Yinhang,Sun Long,Liu Qingming.Neuroendocrine and clinical features in patients with depression[J].China Journal of Health Psychology,2015,23(6):814-816
[22]Guo T Y,Liu L J,Xu L Z,et al.Alterations of the daily rhythms of HPT axis induced by chronic unpredicted mild stress in rats[J].Endocrine.2015,48(2):637-643
[23]Duval F,Mokrani M C,Monreal-Ortiz JA,et al.Cortisol hypersecretion in unipolar major depression with melancholic and psychotic features:Dopaminergic,noradrenergic and thyroid correlates[J].Psychoneuroendocrinology,2006,31(7):876-888
[24]van de Ven A C,Muntjewerff J W,Netea-Maier R T,et al.Association between thyroid function,thyroid autoimmunity,and state and traitfactors of depression[J].Acta Psychiatr Scand,2012,126(5):377-384
[25]Jourdan C,Linseisen J,Meisinger C,et al.Associations between thyroid hormones and serum metabolite profiles in an euthyroid population[J].Metabolomics,2014,10(1):152-164
[26]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