围绝经期抑郁症与性激素水平关系的研究
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摘要
目的：探讨围绝经期抑郁症及围绝经期不同阶段与雌激素和雄激素水平的关系,并探讨围绝经期抑郁症的临床特点,为围绝经期抑郁症的发病机制和临床诊断与治疗提供理论依据。
方法：采用病例对照研究的方法,根据《国际疾病和相关健康问题统计分类第十版》(ICD-10)和《中国精神障碍分类与诊断标准第三版》(CCMD-3),收集40例在围绝经期内首次出现中重度抑郁症患者和40例围绝经期健康对照者。依据月经情况,将实验组和健康对照组分为实验绝经过渡期组和绝经后期组、对照绝经过渡期组和绝经后期组四个亚组,又依据入组前两周有无潮热出汗等血管舒缩症状,将实验组分为有血管舒缩症状组和无血管舒缩症状组两个亚组。采用电化学发光免疫法分别测定血清中雌二醇(E2)和睾酮(T)的水平,并对实验组和健康对照组进行汉密顿抑郁、焦虑量表评分,对实验组进行症状相对发生率量表评定。
结果：
(1)实验组E2水平显著低于健康对照组(P<0.01),与汉密顿抑郁评分呈负相关性(P<0.01);且无论是绝经过渡期(P<0.05),还是绝经后期(P<0.01),E2水平都低于相应阶段的健康对照组。
(2)实验组T水平明显高于健康对照组(P<0.01),且实验绝经过渡期组T水平也高于对照绝经过渡期组(P<0.01),但绝经后期实验组与对照组T水平无显著差异(P>0.05)；并且实验组T水平与汉密顿抑郁评分无相关性(P>0.05)。
(3)实验组与健康对照组E2/T有显著性差异(P<0.01)。
(4)有血管舒缩症状组与无血管舒缩症状组相比较,E2水平无显著性差异(P>0.05),而T水平显著升高(P<0.01)。
(5)症状相对发生率量表评定显示：实验组情绪低落40例,占100%；兴趣下降40例,占100%;躯体化症状37例,占92%；性欲减退22例,占55%；情绪焦虑32例,占80%；睡眠障碍31例,占76%；食欲改变30例,占75%;.激越29例,占73%；消极观念和体重改变各15例,各占38%；迟缓13例,占32%。
(6) HAMD各因子得分分别为焦虑/躯体化因子分2.81±0.24,认识障碍因子分2.57±0.53,迟滞因子分1.34±0.63,睡眠障碍因子分1.97±0.14,体重因子分1.17±0.47。
结论：
(1)围绝经期抑郁症患者体内雌二醇水平下降,且雌二醇水平越低,抑郁症状越严重,提示雌二醇水平下降是围绝经期抑郁症的危险因素。
(2)围绝经期抑郁症患者体内睾酮水平显著升高,可能与围绝经期以血管舒缩症状为主要表现的躯体化焦虑有关。
(3)性激素间比例失衡也是围绝经期抑郁症的危险因素。
(4)围绝经期抑郁症多以躯体化症状、焦虑、激越和睡眠障碍为主要临床表现,而迟缓症状相对较少见,提示围绝经期抑郁症与内源性抑郁症的临床表现不同。
OBJECTIVE:To explore the correlations between serum estralio, testosterone levels, and perimenopause depression, and to clarify the clinical feature of perimenopause depression.
METHODS:To adopt Case-Control study. we collected 40 women with perimenopausal depression as case group and 40 healthy women as control group, to assess the severity of depression by Hamillon depression rating scale(HAMD) and incidence rate by symptoms scale. All the subjects were assigned to four subgroups according to different menstruation situation:menopausal transition period case and control, postmenopausal case and control.40 women with perimenopausal depression (case group) were assigned to subgroup with vascular symptoms and subgroup without vascular symptoms according to presence or absence of flushes. Electrochemiluminescence immunoassay (ECLIA) was used to measure the levels of the estralio(E2) and testosterone(T).
RESULTS:
(1). The level of E2 in case group was significantly lower than that in control group (P<0.01), and had negative correlations with HAMD (P<0.01); In both the menopausal transition period and the postmenopause period, the levelof E2 in case group was lower that in the matched control groups(P<0.05, P<0.01).
(2). The level of T in case group was significantly higher than that in control group (P<0.01), and had the same finding between menopausal transition period 'case and control(P<0.01), but had no significant differences between postmenopause'caseand control (P>0.05). Furthermore, no association could be detected between the level of T and HAMD in case group (P>0.05)
(3).The E2/T in case group and control group had significant differences (P< 0.01).
(4)The level of T in subgroup with vascular symptoms is higher than that in subgroup without vascular symptoms (P<0.01), but the difference about E2 between two subgroups is not statistically signifcant (P>0.05)
(5) In case group,40 patients had blue mood (100%) and drop interest (100%), 37 patients had somatization symptom (92%),22 patients had lack of sexual desire (55%),32 patients had anxiety (80%),31 patients had sleep disturbance (76%),30 patients had changed appetite (75%),29 patients had agitation (73%),15 patients had suicide ideation (38%),15 patients had weight changes (38%),13 patients had retardation (32%).
(6) HAMD scale:anxiety/somatization (2.81±0.24), cognitive disturbance (2.57±0.53), retardation (1.34±0.63), sleep disturbance (1.97±0.14), weight (1.17±0.47).
CONCLUSIONS:
(1)The Serum estradiol level of women with perimenopausal depression is significantly lower. The estradiol level is more lower, and the depressive symptom is more serious. To suggest that lower estradiol is a risk factor of perimenopausal depression.
(2)The serum testosterone level of women with perimenopausal depression were significantly higher. Higher testosterone may be a risk factor of vascular symptoms, which is usually called somatic anxiety.
(3) The imbalance of the ratios of sex hormones is a risk factor for perimenopausal depression.
(4)Perimenopausal depression were mostly charactered by somatization symptom, anxiety, agitation and sleep disturbance, but retardation was less common. To suggest that the clinical characters of perimenopausal depression and endogenous depression are different.
方法：采用病例对照研究的方法,根据《国际疾病和相关健康问题统计分类第十版》(ICD-10)和《中国精神障碍分类与诊断标准第三版》(CCMD-3),收集40例在围绝经期内首次出现中重度抑郁症患者和40例围绝经期健康对照者。依据月经情况,将实验组和健康对照组分为实验绝经过渡期组和绝经后期组、对照绝经过渡期组和绝经后期组四个亚组,又依据入组前两周有无潮热出汗等血管舒缩症状,将实验组分为有血管舒缩症状组和无血管舒缩症状组两个亚组。采用电化学发光免疫法分别测定血清中雌二醇(E2)和睾酮(T)的水平,并对实验组和健康对照组进行汉密顿抑郁、焦虑量表评分,对实验组进行症状相对发生率量表评定。
结果：
(1)实验组E2水平显著低于健康对照组(P<0.01),与汉密顿抑郁评分呈负相关性(P<0.01);且无论是绝经过渡期(P<0.05),还是绝经后期(P<0.01),E2水平都低于相应阶段的健康对照组。
(2)实验组T水平明显高于健康对照组(P<0.01),且实验绝经过渡期组T水平也高于对照绝经过渡期组(P<0.01),但绝经后期实验组与对照组T水平无显著差异(P>0.05)；并且实验组T水平与汉密顿抑郁评分无相关性(P>0.05)。
(3)实验组与健康对照组E2/T有显著性差异(P<0.01)。
(4)有血管舒缩症状组与无血管舒缩症状组相比较,E2水平无显著性差异(P>0.05),而T水平显著升高(P<0.01)。
(5)症状相对发生率量表评定显示：实验组情绪低落40例,占100%；兴趣下降40例,占100%;躯体化症状37例,占92%；性欲减退22例,占55%；情绪焦虑32例,占80%；睡眠障碍31例,占76%；食欲改变30例,占75%;.激越29例,占73%；消极观念和体重改变各15例,各占38%；迟缓13例,占32%。
(6) HAMD各因子得分分别为焦虑/躯体化因子分2.81±0.24,认识障碍因子分2.57±0.53,迟滞因子分1.34±0.63,睡眠障碍因子分1.97±0.14,体重因子分1.17±0.47。
结论：
(1)围绝经期抑郁症患者体内雌二醇水平下降,且雌二醇水平越低,抑郁症状越严重,提示雌二醇水平下降是围绝经期抑郁症的危险因素。
(2)围绝经期抑郁症患者体内睾酮水平显著升高,可能与围绝经期以血管舒缩症状为主要表现的躯体化焦虑有关。
(3)性激素间比例失衡也是围绝经期抑郁症的危险因素。
(4)围绝经期抑郁症多以躯体化症状、焦虑、激越和睡眠障碍为主要临床表现,而迟缓症状相对较少见,提示围绝经期抑郁症与内源性抑郁症的临床表现不同。
OBJECTIVE:To explore the correlations between serum estralio, testosterone levels, and perimenopause depression, and to clarify the clinical feature of perimenopause depression.
METHODS:To adopt Case-Control study. we collected 40 women with perimenopausal depression as case group and 40 healthy women as control group, to assess the severity of depression by Hamillon depression rating scale(HAMD) and incidence rate by symptoms scale. All the subjects were assigned to four subgroups according to different menstruation situation:menopausal transition period case and control, postmenopausal case and control.40 women with perimenopausal depression (case group) were assigned to subgroup with vascular symptoms and subgroup without vascular symptoms according to presence or absence of flushes. Electrochemiluminescence immunoassay (ECLIA) was used to measure the levels of the estralio(E2) and testosterone(T).
RESULTS:
(1). The level of E2 in case group was significantly lower than that in control group (P<0.01), and had negative correlations with HAMD (P<0.01); In both the menopausal transition period and the postmenopause period, the levelof E2 in case group was lower that in the matched control groups(P<0.05, P<0.01).
(2). The level of T in case group was significantly higher than that in control group (P<0.01), and had the same finding between menopausal transition period 'case and control(P<0.01), but had no significant differences between postmenopause'caseand control (P>0.05). Furthermore, no association could be detected between the level of T and HAMD in case group (P>0.05)
(3).The E2/T in case group and control group had significant differences (P< 0.01).
(4)The level of T in subgroup with vascular symptoms is higher than that in subgroup without vascular symptoms (P<0.01), but the difference about E2 between two subgroups is not statistically signifcant (P>0.05)
(5) In case group,40 patients had blue mood (100%) and drop interest (100%), 37 patients had somatization symptom (92%),22 patients had lack of sexual desire (55%),32 patients had anxiety (80%),31 patients had sleep disturbance (76%),30 patients had changed appetite (75%),29 patients had agitation (73%),15 patients had suicide ideation (38%),15 patients had weight changes (38%),13 patients had retardation (32%).
(6) HAMD scale:anxiety/somatization (2.81±0.24), cognitive disturbance (2.57±0.53), retardation (1.34±0.63), sleep disturbance (1.97±0.14), weight (1.17±0.47).
CONCLUSIONS:
(1)The Serum estradiol level of women with perimenopausal depression is significantly lower. The estradiol level is more lower, and the depressive symptom is more serious. To suggest that lower estradiol is a risk factor of perimenopausal depression.
(2)The serum testosterone level of women with perimenopausal depression were significantly higher. Higher testosterone may be a risk factor of vascular symptoms, which is usually called somatic anxiety.
(3) The imbalance of the ratios of sex hormones is a risk factor for perimenopausal depression.
(4)Perimenopausal depression were mostly charactered by somatization symptom, anxiety, agitation and sleep disturbance, but retardation was less common. To suggest that the clinical characters of perimenopausal depression and endogenous depression are different.
引文
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[1]沈渔邨主编.精神病学.第5版.北京：人民卫生出版社,2009.559-561
[2]Murray CJL, Lopez ED. A Comprehensive Assessment of the Maotality and Disability From Diease, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, Mass:Harvard University Press; 1996. The Clobal Burdern of Diseas and injury series; voll.
[3]Shyr Yeu Lin, John R Morrison, David J, et al. Regulation of ovarian function by the TGF-supeffamily and follistatin. Reproduction.2003,126:133-148
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