抑郁症患者神经内分泌节律变化的对照研究  

Controlled study on the diurnal variation of neuroendocrine rhythm in depressed patients

作　　者：崔青[1] 孙丽亚[2] 肖红[2] 侯钢[1] 

机构地区：[1]南京医科大学附属脑科医院精神科,南京210029 [2]南京医科大学附属脑科医院研究所,南京210029

出　　处：《中华行为医学与脑科学杂志》2010年第1期33-35,共3页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：南京市医学科技发展项目（KYY06120）

摘　　要：目的探讨抑郁症患者下丘脑-垂体-肾上腺（HPA）轴、下丘脑-垂体-甲状腺（HPT）轴的功能和节律变化与临床症状晨重夕轻之间的关系。方法采用放射免疫法对49例符合美国精神障碍诊断与统计手册第4版（DSM-IV）重性抑郁发作患者及38例对照组，对早7：00、晚7：00血浆皮质醇（CORT）、促肾上腺皮质激素（ACTH）、三碘甲状腺原胺酸（T3）、四碘甲状腺原胺酸（T4）、甲状腺刺激素（TSH）水平进行测定，采用多因素方差分析比较2组各项指标的变化、并与临床症状之间的关系进行分析。结果病例组早晨血浆CORT、早晨、晚间TSH水平[分别为（365．94±120．78）nmol／L，（6．24±2．47）μIU／ml，（6．68±2．42）μIU／m1]较对照组[（284．91±83．39）nmol／L，（3．82±1．75）μIU／ml，（4．01±1．69）μIU／ml]明显增高，差异有显著性（P〈0．05）；病例组早晨、晚间血浆T4水平较对照组显著降低（P〈0．05）；血浆皮质醇水平的早晚变化在病例组与对照组之间差异有显著性（P〈0．001）；病例组血浆CORT、T3、T4、TSH水平的早晚变化在单相和双相抑郁障碍、伴有和不伴有精神病性症状的临床亚型之间均差异无显著性（均P〉0．05）。结论抑郁症患者血浆皮质醇水平存在早晚异常变化，可能是抑郁症的一项特异的生物学标志。Objective To study the function and diurnal variation of hypothalamie-pituitary-adrenal （HPA） axis and hypothalamic-pituitary-thyroid（HTT） axis,and the relationship with clinical characteristics of diurnal rhythm in depressed patients. Methods Forty-nine depressed patients met diagnostic DSM-IV criteria and thirty-eight normal controls were eolleeted. The plasma levels of eortisol （CORT） , adrenoeorticotropie hormone （ACTH） ,T3,T4,thyroid-stimulating hormone （TSH） at 7am and 7pro were measured by radioimmunoassay, then the results concerned were compared among the depressed groups with and without diurnal variation and control group by multivariate analysis of variance. Results The plasma level of morning CORT, morning and evening TSH （ （ 365.94± 120.78 ） nmoL/L ; （ 6.24 ± 2.47 ） μIU/ml ; （ 6.68 ± 2.42 ） μIU/ml ; respectively ） were respectively higher than those of eontrol group（ （284.91 ± 83.39） mnol/L; （3.82 ± 1.75 ）μIU/ml; （4.01 ± 1.69） μIU/ ml, P 〈 0.05 ）. The plasma levels of morning and evening T4 were significantly lower than those of control group（P 〈0. 05 ）. The CORT morning-evening difference variable distinguished between depressed and control group （P 〈 0. 001 ） , but no signifieant differences eould be found between the depressed groups with and without diurnal variation. There were no significant differences in the CORT, T3, T4, TSH morning-evening difference variable between various clinical suhtypes of depressed patient（unipolar/bipolar; psyehotie/nonpsyehotie）. Conclusion Abnormal CORT morning-evening difference variable was observed in the depressed patients compared with normal controls, and may be used as a special trait mark of depressed group.

关 键 词：抑郁症 晨重夕轻 下丘脑-垂体-肾上腺轴 下丘脑-垂体-甲状腺轴 

分 类 号：R749.4[医药卫生—神经病学与精神病学]