氟西汀对卒中后抑郁患者下丘脑-垂体-甲状腺轴功能低下的干预作用  

The intervention effects of fluoxetine hydrochloride on hypothalamic-pituitary-thyroid axis function deficiency in patients with poststrok depression

作　　者：高春林[1] 郭学英[1] 张雅丽[1] 雷平[2] 王保平[3] 贾俊亚[4] 

机构地区：[1]山西医科大学附属汾阳医院神经科,汾阳032200 [2]天津医科大学总医院神经外科 [3]天津医科大学总医院内分泌科 [4]天津医科大学总医院内科教研室

出　　处：《中华行为医学与脑科学杂志》2012年第1期50-52,共3页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：基金项目：国家自然科学基金资助项目（30800529）

摘　　要：目的探讨氟西汀对脑卒中后抑郁（PSD）患者下丘脑-垂体-甲状腺（HPT）轴功能改变的影响，探讨5-羟色胺在PSD发病中的作用及机制。方法采用队列研究方法，观察脑卒中患者入院0，1，7，14，21d及3月后血T3、T4、FT3、FT4和TSH变化，第7天行促甲状腺激素释放激素（TRH）兴奋试验检测，21d时进行HAMD量表测分，分为单纯卒中亚组（〈8分，25例）、卒中后抑郁亚组（PSD亚组）（≥8分，18例）。对照组为年龄、性别匹配的10例健康体检者。分析PSD患者HPT轴的功能改变。部分PSD患者口服盐酸氟西汀（20mg，每天1次）治疗，于服药前、服药后7d分别行TRH兴奋试验。结果与对照组比较，卒中组患者入院0～14d血TSH较高，FT3较低（均P〈0．05），T3、T4和FT4无差异；21d及3月时，以上指标均无差异。与单纯卒中亚组患者比较，0～21d时PSD亚组血FT3、TSH较低（均P〈0．05），FT4较高（均P〈0．05）；3月时，两亚组间血FT3、FT4、TSH无差异。TRH兴奋试验显示，7d时PSD亚组TSH刺激后升高的幅度高于单纯卒中亚组[（2．65±0．42）uIU／ml，（5．31±0．68）uIU／ml，P〈0．05]。相关分析显示，PSD亚组患者血TSH最大改变量、7dTRH刺激试验TSH0～30与HAMD评分均密切相关（r=0．35，0．25，均P〈0．01）。二阶段试验中，接受盐酸氟西汀治疗7d后的PSD患者TSH刺激后升高的幅度低于未接受盐酸氟西汀治疗者[（4．61±2．02）uIU／ml，（7．05±2．12）uIU／ml，P〈0．05]。结论PSD患者HPT轴功能受到抑制，这可能与TRH不足有关；盐酸氟西汀可改善PSD患者HPT轴功能异常。Objective To investigate the intervention effects of fluoxetine on hypothalamic-pituitary-thyroid（HPT） axis function changes in post-stroke depression （PSD） patients. Methods Mild to moderate stroke patients were enrolled and blood T3 , T4, FT3, FT4 and TSH were measured at day 0,1,7,14,21 and 3 months. At day 7, thyroid hormone releasing hormone （TRH） stimulation test were performed. After evaluated with the anxiety scale screening using the HAMD scale assessment at day 21 ,the subjects were divided into simple stroke subgroup （ 〈 8 points ,25 cases） and PSD sub-group （ ≥ 8 points, 18 cases） ,with 16 healthy age and sex matched individuals as control group. In the 2nd stage ,TRH stimulation test were performed in PSD patients before and after 7 days of fluoxetine administration. Results Compared with control group, stroke patients presented lower FT3 （P 〈 0.05 ） and higher serum TSH （P 〈 0.05 ） at day 0,1,7,14. Furthermore, PSD patients presented lower FT3,TSH levels and higher FT4 levels than simple stroke patients did（P 〈0.05 ）. At day 21 and month 3, T3, T4, FT3, FT4 and TSH levels in stroke patients were not different from those in control group（P〉0.05）. TRH test showed that the responses in PSD patients were lower than those in simple stroke patients （ （2.65 ± 0.42）uIU/ml vs （5.31 ± 0.68 ） uIU/ml, P 〈 0.05 ）. Correlation analysis showed HAMD scores correlated with TSH level changes and TSH0 - 30 in PSD subgroup closely（ r = 0.35,0.25, P 〈 0.01 ）. In the 2nd stage, TRH test showed that PSD patients who took fluoxetine presented a lower TSH level change than PSD patients who did not （ （4.61 ± 2.02） uIU/ml vs （ 7.05 ± 2.12 ） uIU/ml, P 〈 0.05 ）. Conclusion PSD patients present a long and severe HPT axis function inhibition ,which may due to TRH deficiency, and fluoxetine may improve this abnormality.

关 键 词：卒中后抑郁 下丘脑-垂体-甲状腺轴 盐酸氟西汀 

分 类 号：R256.3[医药卫生—中医内科学]