抑郁症共病2型糖尿病患者的认知功能及神经内分泌指标  

Neuroendocrine and cognitive function in patients with comorbid depression and type 2 diabetes

作　　者：任会鹏[1] 王岚[1] 崔卫华[1] 王学义[1] 

机构地区：[1]河北医科大学第一医院,石家庄050031

出　　处：《中国心理卫生杂志》2012年第7期500-504,共5页Chinese Mental Health Journal

基　　金：河北省2010年卫生厅医学科学研究课题计划(20100264)

摘　　要：目的:探讨共病糖尿病后抑郁症的认知功能特点及其与神经内分泌的相关性。方法:按照目的抽样的方法,选取符合中国精神障碍分类方案与诊断标准第3版诊断标准的门诊和住院抑郁症患者84例,其中合并2型糖尿病的患者为共病组(n=42);未合并糖尿病的患者为非共病组(n=42)。对两组进行汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、伦敦塔、言语流畅性、言语记忆、Stroop、连线测验、威斯康星卡片(WCST)测查,并测定血浆皮质醇(COR)与促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、游离甲状腺素(F4)、游离三碘甲状腺原氨酸(F3)浓度。共病组28例和非共病组25例完成认知功能和血浆测查。结果:共病组HAMD总分和躯体化障碍、认知障碍因子分高于非共病组(均P<0.05),ACTH和COR的水平高于非共病组(均P<0.05),两组TSH、F4、F3差异无统计学意义。共病组的WCST的完成第一分类所需的应答数、错误应答数、持续应答数、持续性错误数和非持续性错误数均高于非共病组(均P<0.05);共病组的伦敦塔因子分评分和认知功能的语言记忆评分方面的评分低于非共病组(P<0.05);而WCST完成分类数和连线测验、言语流畅性和Stroop等得分差异无统计学意义(P>0.05)。共病组TOL与HAMD得分之间呈负相关(r=-0.53,P<0.01);COR水平同WCST持续性错误得分呈正相关(r=0.38,P<0.05),与RVR和Stroop得分呈负相关(r=-0.56,-0.55;均P<0.01);ACTH水平同WCST持续性错误呈正相关(r=0.528,P<0.01),与HVLT-R和Stroop得分呈负相关(r=-0.64,-0.60;均P<0.01)。非共病组认知功能和HAMD评分、HAMA评分以及神经内分泌指标之间无统计学相关。结论:共病糖尿病后抑郁程度加重,认知功能受损严重,主要表现在执行功能、注意力和语言记忆方面,可能与皮质醇和促肾上腺皮质激素升高有关。Objective： To explore the characteristics of cognitive and neuroendocrine function in patients with comorbid depression and type 2 diabetes. Methods： By purpose sampling, 84 outpatients and inpatients meeting with the diagnostic criteria for depression of the Chinese Classification and Diagnostic Criteria for Mental Disor- ders, Third Edition （CCMD-3） were selected. Among them, 42 patients with comorbid depression and type 2 diabe- tes were divided into comorbid group, and 42 patients with depression but without type 2 diabetes were divided into un-comorbid group. The two group were assessed with the Hamilton Depression Scale （HAMD）, Hamilton AnxietyScale （HAMA）, Tower of London （TOL）, rapid verbal retrieve （RVR）, Hopkins Verbal Learning Test-Revised （HVLT-R）, Stroop Color Word Test （SCW）, Trail Making Test （TMT）, and Wisconsin Card Sorting Test （WCST）, and their blood were collected for detection of cortisol （COR）, adrenocorticotropic hormone （ACTH）, thyroid stimulating hormone （TSH）, free thyroxine（F4）, and free triodothyronine （F3）. Totz.lly 28 comorbid pa- tients and 25 un-comorbid patients completed cognitive function tests and blood detection. Results： The scores of HAMD were higher in the comorbid group than in the un-comorbid group, especially in score of somatization and cognition sub-scores （Ps 〈 0. 01）. The levels of COR and ACTH were higher in the comobid l;roup than in the un- comobid group （Ps 〈 0. 05）. The cards number required for completing the first category, responses errors, persever- ative responses, perseverative errors, and non-perseverative errors of WCST were higher in the comorbid group than in the un-comborbid group （Ps 〈 0. 05）. The scores of TOL and HVLT-R were lower in the comobid group than in the un-comobid group （Ps 〈 0. 05）. There were no differences in scores of completing category, TMT, RVR and SCW between the two groups （Ps 〉 0. 05）. The HAMD total scores were negatively correlated wit

关 键 词：抑郁症 2型糖尿病 认知功能 神经内分泌 

分 类 号：R749.41[医药卫生—神经病学与精神病学] R587.1[医药卫生—临床医学]