首发抑郁症患者抗抑郁治疗前后甲状腺功能的变化  

Thyroid function in first-episode depressive patients.

作　　者：刘福坤[1] 李立华[1] 范长河[1] 

机构地区：[1]广东省人民医院(广东省医学科学院),广东省精神卫生中心,广州510120

出　　处：《广东医学》2013年第3期371-374,共4页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2010B031600169)

摘　　要：目的探讨首发抑郁症患者经抗抑郁药治疗前后甲状腺功能(T3、T4、FT3、FT4、TSH)水平变化。方法采用化学发光免疫法(CLIA)分别检测35例首发抑郁症患者6周治疗前后及35例健康对照组血清T3、T4、FT3、FT4、TSH水平。采用汉密尔顿抑郁量表17项版(HAMD-17)对抑郁症患者治疗前后症状严重程度进行评定。分析抑郁症患者治疗前后各指标的变化及与对照组的差异。结果观察组治疗前后的各项指标均在临床正常值范围内,观察组治疗前血清T3、FT3、TSH水平均显著低于对照组(P<0.05,P<0.01),血清FT4水平显著高于对照组(P<0.01)。观察组治疗后血清T3、FT3水平较治疗前明显增高(P<0.01),血清FT4较治疗前下降,但差异无统计学意义(P>0.05)。治疗后血清TSH水平仍明显低于对照组(P<0.05),血清FT4水平则与对照组差异无统计学意义(P>0.05)。结论在临床正常值范围内血清T3、FT3、TSH水平的下降,血清FT4水平的增高可能与抑郁症发病相关。首发抑郁症患者可能存在甲状腺激素负反馈调节障碍和甲状腺激素相互转化障碍。血清T3、FT3水平的下降,血清FT4水平的增高可能为抑郁症的状态性特征,血清TSH水平的下降可能为抑郁症的素质性特征。Objective To evaluate the thyroid functions （T3, T4, FT3, FT4, and TSH） in first -episode depressive patients before and after antidepressant treatment. Methods Thirty five first - episode depressive patients and 35 normal healthy controls were included in the study. The serum levels of T3 , T4 , FT3 , FT4, and TSH in depressive patients before and after treatment and in healthy subjects were assessed by chemiluminescence immunoassay. The Hamilton Depression Rating Scale was used to assess the severity of depression. Results The levels of T3 , FT3 , and TSH were significantly lower in the patients before antidepressant treatment than those in controls, Whereas FT4 was significantly elevated. After treatment, significant improvementd of T3 and FT3 in the patients were observed, whereas the level of FT4 was lowered with no significance. Although TSH in the patients after treatment remained significantly lower than that in controis, there was no significant difference in FT4 between them. Conclusion The results suggest the dysfunction of thyroid be involved in first - episode depression. There may be dysregulations in negative feedback of thyroid hormone and mutual transformation in patients with first - episode depression. Decreased serum T3 and FT3 and elevated FT4 may be the illness state marker and decreased TSH maybe the trait marker in the first - episode depression.

关 键 词：首发抑郁症 神经内分泌 甲状腺功能 抗抑郁药 

分 类 号：R749.3[医药卫生—神经病学与精神病学]