围绝经期抑郁症血浆皮质醇水平的特征及抗抑郁治疗前后变化分析  

The characteristics of plasma cortisol level in patients with perimenopausal depression and analysis of the changes before and after antidepressant treatment

作　　者：朱翔贞[1] 李洋 高静芳[1] Zhu Xiangzhen

机构地区：[1]浙江中医药大学附属第一医院,310006 [2]浙江省立同德医院,310012

出　　处：《浙江临床医学》2022年第11期1615-1617,1620,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科学研究基金项目(2015ZB046);浙江省教育厅一般科研项目(Y201534696)。

摘　　要：目的探讨围绝经期抑郁症患者血浆皮质醇水平的特征以及抗抑郁治疗前后的变化,分析血浆皮质醇水平与生活事件及应对方式的相关性。方法选择围绝经期抑郁症患者31例为观察组,采用选择性5羟色胺/去甲肾上腺素再摄取抑制剂(SNRIs)抗抑郁治疗8周,测定抗抑郁治疗前后早晨8时血浆皮质醇水平。同时完成汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、生活事件量表(LES)、应对方式量表(CSQ)评估。正常围绝经期女性31例为对照组,测定早晨8时血浆皮质醇水平,同时完成HAMD、HAMA、LES、CSQ评估。结果观察组抗抑郁治疗前早晨8时血浆皮质醇水平高于对照组(P<0.01),抗抑郁治疗8周后,HAMD及HAMA评分较治疗前降低,差异有统计学意义(P<0.01);抗抑郁治疗8周后血浆皮质醇水平下降(P<0.01),与对照组比较,差异无统计学意义(P>0.05);观察组负性生活事件总刺激量与家庭问题评分高于对照组(P<0.01);观察组解决问题评分低于对照组,自责和逃避评分高于对照组,差异有统计学意义(P<0.05);观察组早晨8时血浆皮质醇浓度与负性生活事件总刺激量和家庭问题评分呈正相关(P<0.01);观察组抗抑郁治疗前HAMD评分与家庭问题评分呈正相关(P<0.05),与求助评分呈负相关(P<0.05)。结论围绝经期抑症患者早晨8时血浆皮质醇水平高于正常围绝经期女性,有效的抗抑郁治疗后血浆皮质醇水平降低,且负性生活事件刺激量与皮质醇水平呈正相关;围绝经期抑郁症患者遭遇更多的负性生活事件,解决问题能力偏低,更多选择自责和逃避的不成熟型应对方式。Objective To investigate the characteristics of plasma cortisol level in patients with perimenopausal depression and the changes before and after antidepressant treatment,and to analyze the correlation between plasma cortisol level and life events and coping styles.Methods 31 patients with perimenopausal depression in the study group were treated with selective serotonin/norepinephrine reuptake inhibitors(SNRIs)for 8 weeks.The plasma cortisol level was measured at 8 a.m.before and after antidepressant treatment.At the same time,Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),life events scale(LES)and Coping Style Scale(CSQ)were completed.The control group was 31 normal perimenopausal women.The plasma cortisol level was measured at 8 a.m.and HAMD,HAMA,LES and CSQ were evaluated at the same time.Results The level of plasma cortisol in the study group was higher than that in the control group at 8 a.m.before antidepressant treatment(P<0.01).After 8 weeks of antidepressant treatment,the scores of HAMD and HAMA were lower than those before treatment,with statistical significance(P<0.01).After 8 weeks of antidepressant treatment,the level of plasma cortisol decreased(P<0.01),and there was no significant difference compared with the control group(P>0.05).The total stimulation of negative life events and the score of family problems in the study group were higher than those in the control group(P<o.o1).The score of problem solving in the study group was lower than that in the control group,and the scores of self-blame and evasion were higher than those in the control group,with statistical significance(P<0.05).In the study group,the plasma cortisol concentration at 8 am was positively correlated with the total stimulation of negative life events and the score of family problems(P<0.01).HAMD score before antidepressant treatment was positively correlated with family problem score(P<0.05),and negatively correlated with help seeking score(P<0.05).Conclusion The level of plasma cortisol in perimenopausal depress

关 键 词：围绝经期 抑郁症 血浆皮质醇 生活事件 应对方式 

分 类 号：R749.4[医药卫生—神经病学与精神病学]