三种重性精神障碍甲状腺功能水平与疾病症状严重程度相关性  

The level of thyroid function in three major mental disorders correlates with the severity of disease symptoms

作　　者：梁承谦 陈明霞 李晓晶 薛芮 李涛 LIANG Chengqian;CHEN Mingxia;LI Xiaojing;XUE Rui;LI Tao(School of Mental Health,Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学精神医学学院,温州325035 [2]浙江大学医学院附属精神卫生中心&杭州市第七人民医院神经生物科 [3]浙江大学良渚实验室,教育部脑科学与脑机集成前沿科学中心,脑机智能国家重点实验室 [4]浙江大学国家卫生健康委与中国科学院医学神经生物学重点实验室

出　　处：《中国神经精神疾病杂志》2023年第4期218-224,共7页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金国际(地区)合作重点项目(编号:81920108018);广东省脑计划项目(编号:2018B030334001);杭州市高峰学科建设项目;浙江省‘尖兵’‘领雁’研发攻关计划资助(编号:2022C03096);国家自然科学基金重点项目(编号:82230046)。

摘　　要：目的分析慢性精神分裂症、慢性双相障碍及慢性重性抑郁障碍患者甲状腺功能的差异,及其与焦虑、抑郁及精神病性症状严重程度的关系。方法纳入515例病程大于10年的精神分裂症(192例)、双相障碍(157例)及重性抑郁障碍(166例)患者,检测患者甲状腺功能指标,如促甲状腺激素(thyroid-stimulating hormone,TSH)、三碘甲状腺原氨酸(triiodothyronine,T3)、甲状腺素(thyroxine,T4)、游离三碘甲状腺原氨酸(free triiodothyro-nine,FT3)和游离甲状腺素(free thyroxine,FT4)水平。使用广泛性焦虑自评量表(generalized anxiety disorder,GAD-7)、9条目患者健康问卷(9-item patient health questionnaire,PHQ-9)和90项症状自评量表(symptom checklist-90,SCL-90)精神病性症状分量表分别评估所有患者焦虑、抑郁和精神病性症状。结果相较于重性抑郁障碍组,精神分裂症组和双相障碍组的TSH和FT4水平更高(P<0.01);精神分裂症组的T4水平高于双相障碍组(P=0.029)和重性抑郁障碍组(P<0.001)。线性回归分析显示,在精神分裂症患者中,T4水平与GAD-7(B=-0.043,P=0.018)、PHQ-9(B=-0.051,P=0.009)总分相关;在双相障碍患者中,T4与患者GAD-7(B=-0.064,P=0.003)、PHQ-9(B=-0.082,P<0.001)总分及SCL-90精神病性症状分量表得分(B=-0.020,P=0.043)相关;在重性抑郁障碍患者中,T4与患者SCL-90精神病性症状分量表得分(B=0.024,P=0.021)相关。结论慢性精神分裂症、双相障碍和重性抑郁障碍甲状腺功能指标存在差异,不同的甲状腺功能状态可能与患者疾病症状严重程度相关。Objective This study aims to evaluate differences of thyroid function among the patients with chronic schizophrenia,bipolar disorder and major depressive disorder,and assess the relationship between the thyroid function and the symptom severity of these patients.Methods A total of 515 cases of chronic schizophrenia(n=192),bipolar disorder(n=157),and major depressive disorder(n=166)with a disease duration of over 10 years were included in this study.We compared the thyroid function indices among the three groups including thyroid-stimulating hormone(TSH),triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),and free thyroxine(FT4).Symptom severity was assessed using the generalized anxiety disorder-7(GAD-7),the 9-item patient health questionnaire(PHQ-9),and the 90-item symptom checklist(SCL-90)psychiatric symptom subscales for anxiety,depression,and psychotic symptoms,respectively.Results Compared to major depressive disorder,patients with schizophrenia and bipolar disorder had significantly higher TSH and FT4 levels(P<0.01).In addition,patients with schizophrenia had significantly higher T4 levels compared to those with bipolar disorder(P=0.029)and major depressive disorder(P<0.001).T4 levels were significantly correlated with GAD-7(B=-0.043,P=0.018)and PHQ-9(B=-0.051,P=0.009)scores in patients with schizophrenia,GAD-7(B=-0.064,P=0.003),PHQ-9(B=-0.082,P<0.001),and SCL-90 psychotic symptoms subscale(B=-0.020,P=0.043)scores in patients with bipolar disorder and SCL-90 psychotic symptoms subscale scores(B=-0.024,P=0.021)in patients with major depressive disorder,respectively.Conclusions The findings suggest that differences in thyroid function in chronic schizophrenia,bipolar disorder,and major depressive disorder may be related to the severity of disease symptoms.

关 键 词：精神分裂症 双相障碍 重性抑郁障碍 甲状腺激素 焦虑症状 抑郁症状 精神病性症状 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]