双相障碍抑郁发作共病边缘型人格患者的血浆皮质醇水平及甲状腺功能分析  

Analysis of plasma cortisol levels and thyroid function in patients with bipolar disorder depression with borderline personality

作　　者：李媛媛[1] 杨永涛 王艳华 崔伟[1] 崔利军[1,3] LI Yuanyuan;YANG Yongtao;WANG Yanhua;CUI Wei;CUI Lijun(Department of Psychiatry,Mental Health Center of Hebei Province,Baoding 071000,China;Department of Psychiatry,Zhuhai Center for Chronic Disease Control,Zhuhai 519000,China;School of Mental Health,Jining Medical College,Jining 272000,China)

机构地区：[1]河北省精神卫生中心精神科,河北保定071000 [2]珠海市慢性病防治中心精神科,广东珠海519000 [3]济宁医学院精神卫生学院,山东济宁272000

出　　处：《大连医科大学学报》2024年第1期20-24,共5页Journal of Dalian Medical University

基　　金：河北省财政厅、河北省卫生健康委政府资助临床医学优秀人才项目(361014)。

摘　　要：目的研究双相障碍(BD)抑郁发作共病边缘型人格(BPD)患者的血浆皮质醇水平、甲状腺功能,为临床工作提供决策参考。方法收集97例BD抑郁发作患者病例资料,符合DSM-5双相障碍目前为抑郁发作的诊断标准,采用DSM-Ⅳ-TR轴Ⅱ障碍临床定式检查中BPD的诊断条目进行评定,入组患者分为共病BPD组(n=42)和不共病BPD组(n=55)。采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、32项轻躁狂症状清单(HCL-32)评估,于入院次日清晨空腹采集静脉血,用全自动生化分析仪测定血浆皮质醇水平及甲状腺功能。结果共病BPD组女性29例(69.05%),不共病BPD组26例(47.27%),差异有统计学意义(χ^(2)=4.599,P=0.040);共病BPD组双相Ⅱ型患者34例(80.95%),不共病BPD组20例(36.36%),差异有统计学意义(χ^(2)=19.185,P<0.001)。共病BPD组FT4为(0.67±0.23)ng/dL,低于不共病BPD组的(1.51±0.67)ng/dL(Z=2.079,P=0.038)。共病BPD组皮质醇为(14.86±7.19)μg/dL,低于不共病BPD组的(18.68±5.98)μg/dL(Z=2.843,P=0.004)。共病BPD组无自伤、自杀情况者明显低于非共病BPD组,自伤与自伤合并自杀意念和行为者明显高于不共病BPD组,差异均有统计学意义(P<0.001)。二项Logistic回归分析显示低年龄(OR=0.931,95%CI 0.884~0.980)、低血浆皮质醇水平(OR=0.909,95%CI 0.837~0.988)是BD抑郁发作共病BPD的危险因素。结论低血浆皮质醇水平与BD抑郁发作共病BPD相关,低FT4可能与自伤、自杀关联更紧密,进一步影响边缘性人格的发生。Objective To study the plasma cortisol and thyroid function levels of bipolar disorder(BD)depression patients with borderline personality,as to provide reference for clinical decision-making.Methods Totally,97 hospitalized patients with bipolar depression were enrolled in the study,who met the diagnostic criteria of DSM-5 bipolar disorder as major depressive episode.The diagnostic criteria for borderline personality disorder(BPD)from Structured Clinical Interview for Diagnostic and Statistic Manual of Mental DisordersⅣRevised Edition AxisⅡDisorders were used to evaluate the patients.The patients were divided into two groups,including the group with BPD(n=42)and the group without BPD(n=55).Hamilton Depression Scale,Hamilton Anxiety Scale,32-item Hypomania Checklist were used to assess clinical symptoms of the patients.Fasting venous blood was collected from the patients next morning after admission,and plasma cortisol and thyroid function were measured by automatic biochemical analyzer.Results The number of female patients were 29(69.05%)in the group with BPD and 26(47.27%)in the group without BPD,the difference was statistically significant(χ^(2)=4.599,P=0.04).There were 34 patients(80.95%)with bipolar typeⅡin the group with BPD and 20 patients(36.36%)in the group without BPD(χ^(2)=19.185,P<0.001).The FT4 level in patients with BPD was(0.67±0.23)ng/dL,significantly lower than patients without BPD(1.51±0.67)ng/dL(Z=2.079,P=0.038).Similarly,the cortisol level in patients with BPD was(14.86±7.19)μg/dL,significantly lower than patients without BPD(18.68±5.98)μg/dL(Z=2.843,P=0.004).The number of patient without self-harm and suicidal ideation/behavior was significantly lower in the group with BPD,and the incidence of self-harm and self-harm combined with suicidal ideation/behavior was significantly higher compared to the group without BPD(P<0.001).Binary logistic regression analysis revealed that age(OR=0.931,95%CI 0.884-0.980)and plasma cortisol level(OR=0.909,95%CI 0.837-0.988)were the risk factors for

关 键 词：双相障碍 边缘型人格 血浆皮质醇 甲状腺激素 LOGISTIC回归 

分 类 号：R749.4[医药卫生—神经病学与精神病学]