抑郁症患者血清甲状腺激素水平的检测及临床研究
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摘要
目的通过对抑郁症患者血清甲状腺激素水平检测分析,探讨抑郁症患者甲状腺功能变化情况及其临床意义。方法将该院精神科于2016年1月至2018年1月收治的127例抑郁症患者作为研究对象,按照发作特点,将单相抑郁症患者作为单相组(n=45),将双相抑郁症患者作为双相组(n=82)。另将在该院体检的53例健康志愿者作为对照组。收集3组的血清样本,采用化学发光免疫分析法对其血清甲状腺激素[三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)]水平进行检测,对比并分析3组间甲状腺功能变化。结果单相组T3、T4降低患者比例明显高于双相组,FT3升高患者比例明显低于双相组,FT4升高患者比例明显低于双相组,FT4降低患者比例明显高于双相组,TSH升高及TSH降低患者比例明显高于双相组,差异均有统计学意义(P<0.05)。单相组FT3水平明显低于双相组,差异有统计学意义(P<0.05);单相组的FT4水平明显低于对照组和双相组,差异均有统计学意义(P<0.05)。结论不同类型抑郁症患者甲状腺激素水平不同,其治疗方法应有所区别。单相抑郁症患者可见甲状腺功能减退,应侧重于心理治疗,而双相抑郁症患者的游离甲状腺激素水平较高,首先应注重药物治疗。
Objective To investigate the changes and clinical significance of thyroid function in patients with depression by detecting serum thyroid hormone levels.Methods Totally 127 cases of depression in the Department of Psychiatric of our hospital from January 2016 to January 2018 were collected as research objects.According to the characteristics of depression,patients with unipolar depression were selected as unipolar group(n=45),while patients with bipolar depression were selected as bipolar group(n=82).Meanwhile,53 cases of healthy volunteers underwent physical examination in the same period in our hospital were collected as control group.The serum samples of three groups were collected and the serum levels of thyroid hormones(T3,T4,FT3,FT4,TSH)were detected by chemiluminescence immunoassay.The changes of thyroid function between the three groups were compared and analyzed.Results The proportion of patients with T3 and T4 decreased in unipolar group were significantly higher than those in bipolar group,and the proportion of patients with T3 increased in unipolar group was significantly lower than that in bipolar group,and the proportion of patients with FT4 decreased in unipolar group was significantly higher than that in bipolar group;and the proportion of patients with TSH increased and TSH decreased in unipolar group were significantly higher than those in bipolar group,the differences were statistically significant(P<0.05).The level of FT3 in unipolar group was significantly lower than that in bipolar group(P<0.05),while the level of FT4 in unipolar group was significantly lower than that in control group and bipolar group,and the differences were statistically significant(P<0.05).Conclusion The level of thyroid hormone in patients with different types of depression was different,so the treatment should be distinguished.Psychological treatment should be focused on the unipolar depression patients with hypothyroidism,while attention should be paid to drug treatment for bipolar depression patients with high levels of free thyroid hormone.
Objective To investigate the changes and clinical significance of thyroid function in patients with depression by detecting serum thyroid hormone levels.Methods Totally 127 cases of depression in the Department of Psychiatric of our hospital from January 2016 to January 2018 were collected as research objects.According to the characteristics of depression,patients with unipolar depression were selected as unipolar group(n=45),while patients with bipolar depression were selected as bipolar group(n=82).Meanwhile,53 cases of healthy volunteers underwent physical examination in the same period in our hospital were collected as control group.The serum samples of three groups were collected and the serum levels of thyroid hormones(T3,T4,FT3,FT4,TSH)were detected by chemiluminescence immunoassay.The changes of thyroid function between the three groups were compared and analyzed.Results The proportion of patients with T3 and T4 decreased in unipolar group were significantly higher than those in bipolar group,and the proportion of patients with T3 increased in unipolar group was significantly lower than that in bipolar group,and the proportion of patients with FT4 decreased in unipolar group was significantly higher than that in bipolar group;and the proportion of patients with TSH increased and TSH decreased in unipolar group were significantly higher than those in bipolar group,the differences were statistically significant(P<0.05).The level of FT3 in unipolar group was significantly lower than that in bipolar group(P<0.05),while the level of FT4 in unipolar group was significantly lower than that in control group and bipolar group,and the differences were statistically significant(P<0.05).Conclusion The level of thyroid hormone in patients with different types of depression was different,so the treatment should be distinguished.Psychological treatment should be focused on the unipolar depression patients with hypothyroidism,while attention should be paid to drug treatment for bipolar depression patients with high levels of free thyroid hormone.
引文
[1]姚琳,潘丽红.伴精神病性症状抑郁症的治疗研究进展[J].临床精神医学杂志,2016,26(3):211-212.
[2]王佩蓉,杨春玉,连中.单相抑郁与双相抑郁障碍患者临床资料和发病特点的对比研究[J].中华全科医学,2014,12(4):513-515.
[3]和昱辰.抑郁症临床研究进展[J].国际检验医学杂志,2013,34(7):832-834.
[4]徐永君,盛慧.抑郁症发病机制研究进展[J].安徽医科大学学报,2012,47(3):323-326.
[5]张林,李乐华.抑郁症和双相情感障碍的共同致病基因[J].国际精神病学杂志,2015,42(1):61-64.
[6]李苒,高杉,李琳,等.抑郁症发病机制的研究进展[J].天津中医药,2013,30(2):121-125.
[7]李岚岚.抑郁症患者血清甲状腺激素水平检测及临床意义[J].中国伤残医学,2013,21(8):301-302.
[8]戴云飞,肖泽萍.中国精神障碍分类与诊断标准第3版与国际疾病分类第10版的比较[J].临床精神医学杂志,2013,23(6):426-427.
[9]乔娟,朱相华,赵后锋,等.难治性抑郁症患者甲状腺激素和血清超敏C反应蛋白与临床症状相关性探讨[J].精神医学杂志,2017,30(2):107-110.
[10]张建,岳莹莹,刘玉局,等.抑郁症患者甲状腺功能异常的流行病学调查[J].临床精神医学杂志,2013,23(3):187-188.
[11]黄立芳,尹超群.心境障碍和甲状腺功能异常相关的研究进展[J].中国全科医学,2016,19(10):1225-1228.
[12]王小泉,王祖森,侯正华,等.单、双相抑郁症临床特征及血清甲状腺激素水平比较[J].精神医学杂志,2015,28(3):182-185.
[13]李广权,周卫东,贺勇,等.抑郁症患者甲状腺功能变化的研究[J].国际精神病学杂志,2017,38(18):2556-2558.
[14]李红丽.不同甲状腺功能状态下游离三碘甲状腺原氨酸与游离甲状腺素和超灵敏促甲状腺素检测的意义研究[J].临床合理用药杂志,2013,6(12):15-16.
[15]HAGE M P,AZAR S T.The link between thyroid function and depression[J].J Thyroid Res,2012,2012:590648.
[16]ZHOU Y,WANG X,ZHAO Y,et al.Elevated thyroid peroxidase antibody increases risk of postpartum depression by decreasing prefrontal cortex BDNF and 5-HT levels in mice[J].Front Cell Neurosci,2017,10:1-9.
[17]王晓宇.甲状腺相关激素在抑郁症中的作用及变化[J].实用检验医师杂志,2018,10(1):60-62.
[2]王佩蓉,杨春玉,连中.单相抑郁与双相抑郁障碍患者临床资料和发病特点的对比研究[J].中华全科医学,2014,12(4):513-515.
[3]和昱辰.抑郁症临床研究进展[J].国际检验医学杂志,2013,34(7):832-834.
[4]徐永君,盛慧.抑郁症发病机制研究进展[J].安徽医科大学学报,2012,47(3):323-326.
[5]张林,李乐华.抑郁症和双相情感障碍的共同致病基因[J].国际精神病学杂志,2015,42(1):61-64.
[6]李苒,高杉,李琳,等.抑郁症发病机制的研究进展[J].天津中医药,2013,30(2):121-125.
[7]李岚岚.抑郁症患者血清甲状腺激素水平检测及临床意义[J].中国伤残医学,2013,21(8):301-302.
[8]戴云飞,肖泽萍.中国精神障碍分类与诊断标准第3版与国际疾病分类第10版的比较[J].临床精神医学杂志,2013,23(6):426-427.
[9]乔娟,朱相华,赵后锋,等.难治性抑郁症患者甲状腺激素和血清超敏C反应蛋白与临床症状相关性探讨[J].精神医学杂志,2017,30(2):107-110.
[10]张建,岳莹莹,刘玉局,等.抑郁症患者甲状腺功能异常的流行病学调查[J].临床精神医学杂志,2013,23(3):187-188.
[11]黄立芳,尹超群.心境障碍和甲状腺功能异常相关的研究进展[J].中国全科医学,2016,19(10):1225-1228.
[12]王小泉,王祖森,侯正华,等.单、双相抑郁症临床特征及血清甲状腺激素水平比较[J].精神医学杂志,2015,28(3):182-185.
[13]李广权,周卫东,贺勇,等.抑郁症患者甲状腺功能变化的研究[J].国际精神病学杂志,2017,38(18):2556-2558.
[14]李红丽.不同甲状腺功能状态下游离三碘甲状腺原氨酸与游离甲状腺素和超灵敏促甲状腺素检测的意义研究[J].临床合理用药杂志,2013,6(12):15-16.
[15]HAGE M P,AZAR S T.The link between thyroid function and depression[J].J Thyroid Res,2012,2012:590648.
[16]ZHOU Y,WANG X,ZHAO Y,et al.Elevated thyroid peroxidase antibody increases risk of postpartum depression by decreasing prefrontal cortex BDNF and 5-HT levels in mice[J].Front Cell Neurosci,2017,10:1-9.
[17]王晓宇.甲状腺相关激素在抑郁症中的作用及变化[J].实用检验医师杂志,2018,10(1):60-62.
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