双相障碍、抑郁障碍患者甲状腺激素水平与治疗转归的相关性研究

Relationship of treatment outcome with thyroid hormone content in patients with biphasic disorder and depressive disorder

目的探讨双相障碍(BPD)、抑郁障碍(DPD)患者治疗前后甲状腺激素水平与治疗转归的相关性。方法选择江门市第三人民医院2017年6月至2019年6月治疗的符合《国际疾病与健康问题统计与分类-第10版》(ICD-10)诊断标准的双相障碍患者72例(BPD组)、抑郁障碍患者46例(DPD组)及健康体检者20例(对照组)。测定所有受试者血清总甲状腺素(TT4)、血清总三碘甲状腺原氨酸(TT3)、高灵敏度促甲状腺激素(HS-TSH)浓度;BPD组、DPD组治疗12周末再测定上述激素浓度。采用17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、贝克-拉范森躁狂量表(BRMS)评定基线时和治疗12周末症状严重程度。比较两组疗效,并观察疗效(量表减分率)与甲状腺激素水平变化的相关性。结果基线时,BPD组中抑郁相患者TT4、TT3分别为(54.75±12.26)nmol/L、(86.26±15.29)nmol/L,均低于对照组的(145.64±12.15)nmol/L、(156.78±36.54)nmol/L,TSH[(68.97±5.98)mIU/L]高于对照[(45.59±9.28)mIU/L];BPD组中躁狂混合相患者TT4、TT3分别为(166.75±12.25)nmol/L、(186.36±35.15)nmol/L,均高于对照组,TSH[(7.87±3.56)mIU/L]低于对照组;DPD组TT4、TT3分别为(65.59±23.11)nmol/L、(92.21±19.36)nmol/L,均低于对照组,TSH[(69.38±14.75)mIU/L]高于对照组,差异均有统计学意义(t=5.867、4.657、2.369、2.789、3.247、6.356、4.358、3.265、2.365,均P<0.05)。12周末,三组TT4、TT3、HS-TSH浓度差异均无统计学意义(均P>0.05);各组HAMa+d、BRMS量表评分均较基线时低,差异均有统计学意义(t=8.854、12.321、6.756,均P<0.05)。HAMa+d评分与TT4、TT3浓度呈负相关,与HS-TSH浓度呈正相关;BRMS评分与TT4、TT3浓度呈正相关,与HS-TSH浓度呈负相关。结论双相障碍、抑郁障碍患者甲状腺激素水平与健康人有差别,甲状腺激素水平与疗效密切相关。

Objective To explore the correlation between thyroid hormone content and treatment outcome in patients with biphasic disorder(BPD)and depressive disorder(DPD)before and after treatment.Methods From June 2017 to June 2019,72 patients with BPD(BPD group),46 patients with DPD(DPD group)who met the diagnostic criteria of International Statistics and Classification of Disease and Health problems-10th Edition(ICD-10)in the Third People′s Hospital of Jiangmen,and 20 normal controls(control group)in our Hospital were enrolled in this study.The serum concentrations of total thyroxine(TT4),total triiodothyronine(TT3)and high sensitivity thyrotropin(HS-TSH)were measured at baseline,and the above hormone concentrations were measured in the study group after treatment for 12 weeks.The 17 Hamilton depression scale(HAMD-17)and Hamilton anxiety scale(HAMA),Bech-Rafaesdn Mania Rating Scale(BRMS)were used to evaluate the severity of symptoms at baseline and at the end of treatment.The curative effect was compared between the two groups,and the correlation between the curative effect(score reduction rate)and thyroid hormone level(concentration change)was observed.Results At baseline,the concentrations of TT4,TT3 of patients with depressive phase in BPD group[(54.75±12.26)nmol/L,(86.26±15.29)nmol/L]were lower than those in the control group[(145.64±12.15)nmol/L,(156.78±36.54)nmol/L],and the TSH level in BPD group[(68.97±5.98)mIU/L]was higher than that in the control group[(45.59±9.28)mIU/L];the levels of TT4,TT3 of patients with manic and mixed phase in BPD group[(166.75±12.25)nmol/L,(186.36±35.15)nmol/L]were higher than those in the control group,and the level of TSH in BPD group[(7.87±3.56)mIU/L]was lower than that in the control group;the concentrations of TT4,TT3 in DPD group[(65.59±23.11)nmol/L,(92.21±19.36)nmol/L]were lower than those in the control group,and the TSH level in DPD group[(69.38±14.75)mIU/L]was higher than that in the control group,the differences were ststistically significant(t=5.867,4.657,2.369,2.789,3.247,6.356,4.358,3.265,2.365,all P<0.05).After treatment for 12 weeks,there were no statistically significant differences in TT3,TT4,HS-TSH concentrations among the three groups(all P>0.05).After treatment for 12 weeks,the scores of HAMa+d,BRMS in BPD group and DPD group were significantly lower than those at baseline(t=8.854,12.321,6.756,all P<0.05).The score of HAMa+d was negatively correlated with TT4,TT3 concentrations,and positively correlated with HS-TSH concentration.The score of BRMS was positively correlated with TT4,TT3 concentrations,and negatively correlated with HS-TSH concentration.Conclusion The level of thyroid hormone in patients with biphasic disorder and depressive disorder is different from that in normal subjects,and the level of thyroid hormone is closely related to the curative effect.