抑郁症患者治疗前后认知、内分泌、细胞因子的变化

The Changes of Cognitive Functions,Plasma Cortisol and Cytokines Levels of Depressed Patients after Treatment

目的:了解抗抑治疗前后抑郁症患者的认知功能及血浆皮质醇、细胞因子水平。方法:符合ICD-10抑郁症诊断标准的抑郁症患者60例,30例正常对照。用Stroop测试(一种阅读流畅性作业)、词语流畅性(VFT)和威斯康星卡片分类(WCST)测验测评认知功能,用放射免疫法测定血浆皮质醇、细胞因子的浓度。患者在治疗前和抗抑郁治疗6周后完成两次测评。结果:治疗前抑郁症病人VFT成绩低于对照组(90·80±26·78/114·83±18·25,t=-4·087,P<0·01)Stroop成绩高于对照组(110·37±132·41/87·55±19·74,t=2·69,P<0·05),WCST除分类数和持续性错误百分数低于对照组(3·18±2·17/5·07±1·41,t=-3·17,40·87±22·83/60·39±17·90,t=-2·74,P<0·01)外,其它项目均高于对照组(t=2·05~2·74,P<0·05,0·01),药物治疗六周后VFT成绩较治疗前提高(98·55±25·72,t=3·28,P<0·01),WCST结果大多数项目均较治疗前评分提高(t=-2·05^-3·65,P<0·05)持续性错误的比较治疗前提高(54·22±27·5/40·87±22·83,t=3·60,P<0·01)治疗前抑郁症患者血浆皮质醇浓度与WCST的持续性汇合、持续性错误及持续性错误百分比呈正相关(r=0·34~0·38,P<0·01),HAMD评分与VFT、Stroop测查结果呈负相关(r=-0·43,-0·32,P<0·05)。结论:抑郁症患者血浆皮质醇浓度的升高与认知功能损害相关。抗抑郁药能改善抑郁症病人的认知功能。

Objective： To explore the changes of cognitive functions, plasma, cortisol and cytokines levels of depressed patients after treatment. Methods： Sixty patients with depression （ICD - 10 ） and 30 normal controls were tested with Stroop Test, Verbal Fluency Test （ VFT ） and Wisconsin Card Sorting Test （ WCST ） . Blood samples were adopted for the radioimmunoassay measurement of plasma cortisol and cytokines levels. The patient group was tested both before and after 6 weeks antidepressant treatmenL Results： Before treatment, the depressive patients had lower score in VFT than control （ 90. 8 ± 26. 8/114. 8 ± 18. 3, t = -4. 09, P 〈0. 01 ） . They had higher score than control in Stroop test （ 110. 4 ± 132. 4/87.7 ± 19. 7, t = 2. 69, P 〈 0. 05 ） . In most item of WCST, the patient group had higher than control except those of number of classification and number of false. After six weeks treatment, the VFT score increased （ 98. 6 ± 25.7, t = 3.28, P 〈 0. 01 ）, those of WCST items increased. There was positive correlation （ r = 0. 34 - 0. 38 ,P 〈0. 01 ） between cortisol level before treatment and the score of WCST. The score of HAMD negatively correlated with results of the VFT and Stroop test （ r = - 0. 43, r = - 0. 32, P 〈 0. 01 ） . Conclusion： Cortisol level increase is related to cognitive decline. Antidepressant treatment can improve cognitive function of depressive patients.