甲状腺功能亢进症患者情绪障碍及SPECT脑灌注相关分析

Mood in hyperthyroidism patients and correlation with SPECT cerebral blood flow perfusion

目的研究甲状腺功能亢进症患者抑郁、焦虑发生情况及其相关因素。方法对25例甲状腺功能亢进症患者和22例正常对照者进行抑郁自评(SDS)、焦虑自评(SAS)及艾森克个性问卷(EPQ),并将抑郁、焦虑评分与相关临床、生化指标及SPECT脑灌注结果进行相关分析。结果本组甲状腺功能亢进症患者抑郁发生率为84%,以中重度抑郁为主;焦虑发生率为52%,以轻度焦虑为主;对照组无抑郁发生,轻度焦虑13.6%。单因素分析显示,抑郁、焦虑与甲状腺功能及自身免疫抗体无显著相关性;抑郁与病程呈正相关,焦虑与病程无显著相关性。抑郁评分与左侧屏状核、左侧豆状核、右侧直回、右侧钩回血流灌注呈负相关,与左侧楔叶、两侧楔前叶、左侧枕上回、右侧缘上回、右侧顶下小叶血流呈正相关。焦虑评分与左侧屏状核、左侧岛叶血流呈负相关。多元回归分析显示,甲亢患者内向、神经质的个性特征,是其发生抑郁的独立影响因子,而神经质的个性特征是其发生焦虑的独立影响因子。结论甲状腺功能亢进症患者存在明显抑郁、焦虑情绪,其不良的个性特征是发生抑郁、焦虑情绪障碍的独立影响因子。大脑血流灌注异常亦可能是其发生情绪障碍的病理生理机制之一。

Objective The mood hyperthyroidism to study its possible change and its related factors were analyzed in patients with pathophysiologieal mechanism. Methods Mood changes were assessed with Self-Rating Depression Scale （SDS） for depression and Self-Rating Anxiety Scale （SAS） for anxiety in 25 patients with hyperthyroidism and 22 healthy controls. EPQ questionair was used to get personality traits for both patients and controls. The correlations were done between SDS, SAS scores and levels of thyroid hormone, thyroid autoimmune antibodies, duration, personality traits and regional cerebral blood flow perfusion （rCBF）. Multiple variable regression analysis was also done to find the related factors. Results Eighty four percent of the patients had depression and 52% had anxiety, and the difference was significant（P〈0.05）. There were no correlations between scores of depression, or anxiety and serum thyroid hormones, or autoimmune antibodies. There was a positive correlation between depression and disease duration. There were negative correlations between scores of depression and rCBF in left claustrum, left lentiform, right rectus gyrus and right uncus; and negative correlation between scores of depression and rCBF in left euneus, bilateral preeuneus, left superior occipital gyrus, right superior marginal gyrus and right inferior parietal lobe. Regional cerebral blood flow in left lentiform and left insula were negatively correlated with scores of anxiety.Introversion and neuroticism were independent factors for depression, neuroticism was an independent factor for anxiety in hyperthyroidism patients by multiple varible regression analysis. Conelusions Depression and anxiety are found in patients with hyperthyroidism, whose specific personality trait is an independent factor for depression and anxiety. Abnormal cerebral blood flow perfusion might be one of the possible mechanisms in mood disorder.