抑郁症治疗前后执行功能及其与血清脑源性神经营养因子水平的关系

The correlations between executive functions and serum BDNF levels in depressive patients before and after treatment

目的探讨抑郁症患者执行功能、血清脑源性神经营养因子(BDNF)水平治疗前后的动态变化及其与抑郁严重程度三者之间的关系。方法采用威斯康星卡片分类试验(WCST)和汉密尔顿抑郁量表(HAMD)分别评定77例抑郁症患者抗抑郁药物治疗4周前后及74名正常对照组的执行功能和抑郁严重程度;采用酶联免疫吸附法(ELISA)测定受试者血清BDNF水平。结果与对照组比较,患者组治疗前WCST的总应答数、持续性错误数、随机错误数均增加,完成分类数减少,血清BDNF水平降低[(36.34±15.16)ng/mLvs(23.09±12.13)ng/mL],上述差异均有统计学意义(P<0.01),而4周治疗后两组间的上述指标的差异均无统计学意义(P>0.05)。与治疗前比较,患者组治疗后完成分类数增加、血清BDNF水平[(37.37±21.04)ng/mL]升高,总应答数、持续错误数、随机错误数减少和HAMD总分降低,上述差异均有统计学意义(P<0.01)。治疗前后血清BDNF水平与相应HAMD总分值均呈负相关(r=-0.28,P=0.01;r=-0.28,P=0.01),而治疗前WCST5个指标及其治疗后变化值分别与相应血清BDNF水平、HAMD总分值及疗后变化值均无相关(P>0.05)。结论抑郁症患者存在执行功能受损和血清BDNF水平的下降,后者与抑郁严重程度密切相关,且抗抑郁治疗后执行功能和抑郁症状均改善,血清BDNF水平升高。

Objective To explore executive functions and serum brain-derived neurotrophic factor （BDNF） levels in depressive patients before and after antidepressant treatment and their correlations with depression severity. Methods Executive functions and depression severity of all depressive patients （ n = 77 ） before and after 4 weeks of antidepressant treatment and normal control subjects （n = 74） were respectively assessed with Wisconsin Card Sorting Test （WCST） and the Hamilton Depression Scale （HAMD） , and their serum BDNF levels were assayed with the ELISA method. Results Compared with control group, depressive patients before treatment had significantly more total responses, preservative errors and nonpreservative errors, significantly lower completed categories and serum BDNF levels [ （36. 34 ± 15.16 ）ng/mL vs （23.09 ± 12. 13） ng/mL] （P 〈 0. 01 ）, and there were not significantly different after treatment （P 〉 0. 05 ）. Compared with pre-treatment, depressive patients after treatment had significantly higher completed categories and serum BDNF levels [ （37.37 ± 21.04） ng/mL], significantly lower total responses, preservative errors, nonpreservative errors and total HAMD scores（ P 〈 0. 01 ）. Before and after treatment serum BDNF levels had significantly negative correlations with corresponding total HAMD scores （ r = -0. 28,P =0. 01 ;r = -0. 28,P = 0. 01 ）. But 5 items of WCST before treatment and their change values were all no correlations with corresponding serum BDNF levels and total HAMD scores and their change values （ all P 〉 0. 05）. Conclusions Depressive patients had impairments of execution functions and decreased serum BDNF levels, and the latter was closely correlated with depression severity and there were improvements of execution dysfunctions and depression symptoms and an increase of serum BDNF levels after antidepressant treatment.