难治性抑郁症患者治疗前后血清甲状腺激素水平的变化

Serum thyroid hormone levels before and after treatment in patients with treatment-resistant depression

目的观察难治性抑郁症患者治疗前后甲状腺激素水平的变化,分析甲状腺激素水平变化与难治性抑郁症治疗效果间的关系。方法以44例难治性抑郁症患者为研究对象,分别于药物治疗开始时(治疗前)和治疗后8周末(治疗后)时间点,进行HAMD-24项量表评定;采用微粒子酶免分析法检测血清甲状腺激素水平,包括血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离T3(FT3)、游离T4(FT4)和超敏促甲状腺素(s-TSH)水平。根据治疗前后HAMD减分率>50%或≤50%分为有效组和无效组,比较和分析两组患者血清甲状腺激素水平。两分类Logistic回归分析影响疗效的相关因素。结果 44例难治性抑郁症患者治疗前后血清甲状腺激素水平均处于正常范围内。两组患者治疗后血清T3水平均较治疗前显著升高(P<0.05)。与治疗前比较,无效组患者血清s-TSH水平呈降低趋势(P>0.05)。有效组患者治疗前后血清FT3水平均明显高于无效组(P<0.05)。Logistic回归分析显示,血清FT3是影响疗效的独立因素(P<0.05)。结论难治性抑郁症患者的甲状腺功能状况对治疗效果有一定影响。疗效差的患者发生甲状腺功能异常的可能性较大;血清FT3水平有可能成为难治性抑郁症患者的疗效评价指标。

Objective To observe the changes of serum thyroid hormone levels before and after treatment in patients with treatment-resistant depression,and investigate the relationship between serum thyroid hormone levels and response to treatment.MethodsForty-four patients with treatment-resistant depression were enrolled,and were assessed with Hamilton Depression（HAMD）-24 scale at the beginning of medicine treatment（before treatment） and at the end of the eighth week after treatment（after treatment）.The serum thyroid hormone levels were detected by microparticle enzyme immunoassay,including triiodothyronine（T3）,tetraiodothyronine（T4）,free T3,free T4 and sensitive thyroid-stimulating hormone（s-TSH）.Patients were divided into effective group and ineffective group according to the score reducing rate before and after treatment（50% for effective group and ≤50% for ineffective group）,and serum thyroid hormone levels were compared and analysed.The related factors associated with clinical outcomes were analysed by Logistic regression analysis.ResultsSerum thyroid hormone levels were in the normal ranges before and after treatment in all patients.Serum T3 levels after treatment in both groups were significantly higher than those before treatment（P0.05）.Compared with that before treatment,serum s-TSH level in ineffective group exhibited a decreased tendency（P0.05）.Serum FT3 levels in effective group were significantly higher than those in ineffective group before and after treatment（P0.05）.Logistic regression analysis revealed that serum FT3 level was an independent factor influencing the clinical outcomes（P0.05）.ConclusionThyroid function of patiens with treatment-resistant depression might affect the clinical outcomes.Patients with poor prognosis have increased possibilities of thyroid dysfunction.Serum FT3 levels might be a parameter to assess the clinical outcomes of patients with treatment-resistant depression.