焦虑症患者皮质醇、甲状腺激素及自主神经功能的对照研究

A controlled study of cortisol, thyroid hormone and autonomic function in anxiety disorder

目的研究焦虑症的皮质醇、甲状腺激素及自主神经的功能特点，了解临床亚型、失眠及性别因素与神经内分泌及自主神经功能的关系。方法随机抽取某三甲医院心理科焦虑症患者及同期健康对照者各60例作为研究对象，当日8时抽血检验血浆皮质醇（COR）、三碘甲状腺原氨酸（T3）、四碘甲状腺原氨酸（T4）、促甲状腺素（TSH）水平，并进行当日心率变异性（HRV）检查，收集资料，焦虑症组行焦虑自评量表（SAS）测试。结果焦虑症组血浆COR、TSH水平及LF／HF指数均显著高于对照组[（531．58±218．59）nmolg／L，P〈0．01；（3．50±1．35）mlU／L，P〈0．05；3．87±3．37，P〈0．01]，SDNN、LF、HF指数均显著低于对照组（27．34±13．13，P〈0．01；338．72±396．34，P〈0．01；135．77±149．95，P〈0．01）。惊恐障碍组血浆COR、TSH水平及LF／HF指数均显著高于广泛性焦虑障碍组（P〈0．05），SDNN及HF指数均显著低于广泛性焦虑障碍组（P〈0．01）；惊恐障碍组血浆COR、TSH水平及LF／HF指数均显著高于对照组，SDNN、LF及HF指数均显著低于对照组（P〈0．01）；广泛性焦虑障碍组血浆COR水平显著高于对照组，SDNN、HF指数显著低于对照组（P〈0．01）。伴与不伴失眠的焦虑症组血浆COR水平及LF／HF指数均显著高于对照组（P〈0．01，P〈0．05），SDNN、LF及HF指数均显著低于对照组（P〈0．01）；伴失眠的焦虑症组血浆TSH水平显著高于对照组（P〈0．05）；伴失眠的焦虑症组与不伴失眠的焦虑症组各项HRV指标及内分泌指标均差异无显著性（P〉0．05）。女性焦虑症组血浆COR、TSH水平均显著高于男性焦虑症组，SDNN、LF及HF指数均显著低于男性焦虑症组（P〈0．01）。男性焦虑症组SDNN、HF指数显著低于同性别对照组（P〈0．01，P〈0．05），女性焦虑症组SDNN、LF及HF指数显著低于同性别对照组，血浆COR、TSH水平显著高于同性别对照组（P〈0．01）。焦虑症组SAS总分与血浆COR水平呈显著正相关，与SDNN、HF均呈显著负相关。结论焦虑症存在神经内分泌及自主神经功能紊乱，紊乱的程度与临床亚型、失眠及性别因素有关。

Objective To investigate the features of the cortisol （COR） , thyroid hormone and autonomic function of anxiety disorder , and to observe the relationships between clinical subtypes, insomnia, gender factors and the neuroendoerine and autonomic function. Methods 60 anxiety disorder patients and 60 healthy controls were randomly selected from a three-grade class A hospital over the same period. Blood at 8：00am to test the plasma COR, T3, T4, TSH level and examined the heart rate variability （HRV） on the same day, the anxiety disorder patients also finish the self-rating anxiety scale （SAS）. Results The plasma COR, TSH level and LF/HF index were significantly higher（ （531.58 ± 218.59） nmol/L, P 〈 0.01 ; （ 3.50 ± 1.35 ） mIU/L, P 〈 0. 05 ;3.87 ± 3.37, P 〈 0.01 ） ,while the SDNN,LF, HF index were significantly lower in anxiety disorder than that in the control group （27.34± 13.13, P 〈 0. 01 ;338.72 ± 396.34, P 〈 0.01 ; 135.77 ± 149.95, P 〈 0.01 ）. The plasma C OR, TSH level and LF/HF index were significantly higher（P 〈 0. 05, P 〈 0. 01, P 〈 0. 01 ）, while the SDNN and HF index were significantly lower in panic disorder than that in the generalized anxiety disorder （P 〈 0.01 ）. The plasma COR, TSH level and LF/HF index were significantly higher, while the SDNN, LF, HF index were significantly lower in panic disorder than that in the control group （P 〈 0. 01 ）. The plasma COR was significantly higher ,while the SDNN and HF index were significantly lower in generalized anxiety disorder than that of the control group （P 〈 0. 01 ）. The plasma COR level and LF/HF index were significantly higher （P 〈 0.01, P〈 0.05） ,while the SDNN, LF, HF index were significantly lower in anxiety disorder with or without insomnia than that in the control group （P 〈 0. 01 ）. The plasma TSH level was significantly higher in anxiety disorder with insomnia than that in the control group （P〈 0.05）. There were no significant difference of the neuroendocrine and autonomic function between anxiety disorder with or without insomnia （P 〉 0.05 ）. The plasma COR ,TSH level were significantly higher,while the SDNN, LF, HF index were significantly lower in the female group than that in the male group （P〈 0.01 ）. The total SAS scores were significantly positively correlated with plasma COB levels, and was significantly negatively correlated with SDNN, HF index in the anxiety group. Conclusion There are neuroendoerine and autonomic nervous system dysfunctions in anxiety disorder,and these dysfunctions are related with clinieal subtypes ,insomnia,and gender.