老年抑郁症患者治疗前后血清脑源性神经营养因子水平动态观察

Dynamic observation of serum brain-derived neurotrophic factor levels in senile depression patients before and after treatment

目的 探讨5-羟色胺再摄取抑制剂治疗老年抑郁症患者的临床疗效及治疗前后血清脑源性神经营养因子水平的变化,为研究老年抑郁症的发生机制以及抗抑郁治疗的生物学指标提供依据.方法 将35例老年抑郁症患者设为病例组,抽取同期健康体检者50名设为对照组.病例组口服5-羟色胺再摄取抑制剂治疗,观察8周;于治疗前及治疗8周末采用汉密顿抑郁量表评定临床疗效.病例组于治疗前及治疗8周末,对照组于入组时检测血清脑源性神经营养因子水平,并进行对比分析.结果 （1）病例组治疗8周末汉密顿抑郁量表评分较治疗前显著下降（t=13.02,P＜0.01）,显效率71.4%,总有效率88.6%.（2）病例组治疗后血清脑源性神经营养因子水平较治疗前显著升高（t=6.94,P＜0.01）,治疗前显著低于对照组（t=8.02,P＜0.01）,治疗后与对照组差异无显著性（t=1.62,P＞0.05）.（3）病例组不同性别患者治疗前后血清脑源性神经营养因子水平差异均无显著性（P＞0.05）.（4）病例组治疗前血清脑源性神经营养因子水平与病程、年龄、治疗前汉密顿抑郁量表评分均无明显相关性（P＞0.05）.结论 脑源性神经营养因子可能参与老年抑郁症的病因与治疗机制,并可能成为预测老年抑郁症抗抑郁疗效的生物学指标之一.

Objective To explore the efficacy of serotonin reuptake inhibitor in senile depression patients and observe the changes of serum levels of brain-derived neurotrophic factor （BDNF） before and after treatment in order to provide basis for researching the occurrence mechanism of senile epresion and the biological parameter of anti-depression therapy. Methods Thirty senile depression patients were assigned to case group and selected 50 healthy examinees in the corresponding peroid to control group. Case group took orally serotonin reuptake inhibitor for 8 weeks; clinical efficacies were assessed with the Hamilton Depression Rating Scale （HAMD） before treatment and at the end of the 8th week. Serum BDNF levels were detected and contrastively analyzed before treatment and at the end of the 8th week in the case group and before treatment in the control group. Results （1） the HAMD score lowered more significantly at the end of the 8th week compared with pretreatment in the case group （t=13.02,P〈0.01）, obvious and total effective were respectively 71.4% and 88.6%. （2） Serum levels of BDNF increased more significantly after treatment compared with pretreatment in the case group （t=6.94,P〈0.01）, those were significantly lower than in the control group before treatment （t=8.02,P〈0.01） and had no significant differences from control group after treatment （t=1.62,P〉0.05）. （3）There were no significant sex differences in serum levels of BDNF before and after treatment in the case group （P〉0. 05）. （4）There was no significant correlation between pretreatment levels of BDNF and course, age as well as pretreatment score of the HAMD in the case group （P〉0.05）. Conclusion BDNF may participate in the pathogenic and therapeutic mechanism of senile depression and be one of effective biological parameters predicting the curative effect of antidepressant treatment.