抑郁症患者的皮质醇、甲状腺功能及心率变异性特征对照研究

A case-control study of the cortisol,thyroid function and heart rate in patients with depression

目的研究抑郁症患者的皮质醇、甲状腺功能及心率变异性特点,探讨其与躯体症状、失眠及性别因素的关系。方法检测60例抑郁症患者和60名正常对照的血清皮质醇(Cortisol,COR)、三碘甲状腺原氨酸(triiodothyronine,T3)、四碘甲状腺原氨酸(tetraiodothyronine,T4)、促甲状腺素(Thyroid stimulating hormone,TSH)水平,当日进行心率变异性检查,进行两组的比较,并按照躯体症状、失眠及不同性别进行分组比较。结果患者组的R-R间期平均标准差(standard deviation of average RR intervals,SDNN)、低频功率(low frequen-cy band,LF)、高频功率(high frequency band,HF)分别为[(34.21±14.31),186.64(846.67,113.87),125.00(839.22,48.50],对照组依次为[(43.86±12.61),375.92(2542.70,233.08),247.51(1547.36,142.33)],前者显著低于后者(均P<0.01)。与对照组相比,患者组COR水平增高[(15.35=6.45)vs.(11.81±6.32),P<0.01],TSH、T3及T4水平无显著差异(P>0.05)。伴躯体症状患者组COR水平显著高于对照组及不伴躯体症状组(P<0.01),SDNN、LF及HF指数均显著低于后两组(P<0.01)。伴失眠的患者组血清COR水平显著高于对照组及不伴失眠组(均P<0.01),SDNN、LF及HF指数均显著低于后两组(均P<0.05)。男性患者组SDNN、LF、HF指数均显著低于正常男性组(均P<0.05);女性患者组血清COR水平显著高于正常女性组(P<0.01),SDNN、LF指数均显著低于正常女性组(均P<0.05)。结论抑郁症HPT轴无紊乱,仅HPA轴及自主神经功能出现紊乱,且HPA轴激素水平及心率变异性与躯体症状、失眠及性别因素有关。

Objective To investigate the cortisol, thyroid function and heart rate in patients with depression, and their relationships with somatization, insomnia, gender factors, the neuroendocrine and autonomic function. Methods Sixty depression patients and 60 healthy controls were included. Blood samples were collected at 8：00 am to examine the plasma COR, T3, T4, TSH levels. The heart rate variability （HRV） was recorded on the same day. Results The standard deviation of average RR intervals, the low frequency band and the high frequency band were [（34.21 ± 14.31）, 186.64（846.67, 113.87） and 125.00（839.22, 48.50）] in the patients group, while were [（43,86 ± 12.61, 375.92（2542.70, 233.08） and 247.51（1547.36, 142.33）] in the control group. The average RR intervals, low frequency band and high frequency band were significantly higher in the patient group than in control group （P 〈 0.01 ）. The plasma COR level was significantly higher in the patient group than in the control group [（15.35 ± 6.45） vs. （11.81 ± 6.32, P 〈 0.01）]. There was no significant differences in the serum TSH, T3, T4 level between the patient and control groups （P 〉 0.05）. The plasma COR level was significantly higher, while the SDNN, LF, HF index were significantly lower in patients with depression with somatization than in those with de- pression without somatization and in the control group （P 〈 0.01 ） ; The plasma COR level was significantly higher（P 〈 0.01）, while the SDNN, LF, HF index were significantly lower in patients with depression with insomnia than in those with depression without insomnia and the control group （all P 〈 0.05） ; The SDNN, LF, HF index were signifi- cantly lower in male patients with depression than in the male control group（all P 〈 0.05） and the plasma COR level was significantly higher （P 〈 0.01） while the SDNN, LF index were significantly lower in female patients with depression than in the female control group （all P 〈 0.05）. Conclusion There are neuroendocrine and autonomic nervous system dysfunctions in patients with depression, which are associated with somatization, insomnia, and gender factors.