治疗范围锂浓度对老年难治性抑郁症患者甲状腺功能的影响

Effect of Lithium on Thyroid Function in Older Patients with Treatment- resistant Depression

目的观察治疗范围内血锂浓度对老年难治性抑郁症和非老年难治性抑郁症患者甲状腺功能影响的差异并进行对比分析。方法选择使用碳酸锂治疗的不同年龄组难治性抑郁症患者共60例作为研究对象,以60岁为界分为老年组28例和非老年组32例,治疗过程中监测血锂浓度处于治疗范围,在入组时及治疗期开始后各阶段(2、4、6、8、10、12周)检测两组患者甲状腺系列(TSH、T3、T4)并对各项指标的变化进行组间组内比较。结果治疗各周老年组甲状腺系列TSH(t=0.21,P>0.05;t=6.80,6.48,7.88,5.81,9.13;P<0.01)、T3(t=5.77,8.60,12.20,13.92,14.09,15.01;P<0.01)、T4(t=2.24,2.07,P<0.05;t=2.96,2.79,3.94,3.08;P<0.01)与入组时比较出现快速、显著、持久的改变,非老年组呈轻度、一过性、可逆性变化;两组患者TSH、T3、T4各项指标组间各周比较存在显著差异TSH(t=0.22,P>0.05;19.74,5.09,12.00,6.07,9.51;P<0.01)、T3(t=5.00,5.05,10.90,16.24,14.51,14.50;P<0.01)、T4(t=2.73,P<0.01;0.74,P>0.05;t=3.98,3.99,3.71,3.77;P<0.01)。结论治疗范围内血锂浓度降低难治性抑郁症患者甲状腺功能,对老年患者的影响较非老年患者迅速、严重而持久。

Objective To investigate the efficacy of reducing lithium of blood for thyroid function in older and non older people with treatment-resistant depression .Methods 28 patients over 60 with treatment-resistant depression as the older group and 32 patients under 60 as the non older group,were treated by lithium carbonate .The thyroid stimulating hormone （TSH）,triiodothyronine（T3）and tet-raiodothyronine（T4）and other indexes were tested before and during the treatment （2,4,6,8,10,12 weeks）.Results TSH（t=0.21,P〉0.05;6.80,6.48,7.88,5.81,9.13;P〈0.01）,T3（t=5.77,8.60,12.20,13.92,14.09,15.01;P〈0.01）,T4（t=2.24,2.07,P〈0.05;t=2.96,2.79,3.94,3.08;P〈0.01）in older group had significant change during the treatment;and there were not much change in TSH in the non older group;There were significant differences between the two groups in TSH （ t=0.22,P〉0.05;19.74,5.09, 12.00,6.07,9.51;P〈0.01）,T3（t=5.00,5.05,10.90,16.24,14.51,14.50;P〈0.01）and T4（t=2.73,P〈0.01;t=0.74,P〉0.05;t=3.98,3.99,3.71,3.77;P〈0.01）.Conclusion Compared with non older people with treatment -resistant depression,reduc-ing lithium in blood is a better therapy for thyroid function of older people with treatment -resistant depression .