血清甲状腺激素、肾上腺皮质激素水平变化与产后抑郁的关系研究

Relationship between serum thyroid hormone,adrenal cortical hormone level changes and postpartum depression

目的探讨分娩前后一周血清甲状腺激素及肾上腺皮质激素水平变化对产后抑郁的影响。方法选取2012年3月-2012年9月在贵阳医学院附属医院就诊的395例孕产妇为研究对象,采用爱丁堡产后抑郁量表(EPDS)对其产后抑郁状况进行评定,并用采用生物素双抗体夹心酶联免疫吸附法(ELISA)测定产妇血清皮质醇(Cor)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素(TSH)、五羟色胺(5-HT)水平。结果 1产后一周抑郁症状检出人数为48例,检出率为12.15%。2抑郁组与非抑郁组COR均高于正常值,抑郁组产后COR稍高于非抑郁组,两两间差异均无统计学意义(P>0.05)。3抑郁组产后血清TSH水平低于非抑郁组,差异有统计学意义(P<0.05)。4相关分析显示:产后EPDS得分与产后血清皮质醇水平呈正相关、与产后5-HT、T3及TSH水平呈负相关(P<0.05)。5逐步线性回归分析显示:甲状腺激素水平及肾上腺皮质醇水平对产后抑郁的直接预测效应无显著意义(P>0.05),对5-HT水平有显著预测效应,预测变异量为65.6%(P<0.05)。结论 5-HT及其受体功能对产后抑郁的发病起重要作用,产后血清甲状腺激素水平及肾上腺皮质醇水平对的产后抑郁没有直接作用,但通过作用于5-羟色胺水平影响产后抑郁症状的发生。

Objective To explore thyroid hormone and adrenal cortical hormone level changing influences on postpartum depres-sion. Methods Selection 395 cases of maternal who saw a doctor in Guiyang Medical College Affiliated Hospital as the research object in March 2012- September 2012, using the Edinburgh postnatal depression scale （ EPDS） to assess the postpartum depression, and using the method of biotin double antibody sandwich enzyme-linked immunosorbent （ ELISA） determination of maternal serum cortisol （Cor）, three iodine thyroid glycine （T3）, four iodine glycine （T4） and thyroid-stimulating hormone （TSH）, serotonin （5-HT） level. Results ①Depression detected the number of 48 cases, detection rate of 12. 15% a week after childbirth. ②depression group with and without depression group COR are higher than normal, depression group Postpartum COR Slightly higher than without depres-sion group, but there was no significant statistical difference （P〉0. 05）,③The postpartum depression group serum TSH level is lower than the without depression group, the difference was statistically significant （P〈0. 05）. ④correlation analysis shows that： postpar-tum EPDS scores and postpartum serum cortisol levels were positively correlated, and postpartum 5-HT, T3 , and TSH levels negative-ly correlated （P〈0. 05）. ⑤Regression analysis showed that thyroid hormone levels and adrenal cortisol levels have no direct predic-tion effect of postpartum depression（P〉0. 05）,but regression analysis also revealed the Cor,TSH, and T3 to 5-HT have prediction effect（R2 =65. 6%,P〈0. 05）. Conclusion 5-HT and its receptors function play an important role in the pathogenesis of postpartum depression. It suggests that 5-HT may play a mediating role between maternal serum cortisol and thyroid hormone of different level on postpartum depressions.