改良电抽搐治疗对抑郁发作患者甲状腺功能和性激素的影响

Effect of modified electroconvulsive therapy on thyroxine and sex-hormone of patients experiencing an episode of depression

目的探讨抑郁发作患者接受改良电抽搐治疗(modified electroconvulsive therapy,MECT)后甲状腺功能和性激素的变化。方法选择符合ICD-10诊断标准的抑郁发作患者57例,采用化学发光免疫法分别检测MECT治疗后30 min和疗程结束后的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺功能(FT4)、促甲状腺功能(TSH)、三碘甲状腺原氨酸(T3)、甲状腺功能(T4)、睾酮(T)、雌二醇(E2)及血清泌乳素(PRL)。采用汉密尔顿抑郁量表17项版(Hamilton Depression Rating Scale,HAMD)对治疗前后的抑郁发作患者进行症状严重程度评定。分析甲状腺功能及性激素与HAMD评分的相关性。结果 MECT治疗后30 min,甲状腺功能无明显变化(P>0.05),E2水平显著下降(P<0.01),PRL水平显著升高(P<0.01)。MECT疗程结束后,T3、FT3和E2水平显著增高(P<0.01)。MECT治疗前后T3水平与HAMD中阻滞因子负相关(r=-0.480,r=-0.471,P<0.01),T水平与HAMD中阻滞因子负相关(r=-0.412,r=-0.385,P<0.01),其他甲状腺功能和性激素与HAMD评分各因子分无相关。结论经MECT治疗的抑郁发作患者可以监测其甲状腺功能水平及性激素水平,以便于临床医生观察疗效和调整治疗方案。

Objective To explore the effect of modified electroconvulsive therapy（MECT） on thyroxine and sex-hormone of the of patients experiencing an episode of depression. Methods Fifty-seven patients meeting the criteria of ICD-10 for depression episode were enrolled into the study. The levels of serum free triiodothyronine （FT3）, free thyroxine （FT4）, thy- roid stimulating hormone （ TSH ）, triiodothyronine （ T3 ）, thyroxine （ T4 ）, testosterone （ T ）, estradiol （ E2 ） and prolactin （PRL） were tested at 30-minutes after the treatment and the end of treatment. Hamilton Depression Rating Scale （HAMD） was performed before and after the treatment to assessseverity of symptom. The correlations among thyroxine, sex-hormone and scores of HAMD were analyzed. Results Thyroxine had no significant changes, E2 was significantly de- creased 30-minutes after the treatment（ P 〈 0.01 ） ,while PRL was significantly increased after that（ P 〈 0.01 ）. T3, FT3 and E2were significantly increased at the end of the treatment（ P 〈0.01 ）. There was significant negative correlation be- tween level of T3 and scores of retardation factor before and after the treatment （ r = - 0.480, r = - 0. 471, P 〈 0.01 ）. There was significant negative correlation between level of T and scores of retardation factor before and after the treatment （r = -0.412 ,r = -0. 385, P 〈 0.01 ） while no correlation among other thyroxine, Sex-hormone and scores of HAMD. Conclusion The clinical doctors can evaluate the efficacy and adjust treatment plan based on the levels of thyroxine and sex-hormone in depressive episodes patients receiving MECT.