锌离子在无抽搐电休克联合抗抑郁剂治疗抑郁症中的作用

Effects of zinc ion on treatment of depression with modified electroconvulsive therapy

目的探讨锌离子(Zn^(2+))在无抽搐电休克(MECT)联合非选择性五羟色胺再摄取抑制剂(SSRIs)治疗抑郁症中的浓度变化及与抑郁症状缓解的相关性。方法选取2015年8月-12月在北京回龙观医院住院治疗的符合《精神疾病诊断与统计手册(第4版)》(DSM-4)诊断标准的中、重度抑郁症患者21例(脱落2例),采用重复测量设计实验,对入组患者进行MECT联合SSRIs抗抑郁药物治疗,每位患者在治疗前、治疗3次、治疗6次后进行心率、血压、脉搏、呼吸等一般生命体征评估、汉密尔顿抑郁量表24项版(HAMD-24)评定并抽取外周血5 mL。采用生化法检测Zn^(2+)浓度。结果①不同时间点Zn^(2+)浓度的GLM分析结果显示,Zn^(2+)浓度呈上升趋势,但差异无统计学意义(P=0.131)。②MECT治疗3次后Zn^(2+)浓度变化差值与HAMD-24及各因子评分无相关性(P>0.05)。③治疗6次后Zn^(2+)浓度与HAMD-24睡眠障碍因子评分变化差值有相关性(r=-0.529,P=0.020)。④MECT治疗3次后和治疗6次后总有效率分别为89.47%、100%,临床痊愈率分别为42.11%、68.42%。结论 MECT联合SSRIs抗抑郁剂治疗抑郁症可能不是通过离子型受体发挥作用,患者血清Zn^(2+)浓度变化与睡眠改善相关,提示抑郁症患者血清Zn^(2+)浓度的变化可以反映睡眠质量的改善情况。

Objective To investigate the concentration change of zinc ion（Zn^2＋ ） in patients treated with modified electroconvulsive therapy （MECT） combined with non - selective serotonin reuptake inhibitors （SSRIs） and the correlation with remission of depressive symptoms. Methods 21 patients with moderate to severe depression who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition（ DSM - IV） in Beijing Huilongguan Hospital, were recruited from August to December 2015 （ with 2 cases drop out）. MECT combined with SSRIs antidepressant drugs were used for the treatment of depression, each patient was conducted general assessment of vital signs, Hamilton Depression Scale - 24 item （ HAMD - 24） and extracted of venous blood 5 mL before treatment, the 3rd and 6th times after treatment. The Zn^2＋ concentration was measured by biochemical method. Results ① T h e level of Zn2 ＋ concentration was gradually increasing at different treatment points but there was no significant difference in GLM analysis （P =0.131）. （2）There was no correlation between the change of Zn^2＋ concentration with the score of HAMD -24 （P 〉0. 05） after three times of MECT treatment. （3）The change of Zn2 ＋ was related to sleep disturbance factor after six times of MECT treatment （r = - 0 . 529 , P = 0. （ ^ 0 ） . ④The total effective rate was 89. 47% and the clinical cure rate was 42. 11% after three times of MECT treatment while the total effective rate was 100% and the clinical cure rate was 68. 42% after six times of MECT treatment. Conclusion MECT combined with SSRIs antidepressant drugs treatment may not contribute to the treatment of depression by ionic receptor. The change of serum Zn2 ＋ concentration in patients is related to sleep improvement, which suggested that the change of serum Zn^2＋ concentration in patients with depression could reflect the improvement of sleep.