左甲状腺素钠片对抑郁症患者残留症状治疗的增效作用

Augmentation in residual depressive symptoms treated by L-thyroxine sodium tablet

目的:探讨左甲状腺素钠片对抑郁症患者残留症状治疗的增效作用。方法:将经治疗后仍有残留症状的抑郁症患者分为低动力组(68例)和非低动力组(16例);给予左甲状腺素钠片及氟西汀替换原有的抗抑郁药治疗8周。治疗前检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平;治疗前后进行汉密尔顿抑郁量表(HAMD-17)和疲劳量表(FS14)评定;并与20位正常对照者(对照组)比较。结果:抑郁症患者血清TSH水平明显低于对照组(P<0.01);治疗后低动力组FS14和HAMD-17评分明显下降(P均<0.01);疗效与治疗前FS14评分呈正相关(r=0.241,P<0.05);与病程、血清TSH水平和HAMD-17评分呈负相关(r=-0.319,-0.530,-0.643;P均<0.01)。结论:有残留症状的抑郁症患者血清TSH水平明显降低;左甲状腺素钠片治疗对低动力抑郁症患者的残留症状有增效作用。

Objective：To study the augmentation in residual depressive symptoms of fatigue treated by L- thyroxine sodium tablet. Method：The patients with residual depressive symptoms were divided into fatigue group （68 cases） and no-fatigue group （ 16 cases）. All of the patients were treated by fluoxetine and L-thyrox- ine sodium tablet for 8 weeks. Before the treatment, the levels of serum free triiodothyronine （ FT3 ）, free tet- raiodothyromine （Pr4） and thyroid stimulating hormone （TSH） were measured in all the patient; and they were assessed by Hamilton depression rating scale 17 items （HAMD-17）and fatigue scale （FS14） before and after treatment respectively. The results were compared with 20 healthy volunteers （ control group）. Results： The level of serum TSH in the patients of depression was lower than the control group（ P 〈 0. 01 ）. After treat- ment the scores of FS14 and HAMD-17 in the fatigue group were significantly decreased than before treatment （ all P 〈 0.01 ）. The effect was positively correlated with FS14 score （ r = 0. 241, P 〈 0.05 ） and negatively correlated with course, the level of serum TSH and HAMD-17 score （r = -0. 319, -0. 530, -0. 043;all P 〈 0. 01 ）. Conclusion： TSH was significantly lower in patients with the residual depressive symptoms. L-thyrox- ine sodium tablet may be effective for the fatigue of residual depressive symptoms.