无抽搐电休克治疗与碳酸锂对双相障碍抑郁发作患者氧化应激水平的影响

The effect of modified electroconvulsive therapy and lithium on oxidative stress status in bipolar disorder patients with depression episode

目的了解无抽搐电休克治疗(modified electroconvulsive therapy,MECT)对双相障碍抑郁发作患者氧化应激水平的影响。方法选取双相障碍抑郁发作患者42例,随机分为两组,MECT组18例患者在抗抑郁药物治疗基础上行12次MECT治疗,碳酸锂组24例患者使用碳酸锂合并抗抑郁药物治疗,共治疗6周。分别在治疗前、治疗6周末采用17项汉密尔顿抑郁量表(17 items Hamilton depression scale,HAMD-17)、杨氏躁狂量表(Young mania rating scale,YMRS)、临床疗效总评量表(clinical global impression scale,CGI)、副反应量表(treatment emergent symptom scale,TESS)评估疗效和不良反应,检测外周血超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)、丙二醛(malondialdehyde,MDA)含量,评估氧化应激水平。结果重复测量方差分析显示,SOD指标分组主效应有统计学意义(F=15.26,P<0.01),碳酸锂组的水平整体高于MECT组(P<0.05);MDA指标分组主效应有统计学意义(F=18.18,P<0.01),MECT组的水平整体高于碳酸锂组(P<0.05);GSH-Px指标分组主效应(F=6.24,P=0.02)、分组与时间交互效应(F=6.39,P=0.02)有统计学意义,碳酸锂组的水平整体高于MECT组(P<0.05),治疗前两组间无统计学差异(P>0.05),治疗6周末MECT组GSH-Px低于碳酸锂组(P<0.05)。治疗6周末,MECT组中治疗有效者CAT水平较无效者高(P<0.05)。结论 MECT能改变双相障碍抑郁发作患者氧化应激水平,其对血浆CAT的调节可能是治疗有效的作用机制之一。

Objective To examine the effect of modified electroconvulsive therapy （MECT） on the plasma oxidative stress level in bipolar depression. Methods Forty-two patients with bipolar depression were randomly divided into two groups. The intervention group （n=18） received antidepressants and 12 times MECT for 6 weeks and the control group （n=24） received antidepressants and Li2CO3 for 6 weeks. The Chinese versions of the 17 items Hamilton Depression Rating Scale （HAMD-17）, Young Mania Rating Scale （YMRS）, Clinical Global Impression Scale （CGI-S） and Treatment Emergent Symptom Scale （TESS） were used to assess participants at baseline and after 6 weeks of treatment. The plasma levels of superoxide dismutase （SOD）, catalase （CAT）, glutathione peroxidase （GSH-Px） and malondialdehyde （MDA） were detected at baseline and after 6 weeks to assess the level of oxidative stress. Results Repeated measures analysis of variance showed that the plasma level of SOD was higher in MECT group than in Li2CO3 group （F=15.26, P〈0.01）, and the level of MDA was higher in Li2CO3 group （F=18.18, P〈0.01）. The interactive effect of group and time was significant in GSH-Px level （F=6.39, P=0.02）. The level of GSH-Px was lower in MECT group than in Li2CO3 group after 6 weeks （P〈0.05）. The CAT level was higher in the response patients than in non-response patients after 6 weeks （P〈0.05）. Con- clusions Both MECT treatment and Li2CO3 treatment can alter oxidative stress levels in patients with bipolar depression. The mechanisms underlying its therapeutic regimen may correct the imbalance of the plasma CAT level.