产科应激事件对产后抑郁症患者神经内分泌功能的影响

Study on the effects of obstetric stress events on neuroendocrine function in patients with postpartum depression

目的探讨产科应激事件对产后抑郁症(PPD)患者相关神经内分泌功能的影响。方法选取2015年1月~2016年12月足月分娩且发生过产科应激事件的304例产妇为研究对象,根据发生产科应激事件数的不同分为观察组1到组6。同时,随机抽取同期足月分娩且未发生产科应激事件的60例产妇作为对照组。对比分析观察组和对照组患者的血清促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇水平以及血浆中各单胺神经递质水平。结果观察组PPD发生率高于对照组(χ2=4.206,P=0.040),爱丁堡产后抑郁量表(EPDS)评分也高于对照组(t=18.482,P<0.001);观察组CRH(t=11.521,P<0.001)、ACTH(t=4.686,P<0.001)、皮质醇(t=6.239,P<0.001)水平均高于对照组,且应激事件数越多,产妇CRH、ACTH、皮质醇水平也越高;观察组5-HT(t=4.108,P<0.001)、DA(t=4.656,P<0.001)、NE(t=7.081,P<0.001)水平均低于对照组,且应激事件数越多,5-HT、DA、NE水平越低。结论产科应激事件可叠加影响产妇的神经内分泌功能,是PPD发生的重要原因之一。

Objective To investigate the effects of obstetric stress events on the neuroendocrine function of patients with postpartum depression(PPD).Methods 304 parturients who gave full-term delivery with obstetric stress events from January,2015 to December,2016 were selected.According to the number of obstetric stress events,all cases were divided into observation group 1 to observation group 6.At the same time,60 parturients who gave full-term delivery without obstetric stress events during the same period were selected as control group.And then,the levels of serum corticotropin releasing hormone(CRH),adrenocorticotropic hormone(ACTH),cortisol and the levels of monoamine neurotransmitters in plasma were compared between the observation group and the control group.Results The incidence of PPD in the observation group was higher than that in the control group(χ2=4.206,P=0.040),and Edinburgh postnatal depression scale(EPDS)score was higher than that of the control group(t=18.482,P<0.001).The levels of CRH(t=11.521,P<0.001),ACTH(t=4.686,P<0.001)and cortisol(t=6.239,P<0.001)in the observation group were all higher than those of the control group,and the more stress events,the higher the levels of CRH,ACTH and cortisol in women.The levels of 5-HT(t=4.108,P<0.001),DA(t=4.656,P<0.001)and NE(t=7.081,P<0.001)in the observation group were all lower than those in the control group,and the more stress events,the lower the levels of 5-HT,DA and NE.Conclusion Obstetric stress events can affect the neuroendocrine function of the parturients,which is one of the important reasons for the occurrence of PPD.