围绝经期绝经前后抑郁发作患者甲状腺激素水平表达

A study on the thyroid hormone level of premenopausal or postmenopausal depressed patients

目的探讨围绝经期绝经前后抑郁发作患者治疗前后抑郁症状及甲状腺激素水平的变化,为临床干预提供依据。方法将133例围绝经期抑郁发作患者根据绝经前后分为绝经前组70例(脱落16例,完成研究54例),绝经后组63例(脱落18例,完成研究45例),抽取同期进行体检的女性健康志愿者40名设为对照组。患者组单一口服艾司西酞普兰片治疗,观察8周。于治疗前后采用汉密顿抑郁量表评定抑郁症状变化,同时检测3组血清甲状腺激素水平变化。结果治疗前绝经前组汉密顿抑郁量表总分及焦虑/躯体化、体重变化、绝望感因子分均显著高于绝经后组(P<0.05或0.01),认知障碍因子分显著低于绝经后组(P<0.01)。3组血清甲状腺素FT4水平组间效应(F=7.38,P<0.01)及组内时点效应(F=3.58,P<0.05)均有统计学意义;绝经前组和绝经后组FT4水平随着治疗时间的延续均逐渐下降,且在治疗前均显著高于对照组(P<0.01)。促甲状腺激素水平组内时点效应有统计学意义(F=3.12,P<0.05),但组间及二者的交互效应均无统计学意义(P>0.05)。绝经前组治疗前血清FT4水平与体重因子评分呈显著负相关(P<0.01)、与焦虑/躯体化因子评分呈显著正相关(P<0.01),4周末及8周末的变化值分别与汉密顿抑郁量表总分、焦虑/躯体化、体重、睡眠障碍、绝望感的变化值呈正相关(P<0.05或0.01),与体重因子评分差值呈显著负相关(P<0.01)。结论围绝经期绝经前后抑郁发作患者各项抑郁症状的严重程度有所不同,抑郁症状的变化与血清甲状腺素FT4水平变化密切相关。

Objective To study the characteristics of depressive symptoms and abnormalities of thyroid hormone levels of premenopausal or postmenopausal depressed patiknts to provide a basis for clinical intervention.Methods 133 patients with perimenopausal depressive episodes were divided into premenopausal group(70 cases,16 patients fall out,54 patients completed the study)and postmenopausal group(63 cases,18 patients fall out,45 patients completed the study).40 female healthy volunteers who were enrolled in the same period for physical examination were set as the control group.The patient group wastreated with a single oral escitalopram tablet for 8 weeks.Before and after treatment,the Hamilton Depression Scale was used to assess the changes of depressive symptoms,and the changes of serum thyroid hormone levels in the three groups were also detected.Results Before treatment,the total score of Hamilton Depression Scale and the scores of anxiety/somatization,body weight and despair in the premenopausal group were significantly higher than those in the postmenopausal group(P<0.05 or 0.01),and the cognitive impairment factor score was significantly lower than that in the postmenopausal group(P<0.01).There were significant differences on theserum levels of FT4 between-subjects effects(F=7.38,P<0.01)and within-subjects effects(F=3.58,P<0.05);the serum level of FT4 among premenopausal and postmenopausal depressed patients decreased gradually,and significantly higher than the control group before treatment(P<0.01).There were significant differences on serum level of TSH on within-subjects effects(F=3.12,P<0.05),but no statistical significance was found on between-subjects effects and interaction effects(P>0.05).The serum FT4 level in premenopausal group was negatively correlated with body mass factor before treatment(P<0.01),and there was a significant positive correlation with the anxiety/somatic factor score(P<0.01).There was a positive correlation with the total score of HAMD,anxiety/somatization,sleep disorder and despair at the end of 4th and 8th week(P<0.05 or 0.01),there was a significant negative correlation with the body weight factor score(P<0.01).Conclusion The severity of depression symptoms in patients with depressive episodes before and after menopause is different,and changes in depressive symptoms are close1y related to changes in serum thyroxine FT4 levels.