产后应激事件对产后抑郁症患者神经内分泌功能的影响

Effect of postpartum stress events on neuroendocrine function in patients with postpartum depression

目的探讨产后应激事件对产后抑郁症患者神经内分泌功能的影响。方法选取2017年6月～2018年6月在我院产科治疗的80例发生产后应激事件的产后抑郁症患者作为观察组,将同期80例无产后应激事件的产后抑郁症患者作为对照组。比较两组患者的汉密尔顿抑郁量表(HAMD)、爱丁堡产后抑郁量表(EPDS)、临床大体印象量表(CGI)评分,性激素六项(卵泡刺激素、黄体生成素、雌二醇、孕酮、睾酮、泌乳素)、甲状腺激素[三碘甲状腺原氨酸(T_3)、四碘甲状腺原氨酸(T_4)、促甲状腺激素(TSH)]及神经内分泌激素[血清皮质醇、促肾上腺皮质激素(ACTH)]水平。结果观察组患者的HAMD、EPDS及CGI评分均明显高于对照组,差异有统计学意义(P<0.05)。观察组患者的卵泡刺激素、黄体生成素、雌二醇、孕酮、睾酮水平均明显低于对照组,而泌乳素水平明显高于对照组,差异有统计学意义(P<0.05)。观察组患者的T_3、T_4、血清皮质醇、ACTH水平均明显高于对照组,差异有统计学意义(P<0.05);观察组患者的TSH水平明显低于对照组,但差异无统计学意义(P>0.05)。结论产后应激事件对产后抑郁症患者神经内分泌功能有明显负面影响,会降低机体性激素水平,升高血清皮质醇、ACTH水平,降低甲状腺功能,临床应尽量避免产后应激事件对产妇的刺激。

Objective To explore the effect of postpartum stress events on neuroendocrine function in patients with postpartum depression.Methods A total of 80 postpartum depression patients who suffered from post-production stress events in obstetrics department of our hospital from June 2017 to June 2018 were selected as the observation group,and another 80 postpartum depression patients without postpartum stress events during the same period were selected as the control group.The scores of Hamilton depression scale(HAMD),Edinburgh postnatal depression scale(EPDS)and clinical gross impression scale(CGI),and the levels of six sex hormones(follicle stimulating hormone,luteinizing hormone,estradiol,progesterone,testosterone,prolactin),thyroid hormones(triiodothyronine[T3],tetraiodothyronine[T4],thyroid stimulating hormone[TSH])and neuroendocrine hormones(serum cortisol,adrenocorticotropic hormone[ACTH])were compared between the two groups.Results The scores of HAMD,EPDS and CGI in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of follicle stimulating hormone,luteinizing hormone,estradiol,progesterone and testosterone in the observation group were significantly lower than those in the control group,while the level of prolactin was significantly higher than that in the control group,and the differences were statistically significant(P<0.05).The levels of T3,T4,serum cortisol and ACTH in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The level of TSH in the observation group was significantly lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion The postpartum stress events have obvious negative effect on the neuroendocrine function of postpartum depression patients,which can reduce the body sex hormone levels,increase the levels of serum cortisol and ACTH,and reduce thyroid function,and the clinical should try to avoid the stimulation of postpartum stress events to the puerpera.