阻塞性睡眠呼吸暂停低通气综合征患者下丘脑-垂体-甲状腺轴激素水平与抑郁状态的相关性研究

The effect of hypothalamic-pituitary-thyroid axis hormone levels and depression in obstructive sleep apnea-hypopnea syndrome

目的通过检测OSAHS患者血清促甲状腺激素释放激素(TRH)、促甲状腺激素(TSH)、游离甲状腺素(FT4、FT3)水平的变化及评估其抑郁状态,探讨OSAHS患者下丘脑-垂体-甲状腺轴激素水平与抑郁状态的相关性.方法根据多导睡眠监测结果,选取2013年8月至2017年5月于中国医科大学附属第一医院呼吸与危重症医学科就诊的73例男性OSAHS患者[年龄20~58岁,平均(39±11)岁]及13例男性单纯鼾症对照组[年龄22~51岁,平均(36±8)岁],其中OSAHS组进一步根据呼吸暂停低通气指数(AHI)分为轻度、中度、重度OSAHS组,根据最低指端血氧饱和度(SpO2)分为正常血氧组、轻度低氧组、中度低氧组、重度低氧组,均行抑郁状态评估,在第2天清晨抽血并检测血清TRH、TSH、FT4与FT3水平.结果重度低氧组患者血清FT3水平[(5.4±0.7)ng/L]、抑郁评分(40±10)均高于对照组[分别为(4.5±0.6)ng/L、30±7](均P<0.05).将重度低氧OSAHS患者进一步分层发现,合并抑郁状态的患者血清FT3水平[(5.0±0.5)ng/L]、FT4水平[(16.2±1.9)ng/L]低于不合并抑郁状态患者[分别为(5.5±0.7)ng/L和(18.2±2.3)ng/L].结论重度低氧OSAHS患者血清FT3、FT4水平降低与抑郁的发生密切相关.

Objective To explore the change of hypothalamic-pituitary-thyroid axis hormones and it′s role in depression in obstructive sleep apnea-hypopnea syndrome. Methods Seventy-three male OSAHS patients [age (39±11) years] and 13 male controls [age (36±7.5) years] were enrolled from August 2013 to May 2017 in the 1st Hospital of China Medical University. Overnight polysomnography and depression were assessed. The serum TRH, TSH, FT4 and FT3 levels were measured on the next morning. The relationship between depression and hypothalamic-pituitary-thyroid axis was analyzed. Results Compared with the control group, severe hypoxia group had higher serum FT3 level [(4.5±0.6) ng/L vs.(5.4±0.7)ng/L, P<0.05)] and depression score (30±7 vs. 40±10, P<0.05). Further analysis revealed that serum FT3 level (5.0±0.5 ng/L vs. 5.5±0.7ng/L, P<0.05) and FT4 level [(16.2±1.9) ng/L vs.(18.2±2.3) ng/L, P<0.05] were lower in the patients with depression than those without. Conclusion The decrease of serum FT3 and FT4 levels in OSAHS patients with severe hypoxia was closely related to the occurrence of depression.