精神分裂症后抑郁患者血浆皮质醇浓度的变化与症状改善的相关性

Correlation between changes of plasma cortisol concentration and symptom improvement in patients withpost schizophrenia depression

目的:探究精神分裂症后抑郁患者血浆皮质醇浓度的变化与其抑郁症状改善的关系。方法:选取2018年3月至2018年12月温州医科大学附属康宁医院60例精神分裂症后抑郁患者作为病例组,60例精神分裂症后恢复的患者作为对照组。病例组和对照组入组前仅给予利培酮治疗,病例组入组后加用帕罗西汀,采用ELISA法检测血浆皮质醇水平,治疗前和治疗4周后运用HAMD量表评估其抑郁症状,治疗4周后复测病例组血浆皮质醇水平。结果:病例组血浆皮质醇含量显著高于对照组,差异有统计学意义(t=7.206,P<0.001);经过4周的治疗,病例组HAMD总分、焦虑/躯体化、体质量、认知障碍、日夜变化、迟缓、睡眠障碍、绝望感因子分和血浆皮质醇含量明显低于治疗前(P<0.001)。spearman相关性分析结果显示,治疗前后病例组皮质醇差值分别与HAMD总分差值以及与焦虑/躯体化因子分差值、认知障碍因子分差值、绝望感因子分差值呈正相关(r=0.346、0.367、0.297、0.246,P<0.05)。多元线性回归分析结果显示,病例组皮质醇差值分别可以解释HAMD总分差值以及与焦虑/躯体化因子分差值、认知障碍因子分差值、绝望感因子分差值的22.5%、26.5%、17.6%、13.6%。结论:血浆皮质醇水平的变化与精神分裂症后抑郁患者症状的改善有明显的关联,血浆皮质醇含量的异常可能是精神分裂症后抑郁发病的影响因素之一。

Objective:To explore the relationship between the changes of plasma cortisol levels and the improvement in patients with post schizophrenia depression.Methods:A total of 60 post schizophrenic depression patients from the Affiliated Kangning Hospital of Wenzhou Medical University between March 2018 and December 2018 were enrolled as case group,while 60 cases of schizophrenia after recovery were enrolled as the control group.Both the case group and the control group were only previously treated with risperidone.The plasma cortisol level of the patients was measured by ELISA after entering the group.Paroxetine was added to the case group.Four weeks before and after the treatment,the depressive symptoms of the case group were evaluated by the HAMD scale.After 4-week treatment,the plasma cortisol level of the case group was measured by ELISA.Results:The plasma cortisol level of cases group was significantly higher than that of the control group(t=7.206,P<0.001).After 4 weeks’treatment,the HAMD total score and factor score of anxiety/somatization,body weight,cognitive disorder,day and night change,retardation,sleep disorder,hopelessness and the plasma cortisol level of the case group were significantly lower than those before treatment(P<0.001).Before and after treatment,the changes of plasma cortisol of the case group were positively related to the improvement of HAMD total scores and factor score of anxiety/somatization,cognitive and hopelessness(r=0.346,0.367,0.297,0.246,P<0.05).The results of linear regression analysis showed the changes of cortisol in the case group could explain 22.5%of the HAMD total,26.5%of the anxiety/somatization,17.6%of the cognitive,13.6%of the hopelessness respectively.Conclusion: The changes of plasma cortisol levels were significantly related to the improvements of symptoms in patients with post schizophrenia depression, so the abnormal plasma cortisol levels might be one of the factors influencing the incidence of post schizophrenia depression.