伴童年创伤抑郁症:临床特点、生物学机制、治疗启示

Major depressive disorder with childhood trauma:Clinical characteristics,biological mechanism,and therapeutic implications

抑郁症又称抑郁障碍,以显著而持久的心境低落为主要临床特征,是心境障碍的主要类型。目前,抑郁症的病因并不非常清楚,但可以肯定的是,生物、心理与社会环境诸多因素参与了抑郁症的发病过程。其中童年创伤被认为是影响抑郁症发生和发展的一个重要因素。既往研究发现近一半的抑郁症患者曾经历过童年创伤,不同类型的童年创伤、性别、年龄对抑郁症的影响也不同。此外,伴童年创伤的抑郁症患者的临床特点也不同,抑郁症状往往更严重,自杀风险更高,认知受损程度更严重,对抗抑郁药物的治疗应答也更差。在生物学机制和标志物方面,5-羟色胺转运体基因和FKBP前体异构酶5已被证实在抑郁症与童年创伤相互作用中发挥了重要作用。此外,在伴童年创伤抑郁症患者的脑影像学和生物特征上亦有一些特异性的改变,如背外侧前额叶皮层的灰质改变,异常亢进的下丘脑-垂体-肾上腺轴功能改变。

Major depressive disorder(MDD)is a main type of mood disorder,characterized by significant and lasting depressed mood.Until now,the pathogenesis of MDD is not clear,but it is certain that biological,psychological,and social factors are involved.Childhood trauma is considered to be an important factor in the development of this disease.Previous studies have found that nearly half of the patients with MDD have experienced childhood trauma,and different types of childhood trauma,gender,and age show different effects on this disease.In addition,the clinical characteristics of MDD patients with childhood trauma are also different,which often have more severe depressive symptoms,higher risk of suicide,and more severe cognitive impairment.The response to antidepressants is also worse.In terms of biological mechanisms and marker characteristics,the serotonin transporter gene and the FKBP prolyl isomerase 5 have been shown to play an important role in MDD and childhood trauma.Moreover,some brain imaging and biomarkers showed specific features,such as changes in gray matter in the dorsal lateral prefrontal cortex,and abnormal changes in hypothalamic-pituitary-adrenal axis function.