抑郁症的嗅觉特征与抑制控制功能分析

Analysis of the olfactory characteristics and the function of inhibitory control in depression

目的探讨抑郁症嗅觉功能治疗前后的改变,并初步探索嗅觉功能与抑郁症严重程度、抑制控制、情绪反应之间的相关性。方法选取上海市杨浦区精神卫生中心以及嘉定区中心医院2017年1月至2018年8月的35例单相发作抑郁症患者作为抑郁症组,选取同时期的33名与抑郁症组性别、年龄、受教育程度相匹配的健康成人作为健康对照组。应用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、基于中国人群的嗅觉命名测验、情绪Stroop任务评估两组的抑郁、焦虑、嗅觉水平及情绪干扰下Stroop任务的反应时间,在治疗前的基线、治疗后的3个月随访时各评估1次。数据的分析和处理采用SPSS 17.0统计软件,年龄、HAMD-17、HAMA、情绪Stroop任务的反应时间与嗅觉测试结果在基线水平的相关分析采用多重线性回归逐步分析法。结果基线时抑郁症组的嗅觉测试总分低于健康对照组[7(6,9)分比9(8,9)分,P<0.001],而治疗3个月后抑郁症组与健康对照组的嗅觉测试总分比较,差异无统计学意义[8(8,9)分比9(8,9)分,P=0.22]。基线时抑郁症组的情绪Stroop五项平均反应时间均高于健康对照组(均P<0.001)。随访时两组的正性一致(POS-C)[(539.0±109.0)ms比(489.7±132.1)ms]与正性不一致(POS-I)[(538.1±98.2)ms比(494.7±135.3)ms]比较,差异无统计学意义(P=0.10、0.13);而两组的负性一致(NEG-C)[(573.0±149.2)ms比(474.8±111.7)ms]、负性不一致(NEG-I)[(530.9±112.7)ms比(474.9±94.0)ms]、中性词(NEU)[(532.2±114.0)ms比(476.2±101.5)ms]比较,差异有统计学意义(t=3.06、2.22、2.14,均P<0.01),提示结果仍长于对照组。抑郁症基线水平时的多重线性回归分析最终获取的回归模型含自变量年龄和NEG-C(F=10.811,校正R2=0.366,P<0.001)。结论抑郁症患者在疾病发作期存在嗅觉功能和抑制控制功能损害,且经过治疗会随着病情好转而好转。多重线性回归结果提示,抑郁症患者嗅觉功能除受年龄影响外,抑制控制功能可能是其关键影响因素,而非量表所评估的情绪严重程度。

Objective To explore the changes of olfactory function in depression before and after treatment,and to preliminarily explore the correlation between olfactory function and depression severity,inhibition control and emotional response.Methods A total of 35 patients with unipolar onset depression in Shanghai Yangpu Mental Health Center and Jiading Central Hospital from January 2017 to August 2018 were selected as depression group,and 33 healthy adults matched with depression group in gender,age and education level were selected as healthy control group.17-item Hamilton Depression Rating Scale(HAMD-17),Hamilton Anxiety Rating Scale(HAMA),Chinese Smell Identification Test(CSIT)and emotional Stroop test(EST)were applied to evaluated the levels of depression,anxiety,olfactory and the response time of Stroop task under emotional interference,at the baseline before treatment and follow-up 3 months after treatment.SPSS 17.0 software was used to analyze and process the data.Multiple linear regression analysis was used to analyze the correlation between age,HAMD-17,HAMA,emotional Stroop task response time at baseline and olfactory test results.Results At baseline,the total CSIT score of the depression group was lower than that of the control group at baseline[7(6,9)vs 9(8,9),P<0.001],while there was no statistically significant difference between the two groups 3 months after treatment[8(8,9)vs 9(8,9),P=0.22].At baseline,the mean response time(MRT)of emotional Stroop test in depression group was higher than that in healthy control group(P<0.001).There were no statistically significant differences in POS-C[(539.0±109.0)ms vs(489.7±132.1)ms]and POS-I[(538.1±98.2)ms vs(494.7±135.3)ms]between the two groups(P=0.10,0.13)at follow-up.At the same time,the differences in NEG-C[(573.0±149.2)ms vs(474.8±111.7)ms],NEG-I[(530.9±112.7)ms vs(474.9±94.0)ms]and NEU[(532.2±114.0)ms vs(476.2±101.5)ms]between the two groups were statistically significant(t=3.06,2.22,2.14;P<0.01),prompting the results were still longer than those of the control group.The final regression model obtained by the multiple linear regression analysis had included two independent variables with age and NEG-C(F=10.811,adjusted R2=0.366,P<0.05)at baseline level of depression.Conclusions The patients with depression have olfactory function and inhibition and control function damage during the attack period,and it will improve with the improvement of the disease.The result of multiple linear regression suggested that in addition to age,the inhibitory control function might be the key influencing factor of the olfactory function,rather than the emotional severity assessed by the scales(HAMD-17 and HAMA).