抑郁严重程度与甲状腺功能减退的关系及超声对抑郁症患者甲状腺功能减退的诊断价值

Relationship between the severity of depression and hypothyroidism and the diagnostic value of ultrasonography in depression patients with hypothyroidism

目的探讨抑郁症与甲状腺功能减退的关系及超声对抑郁症患者伴甲状腺功能减退的诊断价值。方法本研究为前瞻性研究,选取云南省精神病医院2016年9月至2020年1月收治的120例抑郁症合并甲状腺功能减退患者作为观察组,另选取同期进行治疗的120例单纯性抑郁症患者作为对照组,比较两组患者的抑郁严重程度、汉密尔顿抑郁量表(HAMD)量表评分、甲状腺功能之间的差异,研究三碘甲状腺原氨酸(T3)、甲状腺素(T4)以及促甲状腺激素(TSH)水平与HAMD量表评分的相关性,采用超声检查两组患者的甲状腺大小及甲状腺血流参数,以病理检查为金标准,分析超声动脉加速度(A)、收缩峰值流速(PSV)、加速时间(AT)及联合检测对抑郁症合并甲状腺功能减退的诊断效能。结果观察组患者的抑郁严重程度高于对照组,HAMD量表的认知障碍、失眠障碍、躯体性焦虑、精神性焦虑、情绪评分均高于对照组,差异均有统计学意义(P<0.001);观察组患者的T3、T4水平低于对照组,TSH水平高于对照组,差异均有统计学意义(P<0.001);抑郁症合并甲状腺功能减退患者的抑郁程度与T3、T4水平呈负相关,与TSH水平呈正相关(P<0.001)。观察组患者甲状腺的长径、宽径、厚径、峡部厚径低于对照组,且PSV、A、AT值高于对照组,差异有统计学意义(P<0.05)。PSV、A、AT联合检测的特异度最高,为95.83%,曲线下面积(AUC)为0.825。结论抑郁症与甲状腺功能减退呈现显著的相关性,超声对抑郁症患者伴甲状腺功能减退的诊断具有显著意义。

Objective To explore the relationship between depression and hypothyroidism and the diagnostic value of ultrasonography in depression patients with hypothyroidism.Methods This study is a prospective study.A total of 120 patients with depression complicated with hypothyroidism treated in Mental Hospital of Yunnan Province from September 2016 to January 2020 were selected as the observation group,and 120 patients with simple depression treated in the same period were selected as the control group.The differences of depression severity,Hamilton depression scale(HAMD)score and thyroid function between the two groups were compared.The correlation between the levels of triiodothyronine(T3),tetraiodothyronine(T4)and thyroid stimulating hormone(TSH)and the score of HAMD scale was studied.The thyroid size and thyroid blood flow parameters of the two groups were examined by ultrasound.The diagnostic efficacy of ultrasound arterial acceleration(A),peak systolic velocity(PSV),acceleration time(AT)and combined detection in depression with hypothyroidism was analyzed with pathological examination as the gold standard.Results The severity of depression in the observation group was higher than that in the control group,and the scores of cognitive impairment,insomnia impairment,somatic anxiety impairment,mental anxiety impairment and emotion in HAMD in the observation group were higher than those in the control group,the differences were statistically significant(P<0.001).The levels of T3 and T4 in the observation group were lower than those in the control group,and the level of TSH in the observation group was higher than that in the control group,the differences were statistically significant(P<0.001).The degree of depression in patients with depression and hypothyroidism was negatively correlated with T3 and T4,and positively correlated with TSH(P<0.001).The long diameter,wide diameter,thick diameter and isthmus thick diameter of thyroid in the observation group were lower than those in the control group,and PSV,A and AT in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The specificity of combined detection of PSV,A and AT was the highest,which was 95.83%,and the area under curve(AUC)was 0.825.Conclusion There is a significant correlation between depression and hypothyroidism.Ultrasound is of great significance in the diagnosis of depression with hypothyroidism.