双相情感障碍与甲状腺激素水平变化之间的关系

Relationship Between Bipolar Affective Disorder and Thyroid Hormone Levels

目的分析双相情感障碍临床特征并探讨疾病与血清甲状腺激素水平之间的关联。方法随机抽取2020年1月—2022年2月在福建省福州神经精神病防治院进行诊治的双相情感障碍患者67例,将31例抑郁发作患者归入抑郁组,将36例躁狂发作患者归入躁狂组,随机选取健康体检者35例为对照者并归入对照组。对比三组研究对象的甲状腺激素水平,针对双相情感障碍患者血清甲状腺激素水平与蒙哥马利抑郁评定量表(Montgomery-Asberg depression rating scale,MADRS)总评分及杨氏躁狂评定量表(Young mania rating scale,YMRS)总评分的相关性进行分析。结果三组甲状腺素(thyroxine,T_(4))及游离甲状腺素(free thyroid hormone,FT_(4))水平差异无统计学意义(P>0.05)。相比于躁狂组及对照组患者,抑郁组患者促甲状腺激素(thyroid stimulating hormone,TSH)水平显著更低(P<0.05),抑郁组及躁狂组患者游离三碘甲状腺原氨酸(free triiodothyronine,FT_(3))水平均低于对照组(P<0.05),但抑郁组与躁狂组FT_(3)水平差异无统计学意义(P>0.05)。抑郁组血清三碘甲状腺原氨酸(triiodothyronine,T_(3))水平低于躁狂组及对照组,差异均有统计学意义(P<0.05),躁狂组与对照组T_(3)水平差异无统计学意义(P>0.05)。相关性分析结果显示,抑郁发作患者甲状腺激素水平与MARDS总评分及躁狂发作患者TSH、T_(3)、T_(4)、FT_(3)水平与YMRS总评分无明显相关性(P>0.05),仅躁狂发作患者FT_(4)与YMRS总评分正相关(P<0.05)。结论双相情感障碍患者普遍存在甲状腺功能紊乱等现象,患者出现甲状腺功能衰退的风险较高,躁狂发作患者FT_(4)与YMRS总评分具有相关性,而甲状腺激素其余指标T_(3)、T_(4),FT_(3)和TSH与双相情感障碍均无明显关联,但是甲状腺功能与双相情感障碍的发生及发展仍存在重要关联,对临床用药有一定的提示。

Objective To analyze the clinical features of bipolar disorder and to explore the relationship between the disease and serum thyroid hormone levels.Methods A total of 67 patients with bipolar disorder who were diagnosed and treated in Fuzhou Neuro-psychiatric Hospital,Fujian Province,from January2020 to February 2022 were randomly selected,there were 31patients with depressive episodes in the depression group,and there were 36 patients with manic episodes in the mania group,and 35 healthy physical examinees were randomly selected as controls and included in the control group.The thyroid hormone levels of the three groups of subjects were compared,and the correlation between the serum thyroid hormone level of patients with bipolar disorder and the total score of the MontgomeryAsberg depression rating scale(MADRS)and the total score of the Young mania rating scale(YMRS)was analyzed.Results There was no significant difference in the levels of T_(4)and FT_(4)among the three groups(P>0.05).The level of thyroid stimulating hormone(TSH)of the depression group was much lower than that of the mania group and the control group(P<0.05),and the level of free triiodothyronine(FT_(3))of the depression group and the mania group was much lower than that in the control group(P<0.05).The difference of the level of FT_(3)between the depression group and the mania group was not significant(P>0.05).The triiodothyronine(T_(3))level of the depression group was much lower than that of the mania group and the control group(P<0.05).There difference of T_(3)level between the manic group and the control group was not significant(P>0.05).The results of correlation analysis showed that the correlation between the thyroid hormone level in patients with depressive episode and the total MARDS score was not significant,and the TSH,T_(3),T_(4),FT_(3)level and the total YMRS score(P>0.05).Only the FT_(4)level in patients with manic episode was positively correlated with the total score of YMRS(P<0.05).Conclusion Patients with bipolar affective disorder have thyroid dysfunction,and the risk of thyroid dysfunction is high.There is a correlation between FT_(4)and the total score of YMRS in manic patients,while the other indicators of thyroid hormones T_(3),T_(4),FT_(3),TSH have no significant correlation with bipolar affective disorder.However,there is still an important correlation between thyroid function and the occurrence and development of bipolar affective disorder,which may have some implications for clinical medication.