广泛性焦虑障碍患者焦虑症状的改善与甲状腺激素水平的相关性分析

Correlation analysis between improvement of anxiety symptoms and thyroid hormone levels in patients with generalized anxiety disorder

目的探讨广泛性焦虑障碍患者经盐酸帕罗西汀治疗后血清甲状腺激素水平变化与焦虑症状严重程度的相关性。方法选取2023年1月至8月就诊于湖州市第三人民医院的广泛性焦虑障碍患者76例作为研究组,根据汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分将研究组76例患者分为轻度组23例、中度组30例及重度组23例,选取同期69名健康体检者作为对照组。研究组患者予以盐酸帕罗西汀片治疗8周后再次评估焦虑症状,测定并比较基线期及8周末甲状腺激素水平,包括三碘甲状腺原氨酸(triiodothyronine,T_(3))、甲状腺素(thyroxine,T_(4))、游离三碘甲状腺原.氨酸(free triiodothyronine,FT_(3))、游离甲状腺素(free thyroxine,FT_(4))、促甲状腺素(thyroid stimulating hormone,TSH)、抗甲状腺球蛋白抗体(antithyroglobulin antibody,TG)、抗甲状腺过氧化物酶抗体(anti-thyroid peroxidase antibody,TPO)。结果经盐酸帕罗西汀治疗8周后,轻度组、中度组、重度组的显效率依次为73.9%、76.7%、73.9%,三组疗效比较,差异无统计学意义(χ^(2)=0.073,P>0.05)。基线期中度组和重度组患者的FT_(4)水平显著高于轻度组和对照组,差异有统计学意义(P<0.05)。中度组和重度组患者的基线期焦虑症状严重程度与FT_(4)水平分别呈低正相关和显著正相关(r=0.382、0.610,P<0.05)。治疗8周末,中度组和重度组患者的FT_(4)水平较基线期明显下降,差异有统计学意义(t=2.847、3.042,P<0.05)。重度组患者HAMA减分率与基线期和治疗8周末FT_(4)水平变化呈正相关(r=0.517,P<0.05)。通过二元Logistic回归分析显示,中度组和重度组患者基线期FT_(4)越高,其疗效越差。结论基线期较高水平的FT_(4)可影响中度、重度广泛性焦虑障碍患者焦虑症状的改善。

Objective To explore the correlation between the change of the serum levels of thyroid hormone and the severity of anxiety symptoms in patients with generalized anxiety disorder after treatment with paroxetine hydrochloride.Methods 76 patients with generalized anxiety disorder treated in the Third People’s Hospital of Huzhou from January to August 2023 were collected as study group,and they were divided into mild group(n=23),moderate group(n=30),and severe group(n=23),according to degree of anxiety by Hamilton anxiety scale(HAMA),69 healthy examination subjects in the same period were selected as control group.Patients in study group were treated with paroxetine hydrochloride tablets for 8 weeks,patients were evaluated anxiety symptoms,the serum levels of thyroid hormone were measured at baseline and 8 weekend,including triiodothyronine(T_(3)),thyroxine(T_(4)),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid stimulating hormone(TSH),antithyroglobulin antibody(TG),anti-thyroid peroxidase antibody(TPO).Results After 8 weeks of paroxetine hydrochloride treatment,the significant efficacy rates of mild group,moderate group,and severe group were 73.9%,76.7%,and 73.9%,with no statistically significant difference in efficacy among three groups(χ^(2)=0.073,P>0.05).In the baseline period,FT_(4)levels of patients in moderate group and severe group were significantly higher than those in mild group and control group,and the difference was statistically significant(P<0.05).The severity of anxiety symptoms in the baseline period of patients in moderate group and severe group showed a low positive correlation and a significant positive correlation with FT_(4)levels(r=0.382、0.610,P<0.05).After 8 weeks treatment,the FT_(4)levels of patients in moderate group and severe group decreased significantly compared to the baseline period,and the difference was statistically significant(t=2.847,3.042,P<0.05).The reduction rate of HAMA score in severe group was positively correlated with the change in FT_(4)level during the baseline period and at the end of 8 weeks of treatment(r=0.517,P<0.05).By a binary Logistic regression analysis showed that the higher levels of FT_(4)in the baseline period with the worse efficacy in moderate group and severe group.Conclusion The improvement of anxiety symptoms could be affected by high baseline levels of FT_(4)in generalized anxiety disorder patients with moderate to severe anxiety.