初产妇围产期血清性激素水平变化与心理障碍的关系

Relationship between changes in serum sex hormone levels in primiparas during the prenatal period and mental disorders

目的:探讨初产妇围产期血清性激素水平变化与心理障碍的关系。方法:通过放射免疫法测定本院2015年1月-2017年1月就诊的250例初产妇围产期血清雌二醇(E2)、孕酮(P)、催乳素(PRL)水平;通过汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)评价初产妇心理状况,由精神科医生判断产妇是否存在心理障碍。结果:HAMA评分显示,焦虑发生率36.00%,HAMD评分显示抑郁发生率56.80%;与常模比较,初产妇抑郁、躯体化表现、恐怖评分均显著高(t=4.090,2.424,4.369;P<0.05);专业精神科医生判断初产妇心理障碍发生率64.80%;心理障碍组孕早期、孕晚期、产后7d、产后42d血清E2水平均显著低于、P水平均显著高于非心理障碍组(t=-23.352,-17.513,-21.203,-15.756,6.029,15.901,49.691,6.554;P<0.05);Pearson相关性分析显示HAMD评分与E2负相关(r=-0.182,P<0.05),与P正相关(r=0.185,P<0.05);SCL-90量表中抑郁因子与E2负相关(r=-0.229,P<0.05);躯体化因子与E2负相关(r=-0.223,P<0.05),与P正相关(r=0.158,P<0.05)。结论:围产期低E2水平、高P水平是初产妇心理障碍发生的可能原因。

Objective:To investigate the relationship between changes in serum sex hormone levels in primiparas during the prenatal period and mental disorders.Methods:Levels of serum estradiol(E2),progesterone(P)and prolactin(PRL)in 250 primiparas who were admitted to our hospital from January 2015 to January 2017 were determined by radioimmunoassay.The mental status of primiparas was evaluated by Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and symptom checklist 90(SCL-90),and the existence of mental disorders was determined by psychiatrists.Results:The HAMA score showed that the incidence of anxiety was 36.00%,and the HAMD score showed that the incidence of depression was 56.80%.Compared with the norm,scores of depression,somatization and terror of primiparas were significantly higher(t=4.090,2.424,4.369;P<0.05).Professional psychiatrists judged that the incidence of mental disorders in primiparas was 64.80%.Serum E2 levels in primiparas with mental disorders in early pregnancy and late pregnancy,at 7 d and 42 d after delivery were significantly lower,while P levels were significantly higher than those in non-mental disorder group(t=-23.352,-17.513,-21.203-15.756,6.029,15.901,49.691,6.554;P<0.05).Pearson correlation analysis showed that the HAMD score was negatively correlated with E2(r=0.182,P<0.05),and positively correlated with P(r=0.185,P<0.05).The depression factor in SCL-90 scale was negatively correlated with E2(r=0.229,P<0.05),somatization factor was negatively correlated with E2(r=-0.223.P<0.05),and positively correlated with P(r=0.158,P<0.05).Conclusion:Low prenatal E2 level and high P level are the possible causes of mental disorders in primiparas.