左甲状腺激素对干扰素引起慢性丙型肝炎患者抑郁症的影响

发布时间：2018-04-13 05:13

本文选题：左甲状腺激素 + 干扰素　；参考：《承德医学院》2013年硕士论文

【摘要】：目的：探讨年龄、性别和患者体内甲状腺激素水平与干扰素诱导抑郁症的严重程度的相关性，分析慢性丙型肝炎患者与健康对照组及治疗前后各组Th1/Th2细胞因子的表达水平。方法：本研究应用Zung抑郁症自测量表(ZDS)和Zung焦虑症自测量表(ZAS)对患者进行进行心理测评，及时掌握患者出现抑郁和焦虑症状的严重程度，并给予低剂量左甲状腺激素和心理辅助治疗，使发生抑郁和/或焦虑的患者顺利完成抗病毒治疗。用化学发光法检测干扰素治疗前后及应用左甲状腺激素前后患者体内甲状腺激素水平，分离外周血单核细胞，抽提细胞总RNA，进行RT-PCR反应，得到IFN-γ、TNF-α、IL-4、IL-104种细胞因子相对含量(%)。结果：高龄女性患者在干扰素抗病毒治疗过程中，更容易发生抑郁症状；甲状腺激素水平降低与抑郁症发生关系密切；给予低剂量左甲状腺素治疗，，患者抑郁程度能够得到改善。患者应用PEG-IFNα-2a治疗后，出现不同程度甲状腺功能低下的表现，血清甲状腺素FT3、FT4明显降低，TSH水平升高，有统计学差异（p0.01），其体内甲状腺素水平越低，其抑郁和焦虑的发生程度越高；CHC患者与正常对照组比较，Th1细胞因子表达水平较低，有统计学差异(P＜0.05)；而Th2细胞因子表达水平偏高，无统计学差异(P＞0.05)；治疗后Th1类细胞因子IFN-γ和TNF-α的表达水平显著增高，Th2类细胞因子IL-4和IL-10的表达水平与治疗前相比无显著性变化。结论：年龄越大，在干扰素抗病毒治疗过程中，发生抑郁症状的可能性越大，女性病人较男性病人发生抑郁的可能性要大，因此，在实际临床工作中，要给与高度关注。慢性丙型肝炎病人应用干扰素抗病毒治疗过程中，患者血清甲状腺激素水平降低，与抑郁症状发生成正相关关系。慢性丙型肝炎病人应用干扰素抗病毒治疗过程中，对发生抑郁症的患者，补充小剂量甲状腺激素，能够改善抑郁症状，使患者抗病毒治疗过程能够顺利完成。IFN与细胞因子及信号传导的相互作用与抑郁症的发生有关。Th1和Th2细胞因子诱导的免疫反应相互抑制、相互调节，处于动态平衡状态，维持正常的细胞免疫和体液免疫功能。
[Abstract]:Objective:To investigate the correlation between age, sex and thyroid hormone levels in patients with interferon induced depression, and to analyze the expression of Th1/Th2 cytokines in patients with chronic hepatitis C, healthy controls and groups before and after treatment.Methods:In this study, Zung depression self-rating scale (ZDS) and Zung anxiety self-test scale (ZASS) were used to assess the psychological status of the patients, to grasp the severity of depression and anxiety symptoms, and to give low dose of left thyroid hormone and psychological adjuvant treatment.Patients with depression and / or anxiety are successfully treated with antiviral therapy.The levels of thyroid hormones were detected by chemiluminescence before and after interferon treatment and before and after the application of left thyroid hormone. Peripheral blood monocytes were isolated, total RNAs were extracted, and RT-PCR reaction was carried out. The relative contents of IL-104 cytokines were obtained.Results:In the course of interferon antiviral therapy, elderly women are more likely to develop depression symptoms; the decrease of thyroid hormone level is closely related to depression; low dose of levothyroxine treatment can improve the depression degree of patients.After treatment with PEG-IFN 伪 -2a, the patients showed different degrees of hypothyroidism, serum thyroxine FT3FT4 significantly decreased the level of TSH increased, there was statistical difference (p0.01), the lower the level of thyroxine, the lower the level of thyroxine.The higher the degree of depression and anxiety was, the lower the expression of Th1 cytokines in CHC patients was compared with the normal control group (P < 0.05), but the higher the expression level of Th2 cytokines was.The expression of Th1 cytokines IFN- 纬 and TNF- 伪 was significantly increased after treatment. The expression levels of Th2 cytokines, IL-4 and IL-10, had no significant change compared with those before treatment.Conclusion:The older the age, the greater the likelihood of depressive symptoms in the course of interferon antiviral therapy, and the greater the likelihood of depression in female patients than in male patients. Therefore, in the actual clinical work, we should pay high attention to it.The serum thyroid hormone level in patients with chronic hepatitis C was decreased during antiviral therapy with interferon, which was positively correlated with the occurrence of depressive symptoms.In the course of antiviral therapy with interferon in patients with chronic hepatitis C, low dose thyroid hormone supplementation can improve depression symptoms in patients with depression.The interaction between. IFN and cytokines and signal transduction in patients with antiviral therapy is related to the occurrence of depression. Th1 and Th2 cytokines induce immune responses to inhibit each other, regulate each other, and are in a dynamic equilibrium state.Maintain normal cellular and humoral immunity.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.63;R749.4

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