抑郁症共病代谢综合征患者执行功能研究

  本文关键词：抑郁症共病代谢综合征患者执行功能研究，由笔耕文化传播整理发布。

        目的：分析抑郁症共病代谢综合征患者执行功能(认知灵活性，注意转移能力，抑制控制能力，计划能力)情况及其与抑郁、焦虑水平和代谢指标的关系。方法：于2013年4月到12月，从四川省精神卫生中心体检中心、门诊部及住院部收集41例抑郁症患者(抑郁症组)、34例代谢综合征患者（代谢综合征组）、25例抑郁症共病代谢综合征患者(共病组)，以及30名正常人作为对照组（正常人组），共130例。对四组受试者进行血压，腹围，汉密顿抑郁量表（HAMD），汉密顿焦虑量表（HAMA），威斯康辛卡片分类测试（WCST），连线测试A和B（TMT），伦敦塔测试（TOL）和Stroop色词测试（SCWT）检查，并抽取静脉血液进行甘油三脂，高密度脂蛋白，空腹血糖及糖负荷后2小时血糖水平测定。结果：1. HAMD认识障碍、阻滞、绝望感因子分及总分四组之间比较差异有统计学意义（P均<0.05），共病组得分最高，其次为抑郁症组，再次为代谢综合征组，最后为正常人组。HAMD焦虑/躯体化因子分共病组高于抑郁症组、代谢综合征组，抑郁症组、代谢综合征组高于正常人组（P<0.05）；日夜变化因子分共病组、抑郁症组高于代谢综合征组、正常人组（P<0.05）；睡眠障碍因子分共病组高于抑郁症组，抑郁症组高于代谢综合征组、正常人组；体重因子分四组之间比较无统计学差异（P>0.05）。HAMA精神焦虑因子分、总分四组之间比较差异有统计学意义（P均<0.05）,其中共病组得分最高，其次为抑郁症组，再次为代谢综合征组，最后为正常人组。HAMA躯体焦虑因子分四组之间比较差异有统计学意义（P<0.05），其中共病组得分高于抑郁症组和代谢综合征组（P<0.05），抑郁症组和代谢综合征组高于正常人组（P<0.05）。2.代谢综合征各诊断指标四组之间比较差异有统计学意义（P均<0.05），其中腰围、收缩压、舒张压、空腹血糖、糖负荷后2小时血糖及甘油三脂水平共病组、代谢综合征组高于抑郁症组、正常人组（P<0.05），高密度脂蛋白共病组、代谢综合征组低于抑郁症组、正常人组（P<0.05）。3.WCST总应答次数，随机错误数及持续错误数四组之间比较差异有统计学意义（P<0.05），共病组、抑郁症组高于代谢综合征组、正常人组（P<0.05）。连线测试A完成时间及错误数四组之间比较差异无统计学意义（P>0.05）。连线测试B完成时间及错误数四组之间比较差异有统计学意义（P<0.05），共病组、抑郁症组多于代谢综合征组、正常人组(P<0.05)。格式塔测试完成时间，错误数及正确数四组之间比较差异有统计学意义（P<0.05），其中完成时间及错误数共病组、抑郁症组、代谢综合征组多于正常人组(P<0.05)，正确数共病组、抑郁症组、代谢综合征组少于正常人组(P<0.05)。stroop实验字、色测试正确数及错误数四组之间比较差异无统计学意义（P>0.05）。stroop实验字色不一测试正确数四组之间比较差异有统计学意义（P<0.05），共病组、抑郁症组多于代谢综合征组、正常人组(P<0.05)。4.共病组WCST总应答次数与HAMD总分，甘油三脂和糖负荷后两小时血糖正相关(r=0.40～0.43，P<0.05)，与HAMA总分及其他代谢综合征指标不相关。在控制糖负荷后两小时血糖、甘油三脂影响时，WCST总应答次数与HAMD总分正相关（r=0.46,P<0.05）。共病组连线测试B完成时间与HAMD总分、HAMA总分及代谢综合征各诊断指标不相关(P>0.05)。共病组格式塔实验完成时间与HMAD总分、HAMA总分及代谢综合征各诊断指标不相关(P>0.05)。共病组stroop字色不一测试正确数与HAMD总分负相关(r=-0.46，P<0.05)，与HAMA总分及代谢综合征诊断指标不相关(P>0.05)。结论：1.抑郁症共病代谢综合征患者抑郁及焦虑程度比单患其中一种疾病更严重。2.抑郁症共病代谢综合征患者，抑郁症患者，代谢综合征患者执行功能均有损害，但损害维度不同。共病患者，抑郁症患者执行功能损害主要表现在认知灵活性，注意转移能力，抑制控制能力，计划能力。代谢综合征患者的执行功能损害主要表现在计划能力。抑郁症共病代谢综合征患者计划能力损害程度不比单患其中一种疾病更严重。3.可能抑郁症共病代谢综合征患者抑郁水平越高，认知灵活性和抑制控制能力损害越严重。

    Objective: To analyse the executive function(cognitive flexibility，shifting of attention, inhibitory control, plan ability)in patients with comorbiddepression and metabolic syndrome.To analyse the correlation of theexecutive function with the level of depression、anxiety and metabolicindicator.Methods: From April2013to December2013in physical examinationcenter, outpatient and inpatient department of the Mental Health Center ofSichuan Province,41patients meeting with the diagnostic criteria fordepression of the Chinese Classification and Diagnostic Criteria for MentalDisorders，Third Edition (CCMD-3) were selected;34patients meeting withthe diagnostic criteria for metabolic syndrome were selected;25patientsmeeting with the diagnostic criteria for depression of the ChineseClassification and Diagnostic Criteria for Mental Disorders，Third Edition(CCMD-3) and metabolic syndrome were selected;30normal control groupwere selected. A total of130cases were divided into depression group,metabolic syndrome group, comorbid group and normal control group. Thefour groups were measured and assessed with blood pressure, waist, HamiltonDepression Rating Scale, Hamilton Anxiety Scale, Wisconsin Card Sorting,Trail Making Test A and B, Tower of London and Stroop Color Word Test,and their venous blood were collected for triglyceride, high densitylipoprotein, fasting blood glucose, and OGTT two hour postprandial bloodglucose. Results:1.The total scores of HAMD, the scores of cognitive problem，retardation factor points, and hopelessness were different in the four groups，with statistical significance(P<0.05)，and the scores of comorbid group werethe highest, followed by depression group, again for metabolic syndromegroup and finally normal group. The scores of anxiety/somatization factor ofHAMD comorbid group was higher than depression group and metabolicsyndrome group, depression group and metabolic syndrome group was higherthan normal group(P<0.05). The scores of day and night factor of HAMD ofcomorbid group and depression group were higher than metabolic syndromegroup and normal group(P<0.05), and the scores of sleep disturbance factor ofcomorbid group were higher than depression group, depression group werehigher than metabolic syndrome group and normal group. And the scores ofweight factor had no statistical difference in four groups (P>0.05).The total scores of HAMA, the scores of mental anxiety were different infour groups, with statistical significance(P<0.05) and the scores of comorbidgroup，were the highest, followed by depression group, again for metabolicsyndrome group and finally normal group. The scores of somatic anxiety ofHAMA were different in four groups, with statistical significance(P<0.05)and the scores of somatic anxiety of comorbid group were higher thandepression group、metabolic syndrome group(P<0.05), and the scores ofsomatic anxiety of depression group and metabolic syndrome group werehigher than normal group（P<0.05）.2.The metabolic indicators were different in four groups，with statisticalsignificance(P<0.05).The level of waist circumference, systolic pressure,diastolic pressure, FPG, OGTT two hour postprandial blood glucose andtriglycerides of comorbid group, metabolic syndrome group was higher than depression group and normal group(P<0.05). The level of high densitylipoprotein of comorbid group, metabolic syndrome group was lower thandepression group and normal group (P<0.05).3. The total response numbers，perseverative error numbers，non-perseverative error numbers of WCST were different in four groups，withstatistical significance (P <0.05)，and comorbid group、depression group werehigher than metabolic syndrome group、normal group (P <0.05).There were no statistical differences in the completion time and errornumbers of Trail Making Test A in four groups(P>0.05). The completion timeand error numbers of Trail Making Test B were different in four groups，withstatistical significance（P<0.05），and comorbid group、depression groupwere higher than metabolic syndrome group、normal group(P <0.05).The completion time, error numbers and correct numbers of Tower ofLondon were different in four groups，with statistical significance（P <0.05）.The completion time and error numbers of comorbid group、depression groupand metabolic syndrome group were higher than normal group (P<0.05)，andthe correct numbers of comorbid group，，depression group and metabolicsyndrome group were lower than normal group(P <0.05).There were no statistical differences in correct numbers and errornumbers of Stroop Color Word Test word and color in fourgroups(P>0.05).When word and color were different, the correct numbers ofStroop Color Word Test were different in four groups，with statisticalsignificance（P<0.05），and comorbid group、depression group were higherthan metabolic syndrome、normal group(P<0.05).4.The total response numbers of WCST of comorbid group were positively correlated with the total scores of HAMD, triglyceride and OGTTtwo hour postprandial blood glucose(r=0.40～0.43，P<0.05),but were notcorrelated with the total scores of HAMA and other metabolic indicator.WhenOGTT two hour postprandial blood glucose and TG controled，The totalresponses numbers of WCST were positively correlated with the total scoresof HAMD（r=0.46, P <0.05）.The completion time of Trail Making Test B of comorbid group were notcorrelated with the total scores of HAMD, the total scores of HAMA andmetabolic indicator(P>0.05).The completion time of Tower of London of comorbid group were notcorrelated with the total scores of HAMD, the total scores of HAMA andmetabolic indicator(P>0.05).When word and color were different,the correct numbers of StroopColor Word Test were negatively correlated with the total scores ofHAMD(r=-0.46,P<0.05),were not correlated with the total scores of HAMAand metabolic indicator(P>0.05).Conclusion:1.The patients with comorbid depression and metabolicsyndrome might have severer depressive and anxiety symptoms than thepatients with depression or metabolic syndrome.2.The executive function ofpatients with comorbid depression and metabolic syndrome, depression ormetabolic syndrome all were impaired, but had diffirent dimensions. Theexecutive function of patients with comorbid depression and metabolicsyndrome or depression were impaired mainly in cognitive flexibility，shiftingof attention, inhibitory control ability and plan ability. The executive functionof patients with metabolic syndrome were impaired mainly in plan ability.The plan ability of patients with comorbid depression and metabolic syndrome were not worse than the patients with depression or metabolicsyndrome.3.Probably the patients with comorbid depression and metabolicsyndrome had severer depressive symptoms, the cognitive flexibility andinhibitory control ability were worse.

抑郁症共病代谢综合征患者执行功能研究

致谢4-5摘要5-8Abstract8-12前言14-18对象与方法18-25结果25-37讨论37-44结论44-45参考文献45-52综述：抑郁症共病代谢综合征的相关研究52-65    参考文献61-65附录65-66个人简历66-67攻读硕士学位期间发表的学术论文67

  本文关键词：抑郁症共病代谢综合征患者执行功能研究，由笔耕文化传播整理发布。