甲状腺功能与抑郁障碍关系的研究

发布时间：2018-05-08 19:35

本文选题：甲状腺 + 抑郁　；参考：《大连理工大学》2013年博士论文

【摘要】：甲状腺功能异常与抑郁障碍密切相关,甲状腺功能亢进或减退都可导致抑郁障碍；甲减与抑郁症具有相似的临床表现,两者都可引起认知障碍。甲状腺功能异常引发抑郁障碍的机制尚不完全清楚,为探讨甲状腺功能与抑郁障碍的关系我们进行了以下研究： 1、在动物实验部分采用旷野试验及蔗糖试验评价甲状腺功能减退大鼠的行为改变,18F-FDG micro PET显像评价脑葡萄糖代谢的变化,分析行为表现与特定脑区代谢活性的关系。结果发现,甲减大鼠体重、蔗糖偏好度、旷野实验中排便粒数和直立跨格数明显低于对照组：双侧尾状核/豆状核、扣带回皮质、伏隔核、额叶联合部及运动皮质葡萄糖代谢减低,尾状核/豆状核及伏隔核代谢变化与蔗糖偏好度变化显著相关。 2、131I治疗后出现亚临床甲减的患者中抑郁症的发病率(23.5%)显著高于甲状腺功能正常者(7.3%)；对亚临床甲减组中TSH超过10mIU/L的部分患者用左旋甲状腺素进行治疗,结果HAMD得分显著降低,说明替代治疗可使这部分患者受益。 3、选择临床确诊的Graves'病患者,通过量表评分及临床资料分析,探讨甲亢伴发抑郁、焦虑的危险因素,并对SF-36量表在甲亢患者中的适用性进行评价。结果表明,FT3、FT4、TRAb和眼症是Graves'病伴发抑郁的危险因素,FT3、心率和甲状腺肿大是Graves’病伴发焦虑的危险因素；SF-36量表能准确反映甲亢患者的生存质量。 4、用SPECT脑血流显像评价抑郁及甲减患者局部脑血流变化,用Go/No go实验评价认知功能。结果发现抑郁患者双侧尾状核、右侧扣带回血流显著降低,甲减患者双侧前额叶、中央前回、中央后回、海马、顶上小叶及扣带回血流显著降低。两组HAMD得分均显著高于对照组,抑郁组HAMD得分与双侧扣带回及尾状核相对rCBF显著负相关,而甲减组HAMD得分与扣带回相对rCBF显著负相关；抑郁及甲减患者均存在认知障碍,抑郁组Go/No go认知试验正确率与前额叶皮质相对rCBF显著正相关,甲减组Go/No go认知试验正确率与前额叶及海马相对rCBF显著正相关。结论：甲减大鼠脑局部葡萄糖代谢降低,代谢异常与抑郁症状密切相关,甲状腺激素缺乏通过影响边缘系统的功能导致抑郁障碍；甲减与抑郁均引起局部脑血流异常,两者存在部分重叠,甲减与抑郁患者的情感、认知障碍具有相似的神经机制；亚临床甲减增加了抑郁症的发病率,甲状腺激素替代治疗能够改善亚临床甲减患者的抑郁症状；FT3、FT4、TRAb和眼症是Graves'病伴发抑郁的危险因素,FT3、心率和甲状腺肿大是Graves'病伴发焦虑的危险因素,SF-36量表能准确反映甲亢患者的生存质量。
[Abstract]:Hyperthyroidism or hypothyroidism can lead to depressive disorder, and hypothyroidism has similar clinical manifestations with depression, both of which can cause cognitive impairment. The mechanism of depressive disorder caused by abnormal thyroid function is not fully understood. In order to explore the relationship between thyroid function and depressive disorder, we conducted the following research: 1. In animal experiment, the behavioral changes of hypothyroidism rats were evaluated by field test and sucrose test. The changes of glucose metabolism in brain were evaluated by 18F-FDG micro PET imaging, and the relationship between behavior and metabolic activity in specific brain regions was analyzed. The results showed that the weight, sucrose preference, defecation grain number and vertical translattice number of hypothyroidism rats were significantly lower than those of the control group: bilateral caudate nucleus / lentiform nucleus, cingulate cortex, accumbent septal nucleus. Glucose metabolism in the frontal cortex and motor cortex decreased. The metabolic changes of caudate nucleus / lentiform nucleus and nucleus accumbens were significantly correlated with sucrose preference. The incidence of depression in patients with subclinical hypothyroidism after 2131I treatment was significantly higher than that in patients with normal thyroid function, and the HAMD scores of patients with subclinical hypothyroidism whose TSH exceeded 10mIU/L were significantly lower than those of subclinical hypothyroidism group. It is suggested that replacement therapy can benefit this group of patients. 3. The risk factors of depression and anxiety in patients with hyperthyroidism were investigated by scale score and clinical data analysis, and the applicability of SF-36 scale in patients with hyperthyroidism was evaluated. The results showed that FT3 / FT4TRAb and eye syndrome were risk factors for depression in Graves' disease. Heart rate and goiter were the risk factors of anxiety in Graves' disease. SF-36 scale could accurately reflect the quality of life of patients with hyperthyroidism. 4. The changes of regional cerebral blood flow in patients with depression and hypothyroidism were evaluated by SPECT cerebral blood flow imaging, and cognitive function was evaluated by Go/No go experiment. The results showed that the blood flow of bilateral caudate nucleus and right cingulate gyrus decreased significantly in patients with depression, and that in hypothyroidism patients with bilateral prefrontal lobe, precentral gyrus, posterior central gyrus, hippocampus, superior parietal lobule and cingulate gyrus. The HAMD score of both groups was significantly higher than that of the control group. The HAMD score of depression group was negatively correlated with the relative rCBF of bilateral cingulate gyrus and caudate nucleus, while the HAMD score of hypothyroidism group was negatively correlated with relative rCBF of cingulate gyrus, and there were cognitive impairment in depression and hypothyroidism. In depression group, the correct rate of Go/No go cognitive test was positively correlated with relative rCBF in prefrontal cortex, and that in hypothyroidism group was positively correlated with relative rCBF in prefrontal lobe and hippocampus. Conclusion: the regional glucose metabolism in hypothyroidism rats is decreased, and the abnormal metabolism is closely related to the depression symptoms. The hypothyroidism and depression cause depressive disorder by affecting the function of the limbic system, both hypothyroidism and depression cause abnormal regional cerebral blood flow. There is a partial overlap between hypothyroidism and depression, cognitive impairment has similar neural mechanism, subclinical hypothyroidism increases the incidence of depression, Thyroid hormone replacement therapy can improve depressive symptoms in patients with subclinical hypothyroidism. FT3FT-4TRAb and ophthalmopathy are risk factors for Graves' disease with depression. Heart rate and goitre are risk factors for Graves' disease with anxiety. SF-36 scale can accurately reflect the risk factors of Graves' disease with anxiety. Quality of life of patients with hyperthyroidism.
【学位授予单位】：大连理工大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R581.1;R749.4

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