首发抑郁障碍、焦虑障碍、躯体形式障碍的神经内分泌机制研究及治疗前后的比较研究

发布时间：2018-05-30 00:28

本文选题：激素 + 抑郁障碍　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]1.探讨甲状腺激素、性激素、皮质醇、ACTH、生长激素在首发抑郁障碍、焦虑障碍、抑郁焦虑共病、躯体形式障碍患者中的分泌特点与差异,以及各轴激素之间、激素与年龄、疾病严重程度、躯体症状、社会功能的相关性,从而探讨首发抑郁障碍、焦虑障碍、抑郁焦虑共病、躯体形式障碍患者的神经内分泌机制。2.比较治疗前与治疗2周后激素分泌的变化,探讨早期治疗后的神经内分泌变化机制。3.比较治疗前、治疗2周后、治疗12周后的激素水平变化,分析整体激素的变化趋势及激素间的相互作用。4.通过上述几个方面的比较,从而探讨首发抑郁障碍、焦虑障碍、躯体形式障碍等患者充分治疗后的神经内分泌变化机制,最终为治疗效果的评价提供神经内分泌的生物学标记。[方法]第一部分:治疗前抑郁障碍、焦虑障碍、抑郁焦虑共病、躯体形式障碍患者共199名,测定甲状腺激素、性激素、皮质醇、ACTH、生长激素,根据激素分泌的正常范围,观察各疾病组激素分泌的分布特点,比较各疾病组间激素分泌的差异,比较男性和女性之间激素分泌在各疾病组的差异;完成HAMD总分、HAMA总分、SCL-90躯体化因子、社会功能缺陷量表评定,分析治疗前各轴激素之间、激素与各项量表评分之间的相关性。第二部分:治疗2周后收集各组资料齐全患者共127名,测定治疗2周后甲状腺激素、性激素、皮质醇、ACTH、生长激素,完成治疗2周后与治疗前的激素比较。第三部分:另收集治疗12周后各组资料齐全患者15名,测定12周后甲状腺激素、性激素、皮质醇、ACTH、生长激素,比较治疗前、治疗2周后、治疗12周后的激素的差异,并分析其变化趋势。[结果]第一部分:治疗前抑郁障碍、焦虑障碍、抑郁焦虑共病、躯体形式障碍患者中存在甲状腺激素、生长激素、性激素分泌减少,皮质醇、ACTH分泌增多的异常状态。抑郁焦虑共病患者FT4水平高于抑郁障碍、焦虑障碍患者,差异具有统计学意义(LSD-t=-3. 335,P=0. 0010.05; LSD-t=-1. 996,P=0.0470.05),各组其他激素之间无明显差异。抑郁障碍男性患者TSH水平小于女性,差异具有显著性(t=-2.619, P=0.0110.05)。焦虑障碍男性患者TSH水平小于女性,差异具有显著性(t=-2.091,P=0.0420.05),男性患者GH水平小于女性,差异具有显著性(t=-2.721,P=0.0090.05)。抑郁障碍组Cor水平与FT3水平呈负相关(r=-0. 231, P=0. 0470. 05),躯体形式障碍组ACTH水平与TSH水平呈正相关(r=0. 568, P=0. 0270. 05)。抑郁障碍组FT3水平、GH水平、女性 E2 水平与年龄呈负相关(r=-0. 239, P=0. 040; r=-0. 323, P=0. 005; r=-0. 604,P=0.000); Cor水平与社会功能缺陷呈正相关(r=0.262, P=0.0240.05); ACTH水平与HAMD总分、社会功能缺陷呈正相关(r=0.335, P=0.004; r=0.240,P=0.0390.05)。焦虑障碍组女性E2水平与年龄呈负相关(r=-0.707,P=0. 0000. 05); T3水平与HAMD总分、HAMA总分、社会功能缺陷呈负相关(r=-0. 371,P=0. 012; r=-0. 343,P=0. 021; r=-0.426,P=0. 004),FT3 水平与HAMD总分、社会功能缺陷、SCL-90躯体化因子呈负相关(r=-0. 354,P=0.017;r=-0. 443, P=0.002; r=-0. 373, P=0. 012)。抑郁焦虑共病组女性E2水平与年龄呈负相关(r=-0.744,P=0.000),FT3水平与SCL-90躯体化因子呈负相关(r=-0. 261,P=0. 036 ); FT4水平与社会功能缺陷呈正相关(r=0.297,P=0. 0160. 05)。躯体形式障碍组T3、FT3、T4、FT4水平与SCL-90躯体化因子呈负相关(r=-0. 758,P=0. 001;r=-0. 641,P=0. 010;r=-0.629,P=0. 012;r=-0. 657,P=0.008),男性T水平与HAMA总分呈负相关(r=-0.616, P=0.044)。第二部分:治疗2周后较治疗前各组甲状腺激素都有降低,差异具有统计学意义(P0. 05),抑郁障碍女性患者较治疗前GH水平升高,差异具有统计学意义(P=0. 0410. 05),抑郁焦虑共病患者较治疗前Cor水平降低,差异具有统计学意义(P=0.0120.05)。第三部分:抑郁障碍8名患者、焦虑障碍3名患者、抑郁焦虑共病2名患者、躯体形式障碍2名患者共15名患者,治疗2周后较治疗前FT4水平降低,差异具有统计学意义(P=0. 0000. 05),治疗12周后较治疗前FT4水平降低,差异具有统计学意义(P=0.0330. 05),治疗12周后较治疗2周后FT4水平变化不显著。治疗2周后较治疗前ACTH水平升高,差异具有统计学意义(P=0.0450.05),治疗12周后较治疗2周后ACTH水平降低,差异具有统计学意义(P=0. 0020. 05),治疗12周后较治疗前ACTH水平变化不显著。治疗2周后较治疗前睾酮T水平升高,差异具有显著性(P=0.0090.05),治疗12周较治疗前睾酮T水平变化不显著,治疗12周后较治疗2周后T水平变化不显著;其他激素变化无明显差异。抑郁焦虑共病患者FT4水平高于抑郁障碍、焦虑障碍患者,差异具有统计学意义(LSD-t=-3.288,P=0.0070.05; LSD-t=-3. 116,P=0.0100.05),抑郁障碍、焦虑障碍患者FT4水平无明显差异。[结论]1.抑郁障碍、焦虑障碍、抑郁焦虑共病、躯体形式障碍患者会伴有甲状腺激素、GH、性激素分泌功能减退,Cor、ACTH分泌功能增高。各组间激素分泌特点相似。2.治疗前抑郁焦虑共病患者FT4水平较抑郁障碍、焦虑障碍患者FT4水平高,并且FT4水平越高,社会功能越差,可能是抑郁焦虑共病组的异质性表现。3.治疗前抑郁障碍、焦虑障碍女性患者甲状腺激素分泌较男性减退明显。4.抑郁障碍患者FT3水平可能会伴随年龄增长而分泌减少。ACTH、Cor的水平可作为疾病改善的生物学指标。焦虑障碍患者的甲状腺激素水平下降可能用来作为评估焦虑障碍严重程度的指标。5.治疗2周后各组甲状腺激素水平较治疗前降低;抑郁焦虑共病患者Cor水平较治疗前降低,抑郁障碍患者GH较治疗前升高,各组性激素较治疗前无明显差异。治疗2周后患者HPA轴亢进较前减弱,激素的分泌活动有趋离分泌异常的趋势,但病情尚不稳定,激素分泌仍有波动,处在异常状态。6.经过12周治疗后相对低分泌状态的FT4、男性睾酮T会呈现相对升高的趋势,出现相对高分泌状态的Cor、ACTH呈现相对降低的趋势。7.疾病在发展过程中HPA轴的分泌活动对HPT轴、HPG轴、HPGH轴的分泌活动具有抑制作用,内分泌活动之间互相调节,伴随和影响整个疾病的发展过程。
[Abstract]:Objective : To investigate the characteristics and differences of thyroid hormones , sex hormone , cortisol , ACTH and growth hormone in the patients with first depressive disorder , anxiety disorder , depression and anxiety , somatic symptoms and social function . In the first part , 199 patients with pre - treatment depression disorder , anxiety disorder , depression - anxiety comorbidity and somatoform disorder were treated . Results In the first part , there were abnormal states of thyroid hormones , growth hormone , hormone secretion , cortisol and ACTH secretion in patients with pre - treatment depression disorder , anxiety disorder , depression anxiety , and somatoform disorder . The levels of FT4 in patients with depression and anxiety were higher than those in depressive disorder and anxiety disorder ( LSD - t = - 3.335 , P = 0.0010 . 05 ; LSD - t = - 1.996 , P = 0.0470.05 ) . The levels of TSH in male patients with anxiety disorder were lower than those in women ( t = - 2.091 , P = 0.0420 . 05 ) . GH levels in male patients were lower than those in women ( t = - 2.721 , P = 0.0090.05 ) . The level of Cor in the depressive disorder group was negatively correlated with the level of FT3 ( r = - 0.231 , P = 0.0470.05 ) . The level of ACTH in somatoform disorder group was positively correlated with TSH level ( r = 0.568 , P = 0.0270 . 05 ) . The levels of FT3 and GH in depressive disorder group were negatively correlated with age ( r = -0 . 239 , P = 0 . 040 ; r = -0 . 323 , P = 0.005 ; r = -0 . 604 , P = 0.000 ) ; Cor level was positively correlated with the social function defect ( r = 0.262 , P = 0 . 0240 . 05 ) ; the level of ACTH was positively correlated with the total score and social function defect ( r = 0.335 , P = 0.004 ; r = 0.240 , P = 0.0390 . 05 ) . The level of E2 in anxiety disorder group was negatively correlated with age ( r = - 0.707 , P = 0.0000 . 05 ) . The level of T3 was negatively correlated with the total score ( r = - 0.371 , P = 0.012 ; r = - 0.343 , P = 0.021 ; r = - 0.426 , P = 0.004 ) . The level of FT3 was negatively correlated with the total score , social function defect and SCL - 90 somatization factor ( r = - 0.443 , P = 0.002 ; r = - 0.373 , P = 0.012 ) . The level of E2 was negatively correlated with age ( r = - 0.744 , P = 0.000 ) , and the level of FT3 was negatively correlated with SCL - 90 somatization factor ( r = - 0.261 , P = 0.036 ) . The level of FT4 was positively correlated with social function defect ( r = 0.297 , P = 0.0160.05 ) . The levels of T3 , FT3 , T4 and FT4 were negatively correlated with SCL - 90 somatization factor ( r = - 0.758 , P = 0.001 ; r = - 0.641 , P = 0.010 ; r = - 0.629 , P = 0.012 ; r = - 0.657 , P = 0.008 ) . There was a negative correlation between male T level and HAMA total score ( r = - 0.616 , P = 0.044 ) . There was no significant difference in the levels of plasma ACTH before and after treatment for 12 weeks ( P = 0.040.05 ) . The levels of thyroid hormone secretion in patients with anxiety disorder were lower than those before treatment . The levels of thyroid hormones in patients with anxiety disorder were higher than those before treatment .
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749

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