帕金森病伴发抑郁症的进展

本文就帕金森病伴发抑郁症的发病率、病因、临床表现和诊断等方面做一综述。     

抑郁症与帕金森病患者脑多巴胺转运蛋白核素显像的对照研究

目的 探讨抑郁症与帕金森病患者脑多巴胺转运蛋白核素显像的特点.方法 采用多巴胺转运蛋白显像剂(99Tcm-TRODAT-1)通过单光子发射型计算机断层显像(SPECT)成像技术,对13例抑郁症患者、17例帕金森病(PD)患者和10名正常对照进行脑多巴胺转运蛋白分布核素显像.结果 三组比较,右侧纹状体与左侧纹状体(RST/LST)比值比较,差异无统计学意义(P＞0.05),而右侧纹状体与小脑(RST/CB)和左侧纹状体与小脑(LST/CB)放射性比值的差异有统计学意义(均P＜0.01).其中对照组RST/CB和LST/CB最高(分别为3.486±0.207和3.553±0.158),其次为抑郁症组(分别为2.255±0.290和2.317±0.341),而PD组最低(分别为1.522±0.237和1.547±0.262).结论 抑郁症和PD患者的双侧纹状体及小脑的放射性比值均低,其中PD患者更显著.     

抑郁症患者潜在的代谢组学生物标志物研究进展

目前临床上尚缺乏客观的生物标志物帮助抑郁症的诊断、治疗及预后的评估。现有的代谢组学分析平台可测量抑郁症（major depressive disorder,MDD）不同生物样本中的代谢物。本综述介绍了代谢组学研究的主要分析技术及其在各种生物样本中MDD诊断、鉴别诊断以及药物疗效相关的潜在生物标志物,并针对现有研究的不足提出展望,以期准确地筛选MDD患者。     

醒脑静注射液治疗帕金森病抑郁症的疗效观察

目的观察醒脑静注射液在帕金森病伴抑郁症治疗中的效果。方法随机将82例帕金森病伴抑郁症患者分成治疗组42例,对照组40例。治疗前后用汉密尔顿抑郁量表(HAMD)进行评分。结果治疗4周后,治疗组HAMD评分明显低于对照组(P<0.01),2组总有效率比较,差异有统计学意义(P<0.05)。结论醒脑静注射液可明显改善帕金森病患者的抑郁症状。     

基于单细胞转录组测序技术分析缺血性脑卒中脑细胞转录组表达差异

目的缺血性脑卒中(ischemic stroke,IS)发病率高、死亡率高。本实验利用单细胞转录组测序技术探索IS脑细胞的基因表达差异情况,尝试为IS的治疗提供一个新的思路。方法分别选取去骨瓣减压术切除大面积脑梗死患者和颅脑创伤患者的脑组织各2g作为实验组和对照组,进行单细胞转录组测序,对测序结果进行差异表达基因的GO注释和KEGG通路分析。结果 (1)本实验共检测出有效细胞实验组1635个,对照组627个,上述细胞依据表达情况可以分出7个细胞群;(2)在两组之间鉴定到30个具有表达差异的转录本。实验组与对照组比较,表达上调的差异转录本有13个,表达下调的差异转录本有17个;(3)共有23个基因注释到GO系统的84个功能类别(P 0.05),注释到细胞组成的基因有15个;注释到生物过程的基因有10个;注释到分子功能大类的基因有8个。KEGG通路分析结果显示这些差异表达基因中有4个富集到核糖体的形成通路。结论 (1)用单细胞转录组测序技术对IS脑细胞进行基因表达分析是可行的;(2) IS患者的脑细胞基因表达对比颅脑创伤患者存在差异。     

帕金森病伴抑郁症患者的事件相关电位研究

目的评价事件相关电位(ERP)对帕金森病伴抑郁症患者的诊断价值。方法应用听觉经典Oddball序列和视觉非经典Oddball序列分别对正常健康人、帕金森病不伴抑郁症患者、帕金森病伴抑郁症患者进行ERP检查,记录其电生理指标。结果听觉模式下诱发的P300潜伏期和波幅,3组间无明显差异;视觉模式下诱发的P450,帕金森病伴抑郁症组潜伏期较其他2组明显延长,波幅较其他2组明显降低;帕金森病伴抑郁症组患者潜伏期与汉密尔顿得分呈正相关(r=0.382,P<0.05),波幅与得分呈负相关(r=-0.412,P<0.05)。结论一定模式下的ERP对帕金森病伴抑郁症患者的诊断提供了较为可靠的电生理指标。     

文拉法辛联合心理干预治疗帕金森病合并抑郁症的疗效

目的探讨文拉法辛联合心理干预治疗帕金森病合并抑郁症的疗效。方法 120例符合纳入标准的帕金森病合并抑郁症患者随机分为2组,每组各60例。对照组给予文拉法辛治疗,观察组在对照组的基础上联合采用心理干预治疗。比较2组患者临床疗效、MMSE评分及生活质量改善情况。结果观察组总有效率为96.7%,明显高于对照组的80.0%。观察组治疗2周、4周和8周后的MMSE评分均明显升高,差异有统计学意义(P均0.05)。观察组生理机制、躯体疼痛、一般健康状况、精力、社会功能、情感反应及精神健康评分明显高于对照组,差异有统计学意义(P均0.05),而生理机制评分2组比较差异无统计学意义(P0.05)。结论文拉法辛联合心理干预治疗帕金森病合并抑郁症疗效可靠,可提高治疗总有效率,改善认知功能,并提高患者生活质量,值得临床推广。     

基于单细胞转录组的围产期卒中性别差异原因探究

目的 通过对人脑胚胎发育中期的血管组成细胞进行分析,探索围产期卒中性别差异的可能原因。方法 对公开发表的性别相关全基因组关联分析（genome-wide association study,GWAS）结果和血管单细胞转录组进行联合分析,确定性别差异相关的细胞类型。通过基因差异表达分析和功能富集分析,确定性别对细胞功能的影响,分析围产期卒中性别差异产生的潜在原因。结果 经过判定,在胚胎发育中期血管单细胞转录组数据集的7例样本中,有4例男性和3例女性。典型的周细胞（P=0.018）和处于分裂状态的壁细胞（P=0.011）的表达谱与生物学性别的GWAS关联基因显著相关,而平滑肌细胞、成纤维细胞和全部5种内皮细胞类型与性别GWAS关联基因无明显相关性。总计345个基因在男性周细胞中显著高表达、619个基因在女性周细胞中显著高表达,这些差异表达基因分别富集在独特的生物学通路中,也同时富集在细胞能量代谢相关通路中。结论 周细胞具有很强的性别差异性,可能是围产期卒中性别差异产生的原因。     

抑郁症患者的性激素分析

目的　研究抑郁症患者垂体促性腺激素及外周性激素的功能状态,探讨性激素水平改变与性有关症状和药物治疗的关系。方法　采用放射免疫法测定３０ 例（ 男１１ 例,女１９ 例） 抑郁症患者血清促卵泡激素（ Ｆ Ｓ Ｈ） 、黄体生成素（ Ｌ Ｈ） 、催乳素（ Ｐ Ｒ Ｌ） 、睾丸酮（ Ｔ） 、雌二醇（ Ｅ２） 等激素水平,并与２０ 例（ 男女各１０ 例） 正常人对照。结果　试验组男性 Ｌ Ｈ 和女性 Ｆ Ｓ Ｈ、 Ｒ Ｐ Ｌ 明显高于对照组,其他性激素水平两组间无显著性差异。药物治疗前后男性患者 Ｐ Ｒ Ｌ、 Ｔ、 Ｅ２ ,女患者 Ｐ Ｒ Ｌ、 Ｔ 等激素分泌改变非常显著。结论　提示抑郁症患者性腺轴存在功能失调。性有关症状与性激素水平改变无关。抗抑郁治疗可导致性激素分泌紊乱。     

帕金森病外周血生物标记物的研究及评价

PD是一种年龄相关性神经元退行性变,典型病变表现为黑质多巴胺能神经元和蓝斑去甲肾上腺素能神经元变性,路易小体(Lewy body,LB)形成为其特征性病理改变[1].PD起病隐匿,早期无明显临床症状,晚期可表现为运动系统障碍.其发病机制目前尚不明确,现存的几种发病机制亦不能单独解释.目前普遍认为是多因素共同作用结果,包括氧化应激、线粒体功能障碍、蛋白质折叠错误等[2].PD呈进行性发展,早期诊断对疾病治疗和病情监测至关重要,因此寻找合适的生物标记物迫在眉睫.外周血由于易获取且研究技术成熟,受到各国研究者的青睐.因此,笔者就近几年PD外周血生物标记物研究进展综述如下.     

Depression and major depressive disorder in patients with Parkinson's disease

The prevalence of depression in Parkinson's disease (PD) varies greatly. In this study, we investigated major depressive disorder (MDD) and depressive symptoms without MDD in patients with PD. The psychopathological characteristics of depressive symptoms were assessed by a psychiatric interview. A total of 105 Japanese patients with PD without dementia were included. The Japanese version of the Beck Depression Inventory‐II (BDI‐II) with a cutoff score of 13/14 was used to screen for depression. Using a structured interview, a comprehensive psychiatric evaluation of patients with BDI‐II scores >13 (high BDI patients) was completed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV‐TR. Forty patients (38%) had a BDI‐II >13, but 29 did not show any depressed mood. Five cases met the criteria for MDD (three current, two past) and one patient was diagnosed with minor depressive disorder. A slight depressed mood that was associated with worrying about PD was seen in 6 of 34 patients without any depressive disorder and fluctuated with aggravation of PD symptoms in two of these patients. For the diagnosis of MDD, the number of positive items from the DSM‐IV‐TR definition of MDD is most important and useful for differentiating MDD and non‐MDD. The low‐prevalence rate of MDD in our patient population suggests that PD may be a psychological stressor for MDD, but does not necessarily induce MDD. © 2009 Movement Disorder Society     

重性抑郁障碍与双相障碍患者躯体疾病共病调查

目的:了解重性抑郁障碍(MDD)与双相障碍(BD)患者躯体疾病共病情况。方法:对141例MDD和52例BD患者进行一般情况、躯体疾病调查及精神疾病评估。结果:MDD和BD患者躯体疾病的共病率分别为68.1%、46.2%,共病的躯体疾病以慢性病为主,依次为高血压、慢性胃炎、腰椎间盘突出、糖尿病。与非共病患者比较,共病患者年龄及起病年龄大,精神疾病复发次数多(P0.05或P0.01)。MDD共病患者自杀意念风险明显增加(P0.01)。结论:较高龄及较高龄起病的MDD、BD患者更易共病慢性躯体疾病。     

Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients

There is recent evidence that acute coronary syndrome (ACS) patients with first time incident major depressive disorder (MDD) and those with recurrent MDD represent different subtypes among individuals with ACS and comorbid depression. However, few studies have examined whether or not these subtypes differ in coronary artery disease (CAD) severity. We assessed whether those with incident MDD (in-hospital MDD and negative for history of MDD) or recurrent MDD (in-hospital MDD and a positive history of MDD) differ in angiographically documented CAD severity. Within 1 week of admission for ACS, 88 patients completed a clinical interview to assess current and past diagnosis of MDD. CAD severity was assessed in all patients by coronary angiography. A hierarchical regression analysis showed that neither in-hospital MDD status, nor history of MDD were significant predictors of CAD severity, but the interaction term between in-hospital MDD status and history of MDD was a significant predictor of CAD severity, after controlling for age, sex and ethnicity. Follow-up analyses showed that patients with first time, incident MDD had significantly more severe CAD compared to patients with recurrent MDD (p=0.043). To conclude, our study adds to the growing evidence that patients with incident MDD should be considered as a clinically distinct subtype from those with recurrent MDD. Possible mechanisms for differing CAD severity by angiogram between these two subtypes are proposed and implications for prognosis and treatment are discussed.     

Progress and challenges in research of the mechanisms of anhedonia in major depressive disorder

There is an increasing heavy disease burden of major depressive disorder (MDD) globally. Both high diagnostic heterogeneity and complicated pathological mechanisms of MDD pose significant challenges. There is much evidence to support anhedonia as a core feature of MDD. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, anhedonia is further emphasised as a key item in the diagnosis of major depression with melancholic features. Anhedonia is a multifaceted symptom that includes deficits in various aspects of reward processing, such as anticipatory anhedonia, consummatory anhedonia, and decision-making anhedonia. Anhedonia is expected to become an important clinicopathological sign for predicting the treatment outcome of MDD and assisting clinical decision making. However, the precise neurobiological mechanisms of anhedonia in MDD are not clearly understood. In this paper, we reviewed (1) the current understanding of the link between anhedonia and MDD; (2) the biological basis of the pathological mechanism of anhedonia in MDD; and (3) challenges in research on the pathological mechanisms of anhedonia in MDD. A more in-depth understanding of anhedonia associated with MDD will improve the diagnosis, prediction, and treatment of patients with MDD in the future.     

Magnetic motor threshold and response to TMS in major depressive disorder

OBJECTIVE: The aim of this study was to examine motor threshold (MT) during treatment with transcranial magnetic stimulation (TMS). METHOD: The TMS was administered to 46 patients with depression and 13 controls. TMS was performed at 90% power of measured MT. The stimulation frequency was 10 Hz for 6 s, for 20 trains, with 30 s inter-train intervals. The trial included 20 sessions. Patients and controls were assessed on various outcome measures. RESULTS: The MT values were comparable between patients and controls. Neither demographic nor clinical variables were factors in determining MT. MT was not shown to have any predictive value regarding outcome of treatment. CONCLUSION: In this study, MT at baseline or changes in MT during the treatment period were not able to discriminate between patients and controls and were not found to have any predictive value with regard to treatment outcome.     

Plasma metabolome analysis of patients with major depressive disorder

Aim

This study sought to characterize the plasma metabolite profiling of patients with major depressive disorder (MDD).

Methods

Psychiatric assessments were made with the Structured Clinical Interview for DSM‐IV Axis I Disorders. In the exploratory cohort, plasma metabolite profiles of 34 MDD patients and 31 mentally healthy controls were compared using capillary electrophoresis‐mass spectrometry. Among the candidate metabolites, we focused on a metabolite showing the largest difference. The absolute concentrations were measured in two cohorts from a psychiatric primary care clinic to characterize the accuracy of the metabolite biomarker.

Results

Among 23 metabolites significantly lower in the MDD group than in healthy controls, we focused on phosphoethanolamine (PEA) as a candidate. The reduction of PEA levels in MDD was checked in independent clinical sample sets. An ion‐chromatography‐fluorescence detection method was developed to measure plasma PEA levels. In the preliminary cohort, we examined 34 MDD and 43 non‐MDD subjects. The area under the receiver–operator curve (AUC) was 0.92, with sensitivity/specificity greater than 88%, at a cut‐off of 1.46 μM. In the checking cohort, with 10 MDD and 13 non‐MDD subjects, AUC was 0.89, with sensitivity/specificity of 86% and 100%, respectively, at a cut‐off of 1.48 μM. Plasma PEA inversely correlated with MDD severity, depressed mood, loss of interest, and psychomotor retardation.

Conclusion

These results suggest that plasma PEA level could be a candidate biomarker of MDD in the clinical setting. Further studies comparing MDD and mentally healthy controls are needed to confirm the utility of PEA as a biomarker for depression.     

保定市重性抑郁障碍流行病学调查

目的：了解保定市重性抑郁障碍的患病率、人口学特征和社会生活功能状况。方法：采用多阶段分层整群抽样方法随机抽取≥18岁的人群10073人,以一般键康问卷12项（GHQ-12）为筛选工具,以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版（SCID-I／P）为调查诊断工具。用功能大体评定量表（GAF）评价功能状况。结果：重性抑郁障碍的终生患病率为4．19％（95％CI：3．78％～4．60％）;时点患病率为2．64％（95％CI：2．31％～2．97％）。时点患病率女性3．26％明显高于男性2．00％（u=3．73,P〈0．01）;农村2．84％明显高于城市1．40％（u=2．76,P〈0．01）;50～69岁年龄段患病率较高;单次发作60．80％,复发39．20％;GAF平均为（50．74±6．73）分,社会和生活功能受损明显。结论：重性抑郁障碍的患病率相对较高,严重影响患者的社会生活功能。     

Treatment of major depressive disorder in the Finnish general population

Background : Few general population studies of the treatment of major depressive disorder (MDD) have included the whole spectrum of treatments. We estimated the rates of different treatments and the effect of individual and disorder characteristics plus provider type on treatment received. Methods : In the Health 2000 Study, a representative sample (n=6,005) from the adult Finnish population (≥30 years) were interviewed (CIDI) in 2000–2001 for the presence of DSM‐IV mental disorders during the past 12 months. Logistic regression models were used to examine factors influencing the type of treatment: either pharmacotherapies (antidepressants, anxiolytics, sedatives/hypnotics, antipsychotics) or psychological treatment. Results : Of the individuals with MDD (n=288), currently 24% used antidepressants, 11% anxiolytics, 16% sedatives/hypnotics, 5% antipsychotics, and 17% reported having received psychological treatment. Overall, 31% received antidepressants or psychological treatment or both; 18% received minimally adequate treatment. Of those 33% (n=94) using health care services for mental reasons, 76% received antidepressants or psychological treatment or both; 54% received minimal adequate treatment. In logistic regression models, the use of antidepressants was associated with female sex, being single, severe MDD, perceived disability, and comorbid dysthymic disorder; psychological treatment with being divorced, perceived disability, and comorbid anxiety disorder. Conclusions : Due to the low use of health services for mental reasons, only one‐third of subjects with MDD use antidepressants, and less than one‐fifth receives psychological treatment. The treatments provided are determined mostly by clinical factors such as severity and comorbidity, in part by sex and marital status, but not education or income. Depression and Anxiety 26:1049–1059, 2009. © 2009 Wiley‐Liss, Inc.