难治性抑郁症的临床特征与血清甲状腺激素相关性研究

目的：探讨难治性抑郁症的临床特征与血清甲状腺激素相关性。方法对43例难治性抑郁症患者和48例非难治性抑郁症患者采用汉密尔顿抑郁量表17项（ HAMD17）和汉密尔顿焦虑量表（ HAMA）进行评估，采用放射免疫法测定两组患者血清TSH、TT3、TT4、FT3、FT4水平；组间比较采用χ2检验、t检验；验证FT3与是否患TRD的关系：logistic回归分析中以FT3为自变量，是否患TRD为因变量，分析FT3的降低程度与发生TRD风险大小之间的量化关系；通过ROC曲线评价FT3在TRD中的诊断价值。结果难治性抑郁症组（TRD组）与非难治性抑郁症组（非TRD组）比较，起病年龄TRD组（16．98±2．25）岁]比非TRD组（23．50±3．38）岁]更早，受教育年限TRD组（8．53±1．72）年]比非TRD组（11．04±2．07）年]更短，总病程及本次发病病程TRD组（10．14±6．47）年，（60．35±23．64）月]比非TRD组（5．48±4．15）年，（5．00±3．40）月]更长，HAMD总分及其行为阻滞因子分TRD组（19．09±1．59）分，（8．72±0．98）分]比非TRD组（15．69±2．38）分，（4．98±1．63）分]更高，甲状腺激素中FT3值TRD组（3．92±0．15）pmol／L]比非TRD组（4．16±0．20）pmol／L]更低，差异均有统计学意义（P＜0．05）。 Logistic回归分析显示FT3每降低0．1 pmol／L，发生TRD的危险性上升1．006倍 OR＝2．006，95％CI ＝（1．501，2．681）]。 ROC曲线下面积为0．821（P＜0．001），其95％置信区间为（0．734，0．907）。结论难治性抑郁症患者病程更长，起病更早，文化水平更低，HAMD总分更高，阻滞症状更重，血清FT3水平更低；FT3对诊断TRD有较高的参考价值。

The relevant research of thyroid hormones and clinical features in treatment-resistant depression

Objective To explore the clinical characteristics of treatment-resistant depression （ TRD） and of its relevance with thyroid hormones. Methods 43 patients with TRD and 48 patients with non-TRD were as-sessed with 17-item Hamilton depression scale （ HAMD-17） and Hamilton anxiety scale （ HAMA） . The serum lev-el of thyroid-stimulating hormone （ TSH） ,total triodothgronine （ TT3） ,total thyroxine （ TT4） ,free triodothgronine （ FT3） and free thyroxine （ FT4） were determined by radioimmunoassay. χ2 test and t test were used for statistic a-nalysis. The quantitative relation of FT3 level with TRD was analyzed and the value of FT3 level in TRD diagnosis was evaluated by ROC curve.Results Compared with non-TRD patients,the TRD patients showed a younger dis-ease onset age （（16.98±2.25）years vs （23.50±3.38）years） and a longer disease course （（10.14±6.47）years vs （5.48±4.15）years） for total disease course;（60.35±23.64）months vs （5.00±3.40）months for current disease course）,and had shorter education years （（8.53±1.72）years vs （11.04±2.07）years） and higher HAMD total scores （19.09±1.59 vs 15.69±2.38） and behavior retarding factor scores （8.72±0.98 vs 4.98±1.63）. In addition, the FT3 level of TRD patients was lower than that of non-TRD patients （（3.92±0.15）pmol/L vs （4.16±0.20） pmol/L）.All the above differences between two groups were statistically significant （P〈0.05）. The logistic regres-sion analysis showed that the risk of suffering TRD increased by 1. 006-fold when FT3 level reduced 0. 1 pmol/L （OR=2.006,95%CI=（1.501,2.681）. The area under ROC curve was 0.821 （P〈0.001） with its 95% confidence interval of （0.734,0.907）. Conclusion Compared with non-TRD patients,TRD patients have a longer disease course,a younger disease onset age, a lower education level, higher HAMD total scores, more severe retardation symptoms,and a lower FT3 level. The serum FT3 level has a high reference value in diagn