中枢神经递质与内分泌激素联合检测在抑郁症诊疗中的应用

目的 探讨中枢神经递质与内分泌激素联合检测在抑郁症诊疗中的应用效果。方法 收集2021年12月—2023年6月佛山市第三人民医院收治的50例抑郁症患者作为研究组;另选50例健康体检者为对照组。比较两组5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE)、促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)、皮质醇(cortisol,COR)水平;并使用受试者工作特征(area under receiver operating characteristic,ROC)曲线分析5-HT、NE、ACTH、COR单独及联合检测抑郁症的诊断价值。结果 研究组5-HT、NE水平低于对照组,差异有统计学意义(P<0.05);ACTH、COR水平高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,5-HT、NE、ACTH、COR单独及联合诊断抑郁症的曲线下面积值分别为0.661、0.742、0.892、0.894、0.915。结论 抑郁症患者5-HT、NE呈低表达,ACTH、CO...     

经颅直流电刺激联合米氮平治疗产后抑郁症患者的效果及对临床症状 ACTH与孤啡肽水平的影响

目的 分析经颅直流电刺激联合米氮平对产后抑郁症患者临床症状及促肾上腺皮质激素(ACTH)、孤啡肽水平的影响。方法 选取2020年1月—2021年12月温州医科大学附属康宁医院收治的产后抑郁症患者90例,按照随机数字表法将其分为对照组(45例)和研究组(45例)。对照组患者给予米氮平+经颅直流电假刺激治疗,研究组患者给予经颅直流电真刺激联合米氮平治疗。检测两组ACTH、孤啡肽、神经递质[去甲肾上腺素(NE)、5-羟色胺(5-HT)、多巴胺(DA)]水平,对比两组汉密尔顿抑郁量表(HAMD)评分、健康调查简表(SF-36)评分及临床疗效。结果 治疗后,对照组ACTH、孤啡肽水平分别为(46.89±5.04)pg/ml和(21.13±2.59)ng/L,研究组ACTH、孤啡肽水平分别为(40.21±4.23)pg/ml和(17.32±1.88)ng/L。治疗后,研究组ACTH、孤啡肽水平及HAMD量表评分均低于对照组(均P<0.05),NE、DA、5-HT水平及SF-36量表评分均高于对照组(均P<0.05)。研究组治疗有效率高于对照组(P<0.05)。两组患者不良反应发生...     

血清Hcy 5-HT及Cor诊断产后抑郁的价值

目的探讨血清5-羟色胺(5-HT)、同型半胱氨酸(Hcy)、皮质醇(Cor)诊断产后抑郁症的价值。方法选取2018年2月—2020年5月医院就诊的产后抑郁症产妇90例(抑郁组),另选取未发生产后抑郁的产妇90例作为对照组;对比两组的血清Hcy、5-HT、Cor水平,并按照不同抑郁程度进行分层分析;采用受试者工作曲线(ROC)分析上述三项指标诊断产后抑郁的价值。结果抑郁组产妇的血清5-HT水平低于对照组,抑郁组Hcy、EPDS评分、HAMD评分高于对照组,差异均有统计学意义(P<0.05);抑郁组和对照组的血清Cor差异无统计学意义(P>0.05)。中重度抑郁症产妇的血清5-HT水平低于轻度组,Hcy高于轻度组,差异均有统计学意义(P<0.05);中重度和轻度组的血清Cor差异无统计学意义(P>0.05)。血清5-HT水平诊断产后抑郁的截断值为1.97μmol/L、AUC值为0.832、灵敏度为85.18%、特异度为74.20%;血清Hcy水平诊断产后抑郁的截断值为10.74μmol/L、AUC值为0.777、灵敏度为81.33%、特异度为70.94%。结论血清Hcy、5-HT对于产后抑郁的诊断及评估具有一定的临床参考价值。     

ADHD儿童神经生化水平与行为的相关性

目的:探讨注意缺陷多动障碍(ADHD)患儿神经生化水平与行为的关系,为临床诊治提供参考。方法:监测ADHD儿童和正常儿童血清中多巴胺(DA)、5-羟色胺(5-HT)和促肾上腺皮质激素(ACTH)的水平,以及在不同生化水平下儿童行为的变化。结果:两组儿童血清DA、5-HT、ACTH含量比较发现,DA和5-HT差异有统计学意义(P<0.05);并且两组儿童的行为问题比较也有差异;注意缺陷指数水平与5-HT和ACTH呈一定相关,多动指数与DA有一定相关性。结论:ADHD患儿神经生化水平与行为有一定相关性,因此临床治疗可考虑对ADHD儿童的生化水平调控来纠正其行为问题。     

产后抑郁症患者外周血雌激素水平的变化及意义

目的分析产后抑郁症患者外周血雌激素水平的改变情况,并探讨其与炎症及神经递质的相关性。方法回顾性分析2014年1月-2016年1月在湖北医药学院附属襄阳市第一人民医院分娩产妇的临床资料。依据产妇是否患有产后抑郁症将产妇分为观察组(有产后抑郁症)及对照组(无产后抑郁症)。检测并对比两组产妇雌激素、神经递质及炎症因子水平的差异。结果此次研究共纳入观察组产妇43例,对照组产妇40例。观察组雌激素水平、多巴胺(DA)及5-羟色胺(5-HT)水平显著低于对照组,外周血IL-6水平显著高于对照组,差异均有统计学意义(均P<0.05)。相关性分析显示,观察组患者雌激素水平与DA及5-HT水平均呈现显著正相关关系(P<0.05),而与IL-6水平呈现显著负相关关系(P<0.05)。结论产后抑郁症患者雌激素水平显著降低,且与系统性炎症反应及单胺类神经递质水平降低密切相关。     

孕妇焦虑与去甲肾上腺素及5-羟色胺的关系

目的:探讨孕妇产前焦虑与去甲肾上腺素(NE)及5-羟色胺(5-HT)变化的关系。方法:选择择期剖宫产的孕妇80例,术前2 h孕妇自行填写汉密顿焦虑量表(HAS)、汉密顿抑郁量表(HDS)并对各项指标量化评分。根据评分分为无焦虑组(Ⅰ)、轻度焦虑组(Ⅱ)、中重度焦虑组(Ⅲ)3组。填表同时抽血测定NE、5-HT。结果:轻度焦虑组NE水平明显高于无焦虑组(P<0.01),中重度焦虑组NE水平明显高于无焦虑组(P<0.01),与轻度焦虑组无显著性差异(P>0.01)。轻度焦虑组5-HT水平明显低于无焦虑组(P<0.01),中重度焦虑组5-HT水平明显低于无焦虑组和轻度焦虑组(P<0.01)。孕妇焦虑程度与NE呈正相关(r=0.538,P<0.01),与5-HT呈负相关(r=-0.570,P<0.01)。结论:NE、5-HT在孕妇产前焦虑情绪的发生过程中起着重要的作用。     

产后抑郁症患者血清神经递质和甲状腺激素水平与抑郁状况的相关性分析

目的 分析产后抑郁症患者血清神经递质、甲状腺激素水平与抑郁状况的相关性。方法 选取2021年2月—2022年3月丽水市第二人民医院收治的产后抑郁症患者75例为研究组,另选取同期55例健康产妇作为对照组。采用爱丁堡产后抑郁量表(EPDS)、汉密顿抑郁量表(HAMD)评价产妇抑郁状况,检测两组产妇神经递质[5-羟色胺(5-HT)、多巴胺(DA)、去甲肾上腺素(NE)、孤啡肽(OFQ)]水平,甲状腺激素[三碘甲状腺原氨酸(T₃)、甲状腺素(T₄)、促甲状腺激素(TSH)]水平。采用Pearson相关性分析法分析产后抑郁症患者血清神经递质、甲状腺激素水平与抑郁状况的相关性,采用多因素logistic回归分析模型分析产后抑郁症患者的危险因素。结果 研究组5-HT、DA、NE、T₃、T₄、TSH水平分别(0.99±0.22)μmol/L、(2.17±0.43)μmol/L、(28.49±5.14)ng/ml、(2.15±0.32)nmol/L、(124.67±11.03)nmol/L、(1.49±0.24)nm...     

创伤患者血清神经内分泌激素及细胞因子的变化研究

目的旨在探讨神经内分泌激素及细胞因子在创伤后的变化及其临床意义。方法 63例创伤患者根据ISS评分分为中重度两组,创伤后4 h内采血,分别测定患者血清肾上腺素(NE)、促肾上腺皮质激素(ACTH)、皮质醇及促炎因子肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的水平。结果重度创伤患者在血清NE、ACTH、皮质醇及TNF-α和IL-6水平均较对照组显著升高(p<0.05);而且后三者水平在重度创伤者中显著高于中度创伤者(p<0.05)。结论从神经、内分泌、免疫三个系统入手,研究创伤应激的发生机制,并设法对其进行调控,将会对其治疗提供理论依据。     

产后抑郁症患者心率变异性改变及临床意义

目的探讨产后抑郁症(PPD)患者心率变异性(HRV)特点及其临床意义,为临床实践提供一定的理论基础。方法连续性纳入2016年3月-2017年3月医院所收治的35例PPD患者作为研究组,随机纳入研究期间正常复查产妇30例作为对照组。比较两组产妇血清5-羟色胺(5-HT)浓度,爱丁堡产后抑郁量表(EPDS)以及HRV参数差异,并分析PPD患者EPDS评分和血清5-HT浓度与HRV参数相关性。结果相比于对照组产妇,研究组PPD患者EPDS评分显著增高,血清5-HT浓度亦显著降低,SDNN、SDANN、SDNN-Index及rMSSD、PNN50显著降低,差异均有统计学意义(P0.05)。PPD患者EPDS评分与HRV参数呈显著性负相关(P0.05),血清5-HT浓度与HRV参数呈显著性正相关(P0.05)。结论 PPD患者HRV变异幅度显著性降低,且与PPD病情严重程度息息相关。     

正常及妊娠期高血压疾病胎盘组织中单胺类递质的相关研究

目的:通过对正常孕妇及妊娠期高血压疾病孕妇胎盘组织中去甲肾上腺素(NE)、5-羟色胺(5-HT)及多巴胺(DA)的测定,探讨其与妊娠期高血压疾病发病的关系。方法:应用免疫组织化学(免疫组化)链霉素抗生物素-过氧化物酶法,对31例正常早、中、晚孕妇女(正常孕妇组),及38例妊娠高血压、轻度子痫前期、重度子痫前期孕妇的胎盘组织进行NE和DA定位及定量。结果:①定位:正常孕妇组中,早期孕妇的胚胎绒毛滋养细胞NE、DA及5-HT免疫反应呈现强阳性,定位于细胞滋养细胞的细胞膜及细胞浆中;中、晚期孕妇为阳性,定位于合体滋养细胞的细胞膜及细胞浆,以及毛细血管内皮。妊娠期高血压疾病孕妇组定位同正常组。②定量:正常孕妇组NE由孕早期的1.595±0.018降至中、晚期的1.488±0.019和1.419±0.014(P<0.01);DA由孕早期的1.552±0.067,降至中、晚期的1.369±0.051和1.302±0.013(P<0.01),5-HT由孕早期的1.497±0.022升至中、晚期的1.538±0.017和1.554±0.013(P<0.01)。妊娠期高血压疾病组依据病情程度不同DA依次为1.378±0.029、1.305±0.023和1.237±0.024(P<0.01);NE依次为1.494±0.018、1.624±0.014和1.917±0.044(P<0.01),5-HT依次为1.411±0.034、1.374±0.017和1.324±0.014(P<0.01)。结论:正常孕妇组孕早期胎盘组织单胺类递质定位于绒毛滋养细胞中,于孕中、晚期则定位于合体滋养细胞中,正常孕妇组NE及DA含量随孕周增加而逐渐降低,5-HT逐渐升高。妊娠期高血压疾病孕妇组胎盘组织的定位同正常孕妇组的孕晚期相同,NE及5-HT含量随妊娠期高血压疾病病情加重而逐渐升高,DA含量则相反。     

养血清脑颗粒对脑梗死抑郁患者治疗效果的影响

目的探讨养血清脑颗粒对脑梗死后抑郁症患者治疗效果的影响。方法将2016年6月-2019年6月本院纳入的100例脑梗死后抑郁症患者随机分为两组,对照组用帕罗西汀治疗;观察组在对照组基础上加养血清脑颗粒治疗,比较两组汉密斯顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、脑卒中神经功能缺损评分量表(national institute of health stroke scale,NIHSS)评分和皮质醇、去甲肾上腺素(noradrenaline,NE)、多巴胺(dopamine,DA)及5-羟色胺(5-hydroxytryptamine,5-HT)水平及不良反应。结果治疗后,两组NIHSS、HAMD、HAMA评分、皮质醇水平均较治疗前降低,观察组显著低于对照组(均P<0.05),两组5-HT、DA及NE均显著上升,观察组显著高于对照组(均P<0.05);两组不良反应率差异无统计学意义(P>0.05)。结论养血清脑颗粒联合帕罗西汀治疗脑梗死后抑郁患者效果显著,且不增加不良反应。     

2型糖尿病患者应激状态下神经内分泌状态的研究

目的研究应激对2型糖尿病患者神经内分泌状况的影响,为糖尿病人的治疗及养生提供理论参考。方法对78例应激状态下2型糖尿病患者及73例非应激状态下2型糖尿病患者神经内分泌激素水平等数据进行测定并在组间进行统计学分析:患者血糖水平(PG)、血浆胰岛素水平(INS)、血浆胰高血糖素浓度、血浆皮质醇(CPRT)浓度、血浆促肾上腺素(ACTH)浓度、血浆多巴胺(DA)浓度及去甲肾上腺素(NE)浓度。结果应激状态下的2型糖尿病患者体内血糖浓度、胰岛素浓度、血浆多巴胺及去甲肾上腺素水平均高于对照组,而血浆促肾上腺素及皮质醇均低于对照组,P值均小于0.05,差异具有统计学意义。结论应激状态下2型糖尿病患者的神经内分泌状态进一步紊乱,促进胰岛素抵抗及糖尿病病情的发展。     

Correlation between plasma levels of ACTH and cortisol in basal states and during the CRH test in normal subjects and patients with hypothalamo-pituitary disorders.

Using a new ACTH-immunoradiometric assay (IRMA), we measured plasma ACTH levels in the basal states and during CRH test in normal subjects and the patients with hypothalamo-pituitary disorders. The basal levels of plasma ACTH in 76 normal young (25-45 yr) and 140 elderly (60-85 yr) subjects were 23.1 +/- 13.6, and 17.5 +/- 11.2 pg/ml, respectively. The plasma ACTH levels were less than detection limit (5 pg/ml) in 3 patients with isolated ACTH deficiency, and less than 10 pg/ml in 6 of 7 patients with hypopituitarism. A significant correlation was observed between the basal levels of plasma ACTH and of cortisol in two age groups, with almost the same regression line, showing no age-related decline in the plasma levels of ACTH and cortisol. In 2 normal subjects and 2 patients with Cushing's disease, synchronized secretions of ACTH and cortisol were observed between 0800h and 1800h. In normal subjects and the patients with pituitary disorders, a significant correlation was observed between the Area Under the Curve's for plasma ACTH and cortisol during the CRH test. The correlation constant was higher in normal subjects, but lower in the patients with acromegaly, non-functioning pituitary tumor, and Cushing's disease in this order, suggesting low sensitivity of the pituitary-adrenal axis in these patients. These results suggest that the ACTH-IRMA kit provide reliable data for clinical investigation, and that the secretions of ACTH and cortisol correlate each other in basal states and during the CRH test in the patients with pituitary disorders as well as in normal subjects.     

Modified dexamethasone suppression-corticotropin-releasing hormone stimulation test: A pilot study of young healthy volunteers and implications for alcoholism research in adolescents and young adults

The key neuroendocrine component of a response to stress is the hypothalamic-pituitary-adrenocortical (HPA) system. Abnormalities in the HPA system have been implicated in the pathophysiology of psychiatric disorders such as depression, post-traumatic stress disorder, alcoholism and suicide. The dexamethasone suppression test (DST) is the most frequently used test to assess HPA-system function in psychiatric disorders. This neuroendocrine test consists of the administration of a low dose of dexamethasone at 11 pm and the measurement of cortisol levels at one or more time points on the following day. After corticotropin-releasing hormone (CRH) became available for clinical studies, the DST was combined with CRH administration. In this test, patients are pretreated with a single dose of dexamethasone at 11 pm and receive human CRH intravenously at 3 pm the following day. The resulting DST-CRH test proved to be much more sensitive in detecting HPA system alterations than the DST. We have modified the DST-CRH test and used ovine CRH instead of human CRH in a pilot study of a group of young healthy volunteers. Results indicated that it produces results similar to the results obtained with human CRH. This suggests that ovine CRH can be used in psychiatric research. Alcoholism is associated with abnormalities in HPA function. Nonalcoholic subjects with a family history of alcoholism exhibit lower plasma ACTH and beta-endorphin as well as lower ACTH, cortisol, and beta-endorphin responses to psychological stress and CRH stimulation. This suggests that in children of alcoholics, alterations in the mechanisms that regulate HPA axis activity predate the development of alcohol dependence and may be considered inherited traits. Therefore, studies of the HPA system in persons at risk for alcoholism may help understand the neurobiological mechanisms of predisposition to alcoholism.     

Glucocorticoid hypofunction in myotonic dystrophy

INTRODUCTION: Myotonic dystrophy (DM1) is an autosomal dominant disorder whose genetic defect consists of the amplification of an unstable CTG trinucleotide repeat in the 3' untranslated region of the dystrophia myotonica protein kinase gene (DMPK). This is a multi-systemic disease with a well-known endocrinological repercussion. With respect to the adrenal function variable results have been described, although lately they are interpreted as indicators of a hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. MATERIAL AND METHODS: Twenty-five patients (13 men and 12 women) with DM1 were recruited. They were analysed for: basal cortisol and ACTH, stimulus test with 0.25 mg of ACTH for cortisol and CRH test for cortisol and ACTH. Similarly, the degree of expansion of CTG was evaluated by Southern blot and PCR. Twenty-five healthy individuals, comparable by age and sex, were studied as a control group; the CRH test was carried out on 11 of them. RESULT: One patient was diagnosed with primary non-autoimmune adrenal failure. In the rest of the cases there were no differences between the basal ACTH of patients and controls, and the cortisol response to ACTH was normal. The patients showed a lower level of basal cortisol (p<0.01) and also showed, following stimulation with CRH, a lower cortisol response (p<0.05) with higher average values of ACTH. CONCLUSIONS: Our data differs from the latest publications and point to an adrenal hypofunction due to lack of efficacy of the ACTH on its receptor or at the post-receptor level. We suggest that the etiology might be related to the underlying defect in the gene that codifies DMPK.     

产后忧郁、产后抑郁患者雌二醇、孕酮和瘦素水平变化的研究

目的:探讨血清雌二醇(E2)、孕酮(P)和瘦素(Leptin)水平变化与产后忧郁、产后抑郁的关系。方法:使用爱丁堡产后抑郁量表和产后抑郁症诊断标准进行诊断,随访500例孕产妇,测定并分析产后忧郁50例、非忧郁50例、产后抑郁16例和非抑郁18例孕产妇的产前、产后及产后42天血清E2、P和Leptin水平。结果:产后忧郁患者的产后E2、P水平明显低于对照组(P<0.01,P<0.05),产后Leptin水平高于对照组(P<0.05);产后抑郁患者的产后42天E2水平明显低于对照组(P<0.05),产后与产后42天P水平差明显高于对照组(P<0.05),产后42天Leptin水平明显高于对照组(P<0.05);忧郁抑郁患者中,产后42天E2水平明显低于单纯产后忧郁患者(P<0.05),Leptin水平明显高于单纯忧郁患者(P<0.05)。结论:低水平的E2、P可能是产后忧郁的病因;低水平的E2和产后42天P下降幅度较大可能是产后抑郁的病因;高血清Leptin水平与产后忧郁、产后抑郁有关。     

团体人际心理治疗产后抑郁症的疗效观察

目的:探讨团体人际心理治疗对减轻产后抑郁症患者抑郁症状和改善社会功能的效果。方法:人际心理治疗组38例产后抑郁症患者进行8周的团体人际心理治疗,对照组的35例产后抑郁症患者给予一般治疗。两组患者在治疗前及治疗后3个月采用爱丁堡产后抑郁量表(EPDS)、汉密顿抑郁量表(HAMD)、人际问题问卷(IIP)及社会功能缺陷筛选量表(SDSS)等进行评估。结果:与对照组比较,治疗后3个月末的人际心理治疗组人际能力和社会功能改善更明显(P<0.01),人际心理治疗组抑郁症状的缓解程度明显优于对照组(P<0.01)。结论:团体人际心理治疗能够改善产后抑郁症患者的人际能力和社会功能,对产后抑郁症有较好的疗效。     

运动对慢性心理应激大鼠影响

目的研究运动对慢性心理应激大鼠血清皮质醇、白细胞介素-2（IL-2）、白细胞介素-6（IL-6）的影响。方法建立慢性心理应激模型,进行6周游泳训练：测定各组大鼠血清皮质醇、IL-2、IL-6的含量。结果（1）应激组大鼠血清皮质醇含量显著高于对照组（P〈0.01）,血清IL-2I、L-6水平显著低于对照组（P〈0.01）;（2）30min运动组血清IL-2水平显著高于对照组（P〈0.01）,60 min运动组血清IL-2I、L-6水平均显著高于对照组（P〈0.01）,血清皮质醇含量显著低于对照组（P〈0.05）;（3）应激＋30 min运动组、应激＋60 min运动组血清皮质醇含量显著低于应激组（P〈0.01）,IL-2和IL-6水平显著高于应激组（P〈0.01）。结论慢性心理应激引起大鼠下丘脑-垂体-肾上腺皮质（HPA）轴释放过量皮质醇,使免疫功能受到抑制;适量运动能够调节HPA轴适应性,降低皮质醇的过量释放,维护免疫功能稳定。