抑郁症共病糖尿病患者的皮质醇水平与帕罗西汀治疗疗效的关系

目的：探讨抑郁症共病2型糖尿病患者血清皮质醇水平升高的相关因素及与帕罗西汀抗抑郁疗效的关系。方法选取符合抑郁症合并2型糖尿病患者212例，根据血清皮质醇水平分为皮质醇升高组（ n ＝98）和皮质醇正常组（ n ＝114），采用汉密顿抑郁量表（HAMD）评价抗抑郁程度；检测糖化血红蛋白（HbA1c）水平；通过自制调查问卷调查患者一般情况。2组患者使用抗抑郁药物帕罗西汀治疗8周后使用 HAMD 减分率评估疗效。结果 Lo-gistic 回归分析显示，抑郁症共病2型糖尿病的患者皮质醇升高的相关因素包括年龄、每周运动时间、抑郁症病程、HAMD 评分、HbA1c；帕罗西汀治疗8周后，皮质醇升高组患者的 HAMD 减分率低于皮质醇正常组（ P ﹤0.05），HAMD减分率与 HbA1c 及皮质醇水平呈负相关（ P ﹤0.05）。结论抑郁症共病2型糖尿病患者皮质醇升高的相关因素包括年龄、每周运动时间、抑郁症病程、HAMD 评分、HbA1c，血清皮质醇和 HbA1c 水平较高的患者帕罗西汀疗效不佳。     

伴抑郁症状的首发精神分裂症患者血清皮质醇水平的相关研究

目的:探讨伴抑郁症状的首发精神分裂症患者血清皮质醇(COR)的相关水平。方法:选取A组(首发精神分裂症伴随抑郁症状患者)30例、B组(首发抑郁症)30例、C组(首发精神分裂症不伴抑郁症状)30例、D组(健康组)30例作为对照组,用免疫发光化学法检测其血清皮质醇(COR)水平。结果:在每一组中,不同时段人体内血清皮质醇(COR)水平有所不同,A、B、C 3组血清皮质醇(COR)水平明显高于D组(P0.05),伴有抑郁症状的精神分裂症患者血清皮质醇(COR)水平最高,差异具有统计学意义。结论:精神分裂症与抑郁症患者血清皮质醇(COR)水平的不同,首发精神分裂症伴有抑郁症状时,患者体内血清皮质醇(COR)水平较不伴有抑郁症状的精神分裂症及首发抑郁症患者明显升高。     

阿戈美拉汀联合坦度螺酮对老年抑郁症患者血清NE、5-HT水平的影响

目的 观察阿戈美拉汀联合坦度螺酮对老年抑郁症患者血清去甲肾上腺素(NE)、五羟色胺(5-HT)的影响,探讨其对抑郁症的临床疗效. 方法 100例抑郁症患者按照随机数字表法分为观察组50例、对照组50例,对照组给予坦度螺酮口服,观察组在对照组基础上加服阿戈美拉汀.治疗前、治疗8周后分别进行汉密尔顿抑郁量表(HAMD)评分,检测血清NE、5-HT表达水平. 结果 治疗前2组患者HAMD评分及血清NE、5-HT水平比较,差异无统计学意义(P>0.05).治疗8周后,观察组比对照组HAMD评分明显降低(P<0.05),血清NE、5-HT水平均明显升高(P<0.05). 结论 阿戈美拉汀联合坦度螺酮可明显升高老年抑郁症患者血清NE、5-HT水平,降低HAMD评分,显著改善抑郁症状.     

老年期抑郁症的血浆同型半胱氨酸水平研究

目的探讨血浆同型半胱氨酸水平（Hcy）与老年期抑郁症的关系。方法采用毛细管电泳-紫外检测法测定60例老年期抑郁症和80例正常对照组的血浆总同型半胱氨酸水平。患者组入组时和治疗6周后评定汉密顿抑郁量表（HAMD）。结果①老年期抑郁症组的血浆同型半胱氨酸水平显著高于正常对照组;伴和不伴心脑血管疾病的抑郁症患者的血浆同型半胱氨酸水平差异无显著性;伴和不伴认知功能障碍的抑郁症患者的血浆同型半胱氨酸水平差异无显著性;6周末治疗有效组和无效组的血浆同型半胱氨酸水平差异无显著性;②老年期抑郁症患者治疗前HAMD评分与血浆同型半胱氨酸水平无显著相关性。结论血浆同型半胱氨酸水平升高可能是老年期抑郁症发病的一个新的独立的危险因素。     

艾司西酞普兰治疗老年抑郁症的临床疗效观察

目的:探讨艾司西酞普兰治疗老年抑郁症的疗效,为其临床诊治提供参考。方法:选择湖州市第三人民医院2016年3月至2018年6月收治的120例老年抑郁症患者作为研究对象,根据随机数字表法分为对照组和观察组,其中对照组患者给予阿米替林治疗,观察组患者给予艾司西酞普兰治疗。比较2组患者治疗前后临床大体印象量表(CGI)、汉密尔顿抑郁量表(HAMD)评分,分析2组患者治疗前后血清硫化脱氢表雄酮(DHEAS)、皮质醇水平及认知功能变化,观察2组患者临床疗效及不良反应发生情况差异。结果:与治疗前相比,2组患者治疗后的血清DHEAS明显升高,HAMD、CGI评分及血清皮质醇明显降低,且观察组患者治疗后上述指标改善更为显著(P<0.05)。治疗后2组患者WCST评分及MoCA评分差异具有统计学意义(P <0.05)。观察组患者的治疗有效率明显高于对照组,不良反应发生率明显低于对照组(P<0.05)。结论:艾司西酞普兰治疗老年抑郁症,可以显著改善患者抑郁状态及认知功能,提高血清DHEAS水平,降低不良反应发生率,具有一定的临床应用价值。     

重复经颅磁刺激对抑郁症患者的抑郁程度和HPA轴的影响

目的探讨重复经颅磁刺激对抑郁症患者的抑郁程度和下丘脑-垂体-肾上腺（HPA）轴活性的影响。方法采取双盲对照试验方案,将确诊的40例抑郁症患者随机分入工组（治疗组）和Ⅱ组（假刺激对照组）,每组治疗10天。在治疗前及治疗结束后当天检测Hamilton抑郁量表（HAMD）积分、血清皮质醇（CORT）及血清促肾上腺皮质激素（ACTH）浓度。结果治疗前全组的HAMD积分与血清CORT（r=0．948）和ACTH（r=0．971）浓度和治疗后治疗组的HAMD积分与血清CORT（r=0．920）和ACTH（r=0．978）浓度间均呈显著正相关关系（均P〈0．05）。治疗前两组的HAMD积分（t〈0．001）、血清CORT（t=-0．328）和ACTH（t=-0．228）浓度无统计学差异（均P〉0．05）;治疗后两组的上述指标均有统计学差异（P〈0．05）。结论抑郁症患者的抑郁程度与其血清CORT和ACTH浓度呈正相关。rTMS有改善抑郁症状的作用,其抗抑郁作用的机制可能与其下调HPA轴的活性有关。     

解郁丸联合度洛西汀治疗抑郁症疗效及对血清神经递质及神经功能相关因子影响观察

摘要：目的:观察解郁丸联合度洛西汀治疗抑郁发作的疗效,及对患者血清神经递质及神经功能相关因子的影响。方法:90例抑郁发作患者随机分为观察组45例(采用解郁丸联合度洛西汀治疗),对照组45例(采用度洛西汀治疗)。观察两组汉密尔顿抑郁量表(HAMD)评分、临床总体印象量表(CGI)评分变化及临床疗效;比较两组患者血清去甲肾上腺素(NE)及5-羟色胺(5-HT)、S100B蛋白、髓鞘碱性蛋白(MBP)、血清胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)水平变化,记录两组药品不良反应情况。结果:观察组总有效率为88.9%,明显高于对照组的71.1%(P<0.05)。两组患者治疗第2,4,6及8周末HAMD和CGI评分均较治疗前明显降低(P<0.05),且治疗第2周末时观察组HAMD及CGI评分低于对照组(P<0.05)。两组患者治疗第4、第8周末血清NE、5-HT及BDNF水平较前明显升高,S100B蛋白、MBP、GFAP水平较前显著下降(P<0.05);且治疗8周末,观察组各项指标均优于对照组(P<0.05)。两组药品不良反应发生率的差异无统计学意义(P<0.05)。结论:解郁丸联合度洛西汀治疗抑郁症疗效显著,调节患者血清神经递质和神经功能因子水平,安全有效,可供临床治疗借鉴。     

首发抑郁症患者血清 HCY 和 hs-CRP水平检测价值

目的：观察首发抑郁症患者治疗前后血清同型半胱氨酸（ HCY ）和高敏C反应蛋白（ hs-CRP）水平变化,探讨检测血清HCY和hs-CRP水平的临床价值。方法50例抑郁症患者于治疗前及治疗8周末采用汉密尔顿抑郁量表（ HAMD）评定抑郁症状及检测血清HCY和hs-CRP水平,同期检测正常对照组血清HCY和hs-CRP水平。结果治疗8周后HAMD分值及血清HCY和hs-CRP水平较治疗前均显著下降（P＜0.01）,抑郁症患者HAMD分值分别与血清HCY和hs-CRP呈显著正相关（r＝0.602、0.597,P＜0.01）。结论抑郁症患者存在高HCY和hs-CRP血症,随着临床症状的好转其水平显著改善,检测其水平可作为判定抑郁症患者病情及预后的指标。     

初发脑梗死后伴发抑郁和焦虑程度与血清中Hcy及IL-2水平的相关性研究

目的 检测初发脑梗死伴抑郁焦虑病人血清血浆同型半胱氨酸(Hcy)、白细胞介素-2(IL-2)水平,分析其相关性.方法选取在该院住院的脑梗死病人200例,采用汉密尔顿焦虑抑郁/焦虑量表(HAMD/HAMA)评价,分为抑郁焦虑组、非抑郁焦虑组,另取健康体检者作为对照组.病人均行常规脑血管病治疗,在此基础上,抑郁焦虑组病人每天口服氟哌噻吨美利曲辛片.酶联免疫吸附法检测入组病人血清Hcy、IL-2水平及HAMD评分,分析抑郁焦虑的严重程度与血清Hcy、IL-2水平的相关性.结果 抑郁焦虑组病人治疗前血清Hcy、IL-2水平、HAMD评分高于非抑郁焦虑组及空白对照组(P<0.05);治疗后抑郁焦虑组及非抑郁焦虑组的血清Hcy、IL-2水平、HAMD评分均较治疗前有所降低,抑郁焦虑组治疗后血清Hcy、IL-2、HAMD评分与非抑郁焦虑组无明显差异(P>0.05);初发脑梗死抑郁组病人的抑郁焦虑严重程度与血清Hcy、IL-2水平呈正相关(P<0.05).结论 初发脑梗死伴焦虑抑郁的病人血清Hcy、IL-2水平明显升高,抑郁焦虑的严重程度与血清Hcy、IL-2水平呈正相关.     

九味镇心颗粒联合度洛西汀治疗抑郁症的临床研究

目的探讨九味镇心颗粒联合度洛西汀治疗抑郁症的临床效果。方法选取2014年7月—2017年7月南京医科大学附属脑科医院收治的抑郁症患者131例,随机分成对照组(65例)和治疗组(66例)。对照组患者口服盐酸度洛西汀肠溶胶囊,1片/次,1次/d;治疗组患者在对照组基础上口服九味镇心颗粒,1袋/次,3次/d。两组患者均连续治疗6周。观察两组患者临床疗效,同时比较治疗前后两组患者汉密顿抑郁量表(HAMD)和抑郁自评量表(SDS)评分、5-羟色胺和皮质醇水平及不良反应情况。结果治疗后,对照组和治疗组临床有效率分别为83.08%和95.45%,两组比较差异具有统计学意义(P0.05)。治疗后,两组HAMD和SDS评分均显著降低(P0.05),且治疗组HAMD和SDS评分明显低于对照组(P0.05)。治疗后,两组患者5-羟色胺水平显著升高(P0.05),皮质醇水平显著降低(P0.05),且治疗组5-羟色胺和皮质醇水平明显优于对照组(P0.05)。治疗期间,治疗组药物不良反应发生率为3.03%,显著低于对照组的13.85%,两组比较差异具有统计学意义(P0.05)。结论九味镇心颗粒联合度洛西汀治疗抑郁症疗效显著,安全性高,具有一定的临床推广应用价值。     

抑郁症患者血清CRP、BDNF及微量元素变化的研究

目的研究和分析抑郁症患者血清CRP、BDNF及微量元素的变化状态。方法选取2011年9月～2013年10月本院收治的65例抑郁症患者为观察组,并以同期的65例同龄健康者为对照组,将两组的血清CRP、BDNF及微量元素水平进行检测与比较,同时比较不同汉密尔顿抑郁量表评估结果者的检测水平。结果观察组的血清CRP、Fe及Cu均高于对照组,血清BDNF、Zn及Mg均低于对照组,差异有统计学意义（P〈0．05）。重度抑郁患者的血清CRP、Fe及Cu均高于轻度及中度抑郁患者,血清BDNF、Zn及Mg均低于轻度及中度抑郁患者;中度抑郁患者的血清CRP、Fe及Cu均高于轻度抑郁患者,血清BDNF、Zn及Mg均低于轻度抑郁患者,差异有统计学意义（P〈0．05）。结论抑郁症患者的血清CRP、BDNF及微量元素均呈现异常状态,且不同严重程度者间存在显著差异。     

Antepartum/postpartum depressive symptoms and serum zinc and magnesium levels

In the present study, we investigated the relationship between depressive symptoms and serum zinc and magnesium level in antepartum and postpartum women. All women received standard vitamin, zinc and magnesium supplementation. Sixty-six pregnant women in the Czerwiakowski Hospital in Kraków were assessed for prepartum depressive symptoms using the Beck Depression Inventory (BDI). Sixty-two and fifty-eight women were also assessed for postpartum depressive symptoms (using Edinburgh Postnatal Depression Rating Scale, EPDRS) at 3 and 30 days after delivery, respectively. Serum zinc and magnesium levels were also determined at these time points, however, the number of examined subjects were diminished. A significantly higher EPDRS score (by 45%), indicating severity of depressive symptoms, was found on the 3rd day after childbirth compared with the 30th postpartum day. Moreover, the early post-delivery period (3rd day) was characterized by a 24% lower serum zinc concentration than that found on the 30th day after childbirth. BDI scores assessed a month before childbirth revealed mild depressive symptoms, which was accompanied by a serum zinc concentration similar to that found on the 3rd day after delivery. No significant alterations were found in the magnesium levels between these time points. The present results demonstrated a relationship between severity of depressive symptoms and decreased serum zinc (but not magnesium) concentration in a very specific type of affective disorder, the postpartum depression.     

血清总胆固醇水平和抑郁症患者自杀行为的相关性分析

目的探讨自杀未遂抑郁症患者的临床症状与其血清总胆固醇水平的关系。方法抑郁症患者141人,分为伴自杀未遂组（56人）及无自杀行为组（85人）,以汉密顿抑郁量表24项版本（HAMD-24）评定其临床症状,同时测定其血清总胆固醇水平（CHOL）。结果自杀未遂组血清总胆固醇水平低于无自杀组[（4.32±1.02）,（4.67±0.98）,t=2.021,P=0.045];重度抑郁组血清总胆固醇水平低于中度组及轻度组[（4.26±0.94）,（4.74±1.06）,（4.86±1.14）,F=3.393,P=0.037]。HAMD评分与血清总胆固醇水平呈负相关（r=-0.200,P=0.035）。结论低血清总胆固醇水平可能是抑郁症患者出现自杀行为的危险因素。     

Serum creatine kinase level in unmedicated nonpsychotic, psychotic, bipolar and schizoaffective depressed patients.

Creatine kinase (CK) level was previously found to be increased in the majority of hospitalized acute psychotic patients. We aimed to asses the possible differences in CK level in various forms of depression: major with and without psychotic symptoms, of bipolar depression and schizoaffective depression. Unmedicated hospitalized patients participated: nonpsychotic major depression (n=39), psychotic major depression (n=23), bipolar depression (n=23) and schizoaffective depression (n=24). The severity of depression was assessed by the Hamilton Depression Rating Scale (Ham-D) and blood samples were collected in the morning of admission day, prior to any treatment. Ham-D yielded a significantly higher score for psychotic major depression group, compared with all other groups which showed similar score. CK serum level was significantly higher in nonpsychotic major depression than in all other forms of depression. The results indicate a biological difference between the nonpsychotic major depression and the "psychotic" cluster of depressive syndromes.     

Decreased Hypothalamic Functional Connectivity with Subgenual Cortex in Psychotic Major Depression

Hypothalamus communication with the rest of the brain and peripheral target tissues is critically important for many physiological and psychological functions. These functions include maintaining neuroendocrine circadian rhythms and managing affective processes. The hypothalamus maintains both direct neural connections within the brain and it also controls a variety of neuroendocrine processes that can influence target tissues throughout the body. Dysregulation of the hypothalamic pituitary adrenal axis and hyperactivity of the subgenual cortex are both frequently observed in depression. However, many details of how the hypothalamus, the hypothalamic pituitary adrenal (HPA) axis, and the subgenual cingulate interact with each other are unknown. We hypothesized that resting-state functional connectivity between the hypothalamus and the subgenual cortex would be associated with altered circadian rhythm in patients with depression and depressive symptoms. We also hypothesized that this would be most apparent in patients that have major depression with psychotic symptoms, who typically have the most robust HPA-axis dysregulation. Resting-state functional magnetic resonance imaging (fMRI) scans were collected to observe low-frequency resting-state functional connectivity patterns of the hypothalamus in 39 healthy participants, 39 patients with major depression, and 22 patients with major depression with psychotic symptoms. Hourly overnight measures of cortisol secretion and multiple measures of psychiatric symptom severity were also collected on all. Strong hypothalamic functional connectivity with the subgenual cortex was observed in healthy participants. This connectivity was significantly reduced in patients with psychotic major depression. Increased cortisol secretion during the circadian nadir and reduced connectivity were both associated with symptom severity. Reduced connectivity and high cortisol secretion during the circadian nadir are both useful for explaining a significant amount of variance in symptom severity that occurs between healthy participants and depressed patients. However, only cortisol secretion was useful for explaining the severity of symptoms within the depressed groups. This study suggests that the communication between the hypothalamus and the subgenual cortex is disrupted in patients with major depression with psychotic features. It also suggests that these disruptions are associated with increased symptom severity and may be a cause or a consequence of cortisol dysregulation.     

早期心理干预联合氟西汀治疗脑卒中后抑郁症的临床观察

目的:评价急性脑卒中后抑郁的发生情况,并观察早期心理干预联合氟西汀治疗脑卒中后抑郁症的疗效。方法:220例首发急性脑卒中患者用Hamilton抑郁量表、抑郁自评量表和社会支持量表进行抑郁症评价,并进行Logistic多元逐步回归分析。将确诊为抑郁症的118例患者随机分为对照组和心理干预联合氟西汀治疗组,2组均接受常规药物治疗,治疗组在对照组基础上同步进行心理干预联合氟西汀治疗。结果:脑卒中后抑郁的发生率为53.63%;病灶位于皮质和皮质前部的患者抑郁评分显著高于位于皮质下和皮质后部的患者;治疗后治疗组有效率为93.22%,显著高于对照组的61·01%(P<0·05)。结论:首发急性脑卒中的抑郁症发生率较高,其严重程度与病变部位有关。早期心理干预联合氟西汀治疗脑卒中后抑郁症明显有效。     

伴与不伴自杀行为的抑郁症患者临床症状及血清脑源性神经营养因子水平比较

目的比较伴与不伴自杀行为的抑郁症患者临床症状及血清脑源性神经营养因子（BDNF）水平差异。方法采用酶联免疫双抗体夹心法测定抑郁症自杀未遂患者（n=36）和无自杀行为抑郁症患者（n=55）血清BDNF水平,并以汉密顿抑郁量表（HAMD）评定抑郁严重程度。结果自杀未遂组HAMD总分高于无自杀行为组（t=3．632,,P=0．000）,自杀未遂组HAMD因子认识障碍（t=-2．339,P=0．019）和绝望感（t=-2．812,P=0．005）高于无自杀行为组,两组因子焦虑／躯体化、体质量、日夜变化、阻滞和睡眠障碍等评分差异均无统计学意义（均P〉0．05）。自杀未遂组血清BDNF水平低于无自杀行为组（t=-2．122,P=0．037）;不同性别间血清BDNF水平差异无统计学意义（P〉0．05）。结论伴自杀行为的抑郁症患者临床症状有一定特征性,血清BDNF水平低对评估抑郁症自杀风险有重要意义。     

Elevation of the cortisol/dehydroepiandrosterone ratio in schizophrenia patients.

Dehydroepiandrosterone (DHEA) and its sulfate derivative DHEA-S are neurosteroids, produced in the brain, and neuroactive steroids, produced in the adrenals and affecting the brain. We compared the ratios of serum cortisol/DHEA or DHEA-S in schizophrenia patients with normal subjects, and determined the correlation of these ratios with psychopathology and distress. Early morning plasma concentrations of DHEA, DHEA-S, and cortisol were determined by radioimmunassay in 40 medicated schizophrenia inpatients, and 15 healthy subjects with similar age and sex distribution. Subjects were assessed for psychopathology using the Positive and Negative Syndrome Scale (PANSS) and the Montgomery and Asberg Depression Rating Scale (MADRS), anxiety, anger, emotional and somatic distress levels. Schizophrenia inpatients demonstrated significantly higher levels of state and trait anxiety, anger expression index, emotional and somatic self-reported distress scores. Cortisol/DHEA and cortisol/DHEA-S ratios were significantly higher in schizophrenia patients than in healthy comparison subjects. Both ratios correlated positively with age and duration of illness; cortisol/DHEA-S ratio also showed positive association with age of illness onset. When age, illness duration and age of onset were controlled, cortisol/DHEA-S ratio significantly correlated with severity of depression (MADRS, r=0.33, p=0.048), state and trait anxiety (r=0.43, p=0.008 and r=0.40, p=0.014, respectively), trait anger (r=0.41, p=0.012), angry temperament (r=0.46, p=0.004), anger expression index (r=0.36, p=0.033), and hostility (r=0.42, p=0.010). No significant association was found between these ratios and severity of psychopathology, and type or dosage of antipsychotic agents. Thus, elevated cortisol/DHEA and/or cortisol/DHEA-S ratios in schizophrenia patients are positively associated with higher scores for anxiety and anger, depression and hostility, age and age of onset/duration of illness, but are independent of severity of psychopathology (PANSS) and antipsychotic treatment.     

肠易激综合征患者应用双歧杆菌四联活菌联合谷维素治疗的疗效观察

目的：探讨肠易激综合征患者应用双歧杆菌四联活菌联合谷维素治疗的效果。方法采用随机分组的方法,将本院接收的384例肠易激综合征患者分为对照组和实验组,每组各192例。其中对照组给予匹维溴胺及谷维素口服,实验组在对照组治疗的基础上加用双歧杆菌四联活菌口服,分别观察比较分析两组患者治疗前后精神评分、消化道症状评分、治疗效果及不良反应发生情况。结果治疗后两组患者各亚型焦虑量表、抑郁量表评分及消化道症状评分均低于治疗前（P＜0．05）;实验组各亚型治疗后焦虑量表评分、抑郁量表评分及消化道症状评分均显著低于对照组（ P＜0．05）。对照组总有效率为71．88％,实验组总有效率为90．63％,其中腹泻型及腹泻便秘交替型,实验组明显高于对照组（P＜0．05）。两组均有患者出现轻微不良反应,对照组头痛、乏力4例,恶心2例,实验组头痛、乏力及恶心均有2例,经对症治疗后症状均消失。结论应用双歧杆菌四联活菌联合谷维素治疗肠易激综合征患者疗效显著,不良反应少,值得临床推广。