复发性抑郁症患者血清脑源性神经营养因子和胶质细胞源性神经营养因子水平的研究

目的探讨复发性抑郁症患者血清中脑源性神经营养因子(BDNF)与胶质细胞源性神经营养因子(GDNF)水平。方法采用酶联免疫吸附法测定49例治疗前的复发性抑郁症患者以及36例正常对照者血清BDNF和GDNF水平,采用汉密尔顿抑郁量表(HAMD)评定复发性抑郁症患者的抑郁症状。结果复发性抑郁症患者治疗前血清BDNF和GDNF水平显著低于对照组(P<0.01)。在复发性抑郁症患者组,血清BDNF水平与HAMD总分呈显著负相关(P<0.01)。结论复发性抑郁症患者可能存在神经营养因子水平低下,这种变化是否为抑郁发作的生物学指标尚不清楚。     

脑源性神经营养因子与抑郁障碍相关性研究进展

脑源性神经营养因子（brain-derived neurotrophic factor,BDNF）是1982年德同神经生物学家从猪脑中分离出来的小分子蛋白质,有促进突触生长、维持神经元生存的作用。抑郁障碍是以兴趣降低和快感缺乏为显著特征的情感性精神疾病,随着现代生活节奏加快、竞争日益激烈化等社会因素的加剧,其发病率逐年升高,严重危害着人们的心身健康。     

精神分裂症血清脑源性神经营养因子水平研究

目的本文主要观察精神分裂症血清脑源性神经营养因子水平。方法本文总计200例研究对象,于我院2018年3月-2019年3月收治入院,其中100例为精神分裂患者,划分为观察组,剩余100例为健康体检者,作为对照组。抽取患者治疗前后的清晨空腹静脉血,使用酶联免疫吸附试验进行血清检测。结果治疗前血清BDNF对比,观察组数值低于对照组,组间比较有明显差异(P<0.05);治疗前认知评分对比,观察组连线测试评分、符号编码评分高于对照组,其他均低于对照组,组间比较有明显差异(P<0.05);斯楚普测试验评分、符号编码评分、工作记忆评分、言语记忆评分为正相关,连线测试评分为负相关。结论精神分裂症患者血清BDNF水平相比健康人员明显降低,可将此指标作为病情判断及预后评估。     

血清脑源性神经营养因子对双相障碍诊断价值研究

目的探讨血清脑源性神经营养因子(BDNF)对双相障碍的诊断价值。方法采用躁狂量表(YMRS)、功能评定表(GAF)和抑郁表(MADRS),对本院在2013年1月到2016年1月所所收治的100例双相障碍者进行评定,其中双相障碍抑郁组50例,双相障碍躁狂组50例。另外还收集单纯抑郁组50例,健康体检组50例做比较。采用酶联免疫吸附法检测血清脑源性营养因子水平。结果⑴治疗后,单项抑郁组与正常组的BDNF差异无统计学意义(P0.05);⑵治疗后,双相障碍抑郁组BDNF水平显著低于正常组,组间数据对比差异有统计学意义(P0.05);⑶治疗后,双相障碍狂躁组BDNF水平显著低于正常组,组间数据对比差异有统计学意义(P0.05)。结论双相障碍躁狂和抑郁与血清脑源性神经营养因子水平有关。     

脑源性神经营养因子在卒中后抑郁中的检测及临床意义

目的：检测卒中后抑郁患者血清脑源性神经营养因子（BDNF）的水平并研究其临床意义。方法选择2011年1月至2013年6月仙桃市第一人民医院神经内科诊治的50例卒中后抑郁患者为研究对象（观察组）,以同期体检的健康人为对照组,比较两组对象血清BDNF水平的差异,分析不同临床资料下BDNF的差异,分析BD-NF与病灶体积、抑郁评分和NIHSS评分的相关性。结果观察组卒中后抑郁患者BDNF为（10．7＆#177;3．2）ng/mL ,对照组BDNF为（18．4＆#177;5．9）ng/mL ,两组比较差异有统计学意义（P＜0．05）。观察组卒中后抑郁患者血清BDNF在性别、年龄、卒中病因、病灶部位、病灶分布和卒中部位中的差异无统计学意义（P＞0．05）;在病灶体积、抑郁评分和NIHSS评分中的差异有统计学意义（P＜0．05）。将BDNF与病灶体积、抑郁评分和NIHSS评分进行相关性分析,BDNF与病灶体积、抑郁评分和NIHSS评分均呈负相关（P＜0．05）,卒中后抑郁患者病灶体积越大、抑郁评分越高、NIHSS评分越高,血清BDNF值越低。结论卒中后抑郁患者BDNF明显降低,其水平与病灶体积、抑郁评分和NIHSS评分均呈负相关,在卒中后抑郁患者病情及预后的评估中具有重要意义。     

抑郁发作与躯体形式障碍的症状比较

目的比较抑郁发作与躯体形式障碍的异同。方法了解患者临床情况及就医方式，以自编访谈提纲及汉米顿抑郁量表（HRSD）对66例抑郁发作患者和46例躯体形式障碍患者进行调查。结果两组患者性别及首次就医方式有显著性差异；在常见的14项躯体症状中，9项差异显著。两组的（HRSD）总分和7个因子分均有显著性差异。除焦虑，躯体化因子在躯体形式障碍组显著高于抑郁发作组外，其余各项均低于抑郁发作。结论抑郁发作和躯体形式障碍患者各有其临床特点。     

躯体形式疼痛障碍患者的脑影像学研究进展

躯体形式疼痛障碍(somatoform pain disorder,SPD)作为精神医学科的一种功能性疾病已被逐步认识,但仍然难以明确其发生机制,因缺乏行之有效的检测手段,且其临床表现复杂多样,导致该类患者辗转就诊于各大临床科室,而收效欠佳,病程迁延,造成较大的医疗资源、人力物力的消耗。近年来越来越多的脑影像学研究(neuroimaging)证明躯体形式疼痛障碍患者的不同脑区之间存在着结构、功能、生化代谢等方面的异常,为今后的研究提供了一定的理论依据。本文就目前常用脑影像学技术对躯体形式疼痛障碍相关脑区结构、功能及生化代谢方面的改变的研究进展做一综述。     

脑卒中后抑郁患者脑源性神经营养因子与炎症因子的相关性

目的：研究脑卒中后抑郁患者脑源性神经营养因子（BDNF）与炎症因子的相关性。方法选择脑卒中后抑郁患者（PSD组）和健康者（CON组）为研究对象,比较两组研究对象白细胞（WBC）、红细胞（RBC）、中性粒细胞（NEU）、血小板（PLT）、淋巴细胞（LYM）、BDNF、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）和白细胞介素-10（IL-10）的差异,分析脑卒中后抑郁患者BDNF与炎症因子的相关性。结果 PSD组患者WBC和NEU明显高于CON组（均 P＜0．01）,在RBC、PLT 和LYM 方面差异无统计学意义（P＞0．05）。PSD组患者BDNF和IL-10明显低于CON组,hs-CRP、TNF-α、IL-1β、IL-6和IL-8均明显高于CON组（均 P＜0．01）。将脑卒中后抑郁患者BDNF与 hs-CRP、TNF-α、IL-1β、IL-6、IL-8和IL-10进行相关性分析,BDNF与hs-CRP、TNF-α、IL-1β、IL-6和 IL-8均呈负相关（rs ＜0,P＜0．05）,与IL-10呈正相关（rs＞0,P＜0．05）。结论脑卒中后抑郁患者血清BDNF水平与hs-CRP、TNF-α、IL-1β、IL-6和IL-8均呈负相关,与IL-10呈正相关。     

血清脑源性神经营养因子水平与2型糖尿病认知功能障碍的相关性研究

目的探讨血清脑源性神经营养因子(BDNF)水平改变与2型糖尿病患者认知功能障碍之间的相关性。方法筛选2012年8-12月在广东医学院附属医院的2型糖尿病认知功能障碍患者80例为病例组,同期体检健康者80例为正常对照组,记录受试者的一般人口资料和临床资料。重复性成套神经心理状态测验评分(RBANS),并联合酶联免疫吸附法(ELISA)检测血清BDNF水平。结果与对照组相比,病例组性别、年龄、受教育年限差异无统计学意义(P0.05)。病例组BMI、TC、HbA1c、FPG水平增高,血清BDNF水平降低,差异有统计学意义(P0.05)。正常对照组的RBANS量表注意力、即刻记忆、言语功能、延迟记忆评分及标准分以及视觉广度显著高于病例组(P0.05)。Pearson相关分析结果显示RBANS量表评分中即刻记忆、言语功能、注意力、延迟记忆评分及标准分与血清BDNF水平呈正相关(P0.05),视觉广度评分与血清BDNF水平无线性相关性(P0.05)。结论 2型糖尿病患者存在认知功能损伤,该损伤可能与血清BDNF水平降低有关。     

孤独症谱系障碍儿童血清叶酸与脑源性神经营养因子水平检测的临床意义

目的　研究叶酸和脑源性神经营养因子（BDNF）检测在孤独症谱系障碍（ASD）患儿中的临床意义。方法纳入 2017 年 3 月 ~2020 年 3 月 56 例 ASD 患儿作为观察组,按 1:1 比例,另纳入同期 56 例体检健康儿童作为对照组。分别采用化学发光微粒子免疫分析技术（CMIA）和酶联免疫吸附法（ELISA）检测血清叶酸和 BDNF 水平,比较两组儿童血清叶酸和 BDNF 水平。采用儿童孤独症评定量表（CARS）记录 ASD 患儿病情状态,并分析血清叶酸和 BDNF与 CARS 评分的关系。分析血清叶酸水平对判断 ASD 及病情程度的价值,比较不同患儿血清 BDNF 水平,分析 BDNF水平影响因素。结果　观察组患儿血清叶酸水平显著低于对照组（15.39±7.41 nmol/L vs 19.61±6.09 nmol/L）,BDNF显著高于对照组（25.88±11.05 pg/ml vs 20.48±10.30 pg/ml）,差异均有统计学意义（t=2.941,2.670,均 P<0.05）。不同病情程度 ASD 患儿血清叶酸水平比较,差异均有统计学意义（F=14.797,P<0.05）。轻中度 ASD 患儿 BDNF 显著高于重度患儿及健康对照组儿童,差异均有统计学意义（t=2.833,3.130,均 P<0.05）。Pearson 线性相关分析显示CARS 评分与血清叶酸水平呈显著负相关性（r = -0.317,P=0.000）。CARS 评分与血清 BDNF 水平无显著相关性（r =0.074,P=0.132）。受试者工作曲线（ROC）分析显示血清叶酸对判断ASD和重度ASD均具有一定应用价值（AUC=0.779,0.768;P<0.05）。多元线性回归分析结果显示年龄（b=1.214,P<0.05）、家族史（b=2.927,P<0.05）及病情程度（b=3.210,P<0.05）是影响血清 BDNF 水平的独立因素。结论　叶酸和 BDNF 与 ASD 关系密切,叶酸检测可作为 ASD 早期诊断和病情程度判断的指标,BDNF 则是 ASD 的保护因素,但其水平受患儿年龄、家族史及病情程度等影响。     

Determinants of health-related quality of life in patients with persistent somatoform pain disorder.

BACKGROUND: Health-related quality of life (HRQOL) has been investigated widely in patients with chronic pain, but no study has focused particularly on the situation of patients with persistent somatoform pain disorder. AIMS: To survey the impairments of patients with somatoform pain disorder (ICD-10: F45.4) and to predict pain-related impairments and HRQOL on the basis of coping styles. METHODS: A consecutively recruited sample of 100 patients (65% female) was examined in a cross-sectional study. Questionnaires were administered to assess pain intensity (visual analogue scale), pain-related disabilities (Pain Disability Index), quality of life (Short-Form Health Survey-36), and ways of coping with pain (Coping Strategies Questionnaire). To predict pain-related impairments and HRQOL, a multiple linear regression analysis was carried out. RESULTS: HRQOL of patients with somatoform pain is strongly and significantly reduced compared with the general population. Among the coping measures, Increasing Pain Behaviors and Catastrophizing have a negative influence on patients' pain-related impairments and the physical components of HRQOL. The mental component of HRQOL was predicted solely by Catastrophizing. No positive effect of active coping styles on health-related outcome variables could be observed. CONCLUSION: Patients with persistent somatoform pain disorder feel severely impaired. A clear pattern emerges for negative effects of the coping styles Increasing Pain Behaviors and Catastrophizing, while the identification of beneficial coping failed.     

基于大脑半球功能非对称理论对舍曲林联合重复经颅磁刺激治疗持续性躯体形式疼痛障碍的机制研究

目的:探讨大脑半球功能偏侧化与持续性躯体形式疼痛障碍的关系。方法:将37例持续性躯体形式疼痛障碍(PSPD)患者随机分为A、B两组,20例健康受试者设为C组。B组单纯给予舍曲林治疗,每次75mg,每晚1次,疗程6周。A组从开始观察第1天起,药物治疗同B组,并在服用药物的基础上联合重复经颅磁刺激(rTMS)治疗,每日治疗1次,连续治疗5次后,间隔2日,总共治疗15次。分析各组汉密尔顿抑郁量表(HAMD)、数字疼痛评分量表(NRS)及运动阈值(MT)变化,并进行分析比较。结果:PSPD患者双侧大脑半球MT值间比较无显著性差异(P0.05),正常受试者右侧大脑半球MT值高于左侧大脑半球MT值(P0.05);且PSPD患者左侧大脑半球MT值低于正常受试者左侧大脑半球MT值(P0.05),PSPD患者右侧大脑半球MT值与正常受试比较无显著性差异(P0.05);经过3周、6周治疗后A组左侧大脑半球MT值降低(P0.05),右侧大脑半球MT值升高(P0.05);B组仅在治疗后6周右半球MT值降低。经过3周、6周治疗后,A、B两组HAMD、NRS评分均显著低于治疗前(P0.001),且A组HAMD评分低于B组评分(P0.05);治疗后3周A组NRS评分低于B组(P0.05),治疗后6周A、B两组NRS评分无显著性差异。结论:大脑半球功能异常偏侧化可能对PSPD的发病产生重要影响;舍曲林及舍曲林联合rTMS均能缓解PSPD患者疼痛症状、改善PSPD患者的不良情绪,且后者优于前者。     

Childhood adversities in patients with fibromyalgia and somatoform pain disorder.

Primary fibromyalgia is regarded as disorder with a complex symptomatology, and no morphological alterations. Findings increasingly point to a dysfunction of the central nervous pain processing. The study aims to discuss vulnerability for fibromyalgia from a developmental psychopathological perspective. We investigated the presence of psychosocial adversities affecting the childhood of adult fibromyalgia patients (FM) and compared them to those of patients with somatoform pain disorders (SOM) and a control group (CG) with medically explained chronic pain. Using the structured biographical interview for pain patients (SBI-P), 38 FM patients, 71 SOM patients, and 44 CG patients were compared on the basis of 14 childhood adversities verified as relevant regarding longterm effects for adult health by prospective studies. The FM patients show the highest score of childhood adversities. In addition to sexual and physical maltreatment, the FM patients more frequently reported a poor emotional relationship with both parents, a lack of physical affection, experiences of the parents' physical quarrels, as well as alcohol or other problems of addiction in the mother, separation, and a poor financial situation before the age of 7. These experiences were found to a similar extent in the SOM patients, but distinctly less frequently in the CG. The results point to early psychosocial adversities as holding a similar etiological meaning in fibromyalgia as well as in somatoform pain disorders. The potential role of these factors as increasing the vulnerability for fibromyalgia is discussed.     

肠易激综合征患者血清中过氧化还原酶1和脑源性神经营养因子与抑郁和焦虑症状的相关性研究

目的 探讨肠易激综合征(IBS)患者血清中过氧化还原酶1和脑源性神经营养因子与抑郁和焦虑症状的相关性研究.方法 回顾性选择2020年2月至2021年3月上海中医药大学附属曙光医院消化科门诊收治的150例慢性腹泻患者.参考罗马Ⅳ标准将患者分为IBS 80例(IBS组),非IBS 70例(非IBS组);检测并比较两组患者的...     

Somatic symptoms in patients with chronic non-cancer-related and cancer-related pain

This study describes and compares patients' reports of somatic symptoms and physicians' ratings of the same symptoms in patients with chronic non-cancer-related and cancer-related pain. Ninety-seven patients with chronic non-cancer-related pain and 100 patients with chronic cancer-related pain reported somatic symptoms using a newly developed checklist of somatic symptoms. Patients also completed the Brief Symptom Inventory-18, Courtland Emotional Control Inventory, Catastrophizing scale, two items from the Coping Strategies Questionnaire (one about efficacy to control and another about ability to decrease pain), and a numeric rating of average pain. After they completed medical histories and physical examinations on patients, physicians rated the degree to which the patients' reported somatic symptoms on the checklist were medically unexplainable. Over 80% of patients in both groups reported somatic symptoms that their physicians rated as not fully explainable. Strong associations existed between patient-reported somatic symptoms and negative mood states. For the majority of patients, results supported a concept of combined illness- and affect-related pathology rather than one of pure somatoform disorder. Assessing patients' reports of somatic symptoms and negative mood states and incorporating physicians' ratings of level of medically unexplainable somatic symptoms were useful for distinguishing these diagnoses.     

脑源性神经营养因子G196A基因多态性与抑郁症及认知功能的关系

目的:探索脑源性神经营养因子(BDNF)G196A基因多态性与中国汉族人群抑郁症及其认知功能的关系。方法:采用病例对照研究方法,以153例抑郁症患者及180名正常对照人群为研究对象,采用PCR-RFLP技术检测BDNF G196A基因多态性,采用连线测验A和B、言语流畅性测验、威斯康辛卡片分类测验-改良版(M-WCST)、汉诺塔测验评定患者的认知功能。比较抑郁症患者与正常对照组BDNF基因型及等位基因频率的差异;比较携带不同等位基因或基因型的抑郁症患者认知功能的差异。结果:抑郁症患者BDNF基因A等位基因的频率(60.1%)高于对照组(52.2%),比较差异有统计学意义(P<0.05)。携带BDNF 196A等位基因的抑郁症患者的各项认知功能测验的成绩与没有携带A等位基因者比较差异无统计学意义(P>0.05)。按基因型分类比较抑郁症患者的认知功能,携带A/A型患者的WSCT分类数低于其它两种基因型携带者、WSCT持续错误数高于其他两种基因型携带者(P<0.05)。结论:BDNF 196A等位基因是抑郁症发病的危险因素,携带A/A基因型的抑郁症患者执行功能损害更严重。     

Affective pain modulation in fibromyalgia,somatoform pain disorder,back pain,and healthy controls

Previous research suggested that patients with fibromyalgia (FM) experience a higher pain intensity (clinical pain) than do patients with musculoskeletal pain after negative emotional priming compared to positive priming. To further examine affective pain modulation in FM, we applied an experimental pain induction to compare 30 patients with FM with 30 healthy (pain‐free) participants (HC), and 30 patients with back pain (BP). For another group of 30 patients with somatoform pain disorder (SF), we predicted the same pain modulation as for FM. As primes we presented positive, neutral, negative, and pain‐related pictures and assessed pain intensity in response to a fixed pressure weight. Overall, picture valence modulated pain intensities (in the order of pain‐related>negative pictures>neutral), but the pain intensities between neutral and positive pictures did not differ significantly. SF reported significantly higher pain intensities than did BP and HC; FM were in between, but did not differ significantly from the three other groups. There was no interaction of priming and group. Affective modulation of pain was not specifically altered in FM and SF, but SF were more sensitive to pressure pain than BP and HC.     

The relationship between pain and depressive symptoms after lumbar spine surgery

Although depressive symptoms are common among those living with back pain, there is limited information on the relationship between postsurgical pain reduction and changes in depressive symptoms. The objective of this prospective cohort study was to examine the change in pain and depressive symptoms and to characterize the relationship between pain and depressive symptoms after lumbar spine surgery. We assessed 260 individuals undergoing lumbar spine surgery preoperatively and postoperatively (3 and 6months) using a pain intensity numeric rating scale and the Patient Health Questionnaire depression scale. The relationship between change in pain (a 2-point decrease or 30% reduction from the preoperative level) and depressive symptoms was examined using standard regression methods. Preoperatively, the mean pain intensity was 5.2 (SD 2.4) points, and the mean depressive symptom score was 5.03 (SD 2.44) points. At 3months, individuals who experienced a reduction in pain (63%) were no more likely to experience a reduction in depressive symptoms (odds ratio 1.07, 95% confidence interval [CI] .58 to 1.98) than individuals who experienced no change from preoperative pain (34%). However, at 6months, individuals who experienced a reduction in pain (63%) were nearly twice as likely to experience a reduction in depressive symptoms (odds ratio 1.93, 95% CI 1.15 to 3.25) as those who experienced no change or an increase in pain (31%). We found that most individuals experienced clinically important reductions in pain after surgery. We concluded that those whose pain level was reduced at 6months were more likely to experience a reduction in depressive symptoms.     

Randomized double-blind comparison of serotonergic (Citalopram) versus noradrenergic (Reboxetine) reuptake inhibitors in outpatients with somatoform, DSM-IV-TR pain disorder.

OBJECTIVES: Whether the effect of tricyclic antidepressants on Pain Disorder arises from their noradrenergic or serotonergic actions or both remains unclear. We compared the selective serotonin reuptake inhibitor (SSRI) citalopram and the noradrenergic reuptake inhibitor (NARI) reboxetine in outpatients with Pain Disorder. We also distinguished the drugs' analgesic and antidepressant effects. METHODS: In this 8-week, randomized double-blind study, 35 patients with a DSM-IV-TR diagnosis of Pain Disorder were randomly assigned to receive either citalopram 40 mg/day (N=17 patients) or reboxetine 8 mg/day (N=18). The Present Pain Intensity (PPI) scale and the Total Pain Rating Index (tPRI) of the McGill Pain Questionnaire were used to measure the effect on pain symptoms. Changes in the Zung Self-Rating Depression Scale (Zung-D) scores were evaluated to monitor a possible antidepressant effect. For all patients who had at least one assessment, an intent-to-treat analysis was performed. RESULTS: No significant differences were found in the demographic variables or clinical characteristics of the two treatment groups. In the citalopram group, PPI and tPRI scores measured at baseline decreased after treatment (tPRI: 41.9 vs. 30.0, p=.004; PPI: 3.5 vs. 2.8, p=.045) whereas in the reboxetine group differences were not statistically significant (tPRI: 35.2 vs. 31.5; PPI: 3.7 vs. 3.1). The Zung-D showed no significant changes between baseline and endpoint assessment in either group. CONCLUSIONS: Our study suggests that the SSRI citalopram may have a moderate analgesic effect in patients with Pain Disorder, and that this analgesic activity appears to be not correlated to changes in depressive scores. If confirmed in a larger sample, this evidence suggests that patients who are intolerant or resistant to tricyclic antidepressants, may be treated with SSRIs.     

Pain symptomatology and pain medication use in civilian PTSD

The comorbidity of pain syndromes and trauma-related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma-related disorders such as posttraumatic stress disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD-related stress disorders. PTSD symptoms were found to be significantly positively correlated with pain ratings (r = .282, P < 0.001) and pain-related functional impairment (r = 0.303, P < 0.001). Those with a current PTSD diagnosis had significantly higher subjective pain and pain-related impairment ratings than those with no PTSD. Furthermore, those with a current diagnosis of PTSD were significantly more likely to have used opioid analgesics for pain control compared to those without a diagnosis of PTSD (χ² = 8.98, P = 0.011). When analyzing the separate PTSD symptom subclusters (re-experiencing, avoidance, and hyperarousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway, including the endogenous opioid neurotransmission systems.