抑郁症患者血清脱氢表雄酮变化

目的检测抑郁症患者血清脑神经甾体脱氢表雄酮(dehydroepiandrosterone,DHEA)水平及其治疗后的变化。方法选取抑郁症患者及健康对照各40名,患者予氟西汀、米氮平或文拉法辛治疗4周。测定对照组和患者组治疗前后DHEA浓度。采用汉密尔顿抑郁量表(HAMD)评定患者症状好转程度。结果患者组治疗前血清DHEA水平明显低于对照组(t=3.61,P=0.001),治疗后较疗前明显升高(t=6.76,P<0.001),且高于对照组(t=3.71,P=0.001);患者组治疗前后DHEA变化与HAMD减分率显著正相关(r=0.541,P<0.001)。不同性别组间和不同的药物组间治疗前后DHEA变化的差异没有统计学意义。结论血清DHEA水平低下可能与抑郁症有关,抗抑郁药物治疗后DHEA升高,且其变化与抑郁症状改善相关。     

脱氢表雄酮与抑郁症及其认知功能损害

本文从脑结构,脑生化,神经内分泌等各个方面综述了脱氢表雄酮与抑郁症及其认知损害的关系的最新研究进展.     

抑郁症患者治疗前后血浆皮质醇水平的变化

目的:探讨抑郁症患者治疗前后血浆皮质醇水平的变化。方法:对160例抑郁症患者给予抗抑郁药治疗6周,分别于治疗前及治疗后进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估及血浆皮质醇水平检测。结果:本组治疗前后HAMD总分分别为(24.98±5.10)和(7.57±5.61);HAMA总分分别为(20.62±6.90)和(6.21±5.17);血浆皮质醇水平分别为(407.34±144.29)nmol/L和(354.64±137.13)nmol/L。治疗后HAMD总分、HAMA总分及血浆皮质醇水平较治疗前明显下降(P均<0.001);不同性别间血浆皮质醇水平差异无统计学意义(P>0.05);血浆皮质醇变化值与HAMD、HAMA减分率不相关(r=0.084,r=0.049;P均>0.05)。结论:抗抑郁药物治疗可显著降低抑郁症患者血浆皮质醇水平。     

老年期抑郁症抗抑郁药物治疗前后感觉门控P50改变

目的 探讨老年期抑郁症的感觉门控(Sensory Gating,SG)P50特征及其在抗抑郁治疗后的变化.方法 采用条件刺激(S1)-测试刺激(S2)模式对38例老年期(发病年龄＞60岁)抑郁症患者和正常对照组的42名健康老人进行P50检测,前者在给予帕罗西汀20mg/d治疗16个月末再次检测.使用17项汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD17)评估患者治疗前后的抑郁症状.结果 与正常对照组比较,患者组S2-P50波幅增高[(2.89±1.02)μV vs (1.30±1.07) μV,P<0.01)],潜伏期延迟[ (64.14±14.69) ms vs (55.92±17.73) ms,P<0.05) ],提示P50抑制明显减弱;与治疗前相比,患者组在治疗16个月末的所有P50指标均无明显改变(P>0.05).治疗前后感觉门控P50指标S2/S1、S1-S2和100(1-S2/S1)与HAMD17分值无相关(P>0.05).结论 老年期抑郁症患者感觉门控抑制存在明显缺损,具有跨状态稳定性,可能为素质性.     

瑞美隆与文拉法辛治疗老年期抑郁症对照研究

目的　比较瑞美隆与文拉法辛治疗老年期抑郁症的临床疗效及安全性。方法　将 4 5例老年期抑郁症患者随机分为两组 ,其中瑞美隆组 2 3例 ,文拉法辛组 2 2例 ,总疗程 6周 ,并使用HAMD和TESS量表评估两组疗效和安全性。结果　经过 6周治疗后 ,瑞美隆组有效率和显效率分别为91.3%和 73.9% ,而文拉法辛组为 86 .4 %和 72 .7% ,两组比较无显著性差异 (P >0 .0 5 % ) ,而两组TESS评分比较无差异 (P >0 .0 5 )。瑞美隆常见不良反应为 :嗜睡、头昏 ,食欲增强 ,体重增加 ,而文拉法辛为恶心、呕吐、头昏、便秘、排尿困难。结论　两者均为治疗老年抑郁症有效而安全的抗抑郁药物     

脱氢表雄酮硫酸酯治疗老年男性骨质疏松症120例*★

目的：虽然已经有较多的证据提示脱氢表雄酮在骨质代谢中具有良性作用，但还需要更加合理和深入的实验来剔除其衍生激素的生物学效应，以更好地明确脱氢表雄酮对骨质代谢的作用。实验拟进一步验证脱氢表雄酮硫酸酯治疗老年男性骨质疏松症的疗效及安全性。 方法：①试验对象：选择2005-10/2006-10本院老年男性门诊及住院原发性骨质疏松症患者120例。诊断标准参照WHO新标准：所测骨密度值低于同性别骨峰值2.5个标准差以上诊断为骨质疏松，从未用过性激素。所有患者随机分为治疗组和对照组，每组60名。②试验方法：治疗组口服脱氢表雄酮硫酸酯100 mg、钙尔奇D 600 mg；对照组口服钙尔奇D 600 mg。③试验评估：6个月后测定骨密度、血生化指标、骨吸收指标和骨形成指标以及副作用等方面的变化。 结果：纳入骨质疏松患者120例，均进入结果分析。①腰椎1、腰椎2~4、股骨颈、股骨上端部位骨密度与治疗前及对照组比较，差异显著(P < 0.01)。②治疗后治疗组脱氢表雄酮硫酸酯、胰岛素样生长因子Ⅰ、血清钙、碱性磷酸酶、尿吡啶啉、骨钙素较治疗前及对照组明显提高（P < 0.01，P < 0.05）。对游离睾丸酮、雌二醇、前列腺特异抗原、谷丙转氨酶、尿素氮、肌酐则无明显影响（P > 0.05）。 结论：脱氢表雄酮硫酸酯治疗老年男性骨质疏松症有较好疗效且安全可靠，无明显不良反应。     

血浆中脱氢表雄酮硫酸酯检测对阿尔茨海默病的临床意义

目的研究阿尔茨海默病(AD)患者血浆脱氢表雄酮硫酸酯(DHEAS)含量及临床意义。方法采用高效液相色谱-质谱法(HPLC-MS)检测20例AD患者和29例正常对照老年人血浆DHEAS含量。结果 AD患者血浆中血浆DHEAS含量显著低于对照组(P<0.05);以458.2ng/ml作为正常人群血浆DHE-AS含量的下限,诊断老年性痴呆的敏感性为65.0%,特异性为83.7%;经相关分析,血浆DHEAS含量与MMSE评分之间未发现显著相关关系(P>0.05)。结论 AD患者血浆中DHEAS含量降低对诊断老年性痴呆有较高的敏感性和特异性,有一定的临床应用价值,DHEAS可作为阿尔茨海默病的一项早期诊断指标。     

无抽搐电休克治疗老年期抑郁症44例观察

目的探讨无抽搐电休克治疗老年期抑郁症的临床疗效。方法对44例老年期抑郁症患者进行无抽搐电休克治疗,分别于治疗前及治疗第1周、2周、4周、6周末采用汉密顿抑郁量表进行疗效评定;治疗结束后第1d、第1周及2周末采用韦氏记忆量表（WMS）评定不良反应。结果治疗第1周末,汉密顿抑郁量表（HAMD）评分较治疗前减少,差异有显著性;治疗第6周末有效率93．2％,不良反应少。结论无抽搐电休克对老年期抑郁症安全有效,不良反应少。     

认知行为治疗对老年期抑郁症的辅助治疗

目的：探讨认知行为疗法在老年期抑郁症治疗中的辅助治疗作用。方法：79例老年期抑郁症患者随机分为两组。合用组采用帕罗西汀联合认知行为治疗,对照组单纯给予帕罗西汀治疗,治疗前和治疗2,8周及1年用汉密尔顿抑郁量表（HAMD）评定疗效。结果：治疗8周合用组疗效显著好于对照组,合用组各期HAMD评分下降比对照组更为显著。结论：认知行为疗法联合帕罗西汀治疗老年期抑郁症可提高疗效,且复发率低,远期疗效好。     

老年期抑郁症患者瞬目反射的研究

目的：探讨老年期抑郁症与瞬目反射（BR）的关系。方法：对34例老年期抑郁症患者及30名正常老年人进行BR检测,并对其中19例患者于治疗后进行复测。结果：患者组在左侧R2、R2′潜伏期以及右侧R2潜伏期指标显著高于对照组（P〈0．01）;患者组R1与R2、R1与R2′波潜伏期差值明显大于对照组。左侧R1与R2、R1与R2′,右侧R1与R2波潜伏期差值与对照组比较差异显著。19例患者治疗前后各项BR指标差异均无显著性。治疗前后HAMD变化与BR各项指标变化无显著相关。结论：老年期抑郁症患者存在BR异常,提示老年期抑郁症患者可能存在脑干功能障碍。     

Seizure frequency and cortisol and dehydroepiandrosterone sulfate (DHEAS) levels in women with epilepsy receiving antiepileptic drug treatment

PURPOSE: Hormonal changes occur in epilepsy because of seizures themselves and of antiepileptic drug (AED) effects on steroid production, binding, and metabolism. Conversely, steroids may influence neuron activity and excitability by acting as neuroactive steroids. This cross-sectional observational study aimed to evaluating cortisol and dehydroepiandrosterone sulfate (DHEAS) levels in female epilepsy patients with different disease severity, as assessed by a seizure frequency score (SFS). METHODS: Morning serum levels of cortisol and DHEAS were assayed in 113 consecutive women, aged 16 to 47 years, with varied epilepsy syndromes, receiving mono- or polytherapy with enzyme-inducing and/or noninducing antiepileptic drugs (AEDs). Hormonal data were correlated with clinical parameters (age, body mass index, epilepsy syndrome, disease onset and duration, SFS, AED therapy, and AED serum levels) and compared with those of 30 age-matched healthy women. RESULTS: In epilepsy patients, cortisol levels and cortisol-to-DHEAS ratios (C/Dr) were significantly higher, whereas DHEAS levels were significantly lower than those in controls. Patients with more frequent seizures showed higher cortisol and C/Dr values and lower DHEAS levels than did those with rarer or absent seizures during the previous 6 months. SFS mainly explained the increase of cortisol levels and C/Dr in patients with more active disease. Changes in DHEAS levels correlated with SFS and epilepsy syndrome, as well as with AED treatments and ages. CONCLUSIONS: Women with more frequent seizures had alterations of their adrenal steroids characterized by an increase of cortisol and a decrease of DHEAS levels. Such hormonal changes might be relevant in seizure control and in patient health.     

抑郁症患者治疗前后血浆孤啡肽的研究

Objective To explore the changes of plasma orphanin FQ (OFQ) level in depressive patients before and after treatment. Methods The plasma OFQ levels of 38 depressive patients were determined with radioimmunoassay at baseline and after 8 week antidepressant treatment, and 32 healthy persons were examined once as controls. Results The concentrations of OFQ in patients were significantly higher at baseline than after treatent and in controls [(21.9 ± 2. 3 ) ng/L vs. ( 10. 9 ± 2. 1 ) ng/L; (21.9±2. 3) ng/L vs. (10. 2 ± 1.8 )ng/L; all P < 0. 01]. There were no significant differences in OFQ between patients after treatment and in controls. The OFQ concentration in patients at baseline was positively correlated to the scores of 24-items Hamilton Depression Scale (HAMD) (r =0. 857,P <0. 01 ), the change of OFQ concentration between baseline and after treatment was also positively correlated to the alteration of HAMD scores (r = 0. 342, P < 0. 05 ). Conclusions The results suggest that the alteration of OFQ may be involved in depression.     

氢溴酸西酞普兰对缺血性脑卒中后抑郁患者的情绪、认知功能和神经功能的影响

目的 探讨氢溴酸西酞普兰联合奥扎格雷钠对缺血性脑卒中后抑郁患者的情绪、认知功能和神经功能的影响.方法 选取我科2017年7月～2019年7月期间收治的119例缺血性脑卒中后抑郁患者作为研究对象,采用随机数字表法分为2组,均给予奥扎格雷钠作为基础治疗,对照组59例增加氟西汀治疗,观察组60例增加氢溴酸西酞普兰治疗,16周...     

The ratio of cortisol/DHEA in treatment resistant depression

OBJECTIVE: Hypercortisolaemia has been well described in depression and may be a factor associated with treatment resistance. The role of the more abundant adrenal steroid dehydroepiandrosterone (DHEA) has been recently investigated, with some evidence that it may have an antiglucocorticoid effect. This study measured cortisol, DHEA and their ratio in treatment resistant depression (TRD) and healthy controls and also related these measures to treatment outcome. METHOD: Plasma cortisol, DHEA and cortisol/DHEA ratio were determined at 0900h in 28 patients with TRD and 40 healthy controls. The measures were repeated following inpatient treatment in a subgroup of 21 patients and related to the outcome of such treatment. The stability of cortisol/DHEA ratios was assessed with 2 hourly samples from 0900 to 1700h in a subgroup of 15 controls. RESULTS: Basal levels of cortisol and the cortisol/DHEA ratio were higher in patients compared to controls. Whilst cortisol levels were lower after treatment, there was no relationship between cortisol levels and treatment outcome. In contrast, treatment responders had significantly lower DHEA on admission and a higher cortisol/DHEA ratio both on admission and on discharge. Cortisol/DHEA ratios were stable between 9 a.m. and 5 p.m. CONCLUSIONS: In addition to cortisol, the cortisol/DHEA ratio is raised in TRD; thus, there is no evidence that DHEA levels could negate the increased glucocorticoid activity in TRD. Patients with a more abnormal cortisol/DHEA ratio, possibly indicating greater biological dysfunction, responded preferentially to inpatient therapy, though the raised cortisol/DHEA ratio persisted after response. The cortisol/DHEA ratio is stable throughout the day and may be a more practical biological marker of TRD.     

Salivary cortisol levels and their correlation with plasma ACTH levels in depressed patients before and after the DST.

OBJECTIVE: The aim of this work was to study the clinical utility of salivary cortisol concentrations in a group of depressed patients undergoing the dexamethasone suppression test (DST) and the correlation of these concentrations with plasma ACTH levels. METHOD: Twenty outpatients from the psychiatric department of a Barcelona hospital who were diagnosed as having nonendogenous (N = 9) or endogenous (N = 11) depression according to DSM-III criteria and the Newcastle scale participated in the study. The comparison group consisted of 12 healthy volunteers. Blood and saliva samples were taken before and after administration of 1 mg of dexamethasone Salivary cortisol and plasma ACTH concentrations were determined by direct iodine-125 radioimmunoassay with commercial kit reagents. RESULTS: Predexamethasone salivary cortisol concentrations were significantly higher in the group with endogenous depression than in the comparison group. A significant correlation was obtained between plasma ACTH and predexamethasone salivary cortisol levels in the group with nonendogenous depression and in the comparison subjects. CONCLUSIONS: These preliminary findings indicate that salivary cortisol could substitute for plasma cortisol in clinical studies in which the DST and hypercortisolemia are evaluated. The lack of correlation between ACTH and cortisol levels in saliva in the group of endogenously depressed patients could indicate a disturbance in the regulation of cortisol secretion in major depression.     

Circadian analysis of plasma cortisol levels before and after dexamethasone administration in depressed patients

Pituitary-adrenal regulation in healthy subjects and in depressed patients is very dynamic. Interpretation of results of the 1-mg dexamethasone suppression test has usually depended on the result of a single blood cortisol level measurement obtained in the morning or afternoon. We analyzed circulating cortisol concentrations by obtaining blood samples at 20-minute intervals for 24 hours before and after dexamethasone administration in depressed patients. The results illustrate the variability in patterns of escape from the effects of dexamethasone among depressed patients; they also indicate the influence of the sampling time on the test results and thus on the relationship of the test result to various clinical classifications. Finally, these results provide the basis for understanding the consequences of alternative sampling strategies.     

Positive correlation between anxiety severity and plasma levels of dehydroepiandrosterone sulfate in medication-free patients experiencing a major episode of depression

Although numerous studies have identified a correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial. The purpose of the present study was to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication-free patients experiencing a major depressive episode. Twenty-eight medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17 [HAM-D 17] score >or=17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900-1100 h Depression severity was assessed with the HAM-D 17 and the Hospital Anxiety and Depression Scale (HADS) depression subscale. Anxiety was assessed using the HADS anxiety subscale. Serum concentrations of DHEAS were measured immediately following the HAM-D 17 and HADS assessments. A significant, positive correlation was identified between HADS anxiety subscale total score and morning serum DHEAS concentration (P = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations. This preliminary study provides pilot data indicating that morning serum DHEAS concentrations were positively correlated with HADS anxiety subscale score (anxiety severity) after controlling for age, gender and BMI in medication-free outpatients experiencing a major depressive episode. It is not known if morning serum DHEAS levels would show similar or dissimilar changes in non-depressed subjects. The present result needs subsequent replication.     

西酞普兰与文拉法辛治疗老年期抑郁症对照研究

目的：比较西酞普兰与文拉法辛对老年期抑郁症的疗效及不良反应.方法：将58例符合中国精神障碍分类与诊断标准第3版诊断标准的老年期抑郁症患者随机平分为两组,分别给予西酞普兰与文拉法辛治疗6周.采用汉密尔顿抑郁量表（HAMD）、临床疗效总评量表（CGI）及副反应量表（TESS）评定疗效和不良反应.结果：治疗6周后西酞普兰组和文拉法辛组的有效率分别为89.7%和86.2%,两组差异无显著性.起效均较快、不良反应少而轻微.结论：西酞普兰与文拉法辛都是治疗老年期抑郁症较理想药物.     

抑郁症患者血浆P物质含量变化及其相关性研究

目的探讨抑郁症患者血浆P物质水平的变化及其与抑郁症的关系。方法对32例抑郁症患者(抑郁症组)应用帕罗西汀治疗6周,分别于治疗前和治疗后第6周末采用放射免疫法测定患者血浆P物质含量;同时以汉密尔顿抑郁量表(24项,HAMD)、汉密尔顿焦虑量表(18项,HAMA)评定症状严重程度,以HAMD减分率评定疗效。以32名健康志愿者为对照组。结果抑郁症组患者治疗前血浆P物质水平[(51±13)ng/L]明显高于对照组[(43±11)ng/L],差异有统计学意义(P=0.010);治疗后血浆P物质水平[(44±10)ng/L]较治疗前明显下降,差异有统计学意义(P=0.001);治疗前后血浆P物质的变化与HAMD总分值的减分率呈显著正相关(rs=0.826,P=0.000)。结论抑郁症患者的血浆P物质存在异常,动态观察血浆P物质水平变化可能有助于判断疗效。