抑郁症患者甲状腺激素水平的特征、治疗前后的变化及疗效性分析

目的:探讨抑郁症患者血清甲状腺激素水平的特征、治疗前后的变化及疗效性分析。方法:于2013年5月至2015年12月入组抑郁症患者40例、健康对照者47名。抑郁组予选择性5-羟色胺再摄取抑制剂治疗4周,分别于治疗前后检测血清甲状腺激素水平,评估抑郁、焦虑症状严重程度。结果:抑郁组治疗前血清甲状腺素(T4)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平明显低于对照组;治疗后HAMD-17总分、HAMA总分、T4、FT4水平显著下降(P<0.05或P<0.01)。临床痊愈组治疗前后血清三碘甲状腺原氨酸(T3)、治疗后游离三碘甲状腺原氨酸(FT3)水平低于非临床痊愈组(P<0.05或P<0.01)。抑郁组治疗前,T4与HAMD-17有罪感因子分、工作和兴趣因子分、总分呈负相关;FT4与躯体性焦虑因子分呈正相关,与总分呈负相关;TSH与体质量减轻因子分呈负相关(P<0.05或P<0.01)。结论:抑郁症患者血清T4、FT4、TSH水平均低于健康正常人,与抑郁症状及严重程度具有相关性。治疗前T3水平低的患者可能对抗抑郁药更敏感,疗效更好。

Analysis on characteristics of serum thyroid hormone levels,the change before and after treatment and efficacy in patients with depression

Objective:To explore the characteristics and changes of serum thyroid hormone levels before and after treatment and its efficacy in patients with depression.Method:40 patients with depression(depression group)and 47 normal controls(control group)were included from May 2013 to December 2015.The depression group was treated with Selective Serotonin Reuptake Inhibitors(SSRIs)for 4 weeks.The serum thyroid hormone levels were detected and the severity of depressive and anxiety symptoms were assessed at baseline and after treatment.Results:At baseline,the serum thyroxine(T4),the free thyroxine(FT4)and the thyrotropin(TSH)level in the depression group were lower than those in the control group(P<0.05).After treatment,Hamilton Depression Scale(HAMD-17)score,Hamilton Anxiety Scale(HAMA)score,T4 level and FT4 level were significantly lower than those before treatment(P<0.05 or P<0.01).The triiodothyronine(T3)level at baseline and after treatment and free triiodothyronine(FT3)level after treatment in the clinical cure group was lower than those in nonclinical cure group(P<0.05 or P<0.01).The T4 level in the depression group at baseline was negatively associated with the guilt factor score,work and interest factor score and the total score of HAMD-17.The FT4 level was positively associated with the somatic anxiety factors score,and negatively associated with the total score of HAMD-17.The TSH level was negatively associated with weight loss factor score(P<0.05 or P<0.01).Conclusion:The patients with depression have less serum T4,FT4 and TSH levels than healthy normal people,which are correlated with depressive symptoms and severity of symptoms.Patients with low T3 level are more sensitive to antidepressant drugs,with better clinical efficacy.