围绝经期抑郁症的临床特征及其与血浆雌激素的关系

目的研究围绝经期首发抑郁症的临床特征及其与血浆雌激素的关系。方法对86例绝经前期抑郁症（PRD）患者和42例围绝经期抑郁症（PMD）患者进行HAMD、HAMA评估及血浆雌二醇（E2）检测,通过分组对照比较其临床表现差异,应用回归模型分析其临床特征和雌激素的相关性。结果 PMD组HAMD体重因子分高于PRD组（P=0.004）,HAMD总分及其他因子分组间差异无统计学意义;PMD组HAMA总分（23.50±8.75,18.49±9.82;P=0.006）及躯体性焦虑（7.56±4.32,5.66±5.01;P=0.037）、精神性焦虑因子分（15.94±5.34,12.83±6.34;P=0.007）均高于PRD组;PMD组重度抑郁（47.10%,25.7%;P=0.041）、中重度焦虑（42.8%,28.0%;P=0.045）比例高于PRD组;一元线性回归分析发现E2进入HAMA总分及两因子分的回归方程,而和HAMD总分及各因子的相关性无统计学意义;Logistic回归分析发现是否处于围绝经期是重度抑郁的危险因素（OR=2.57,95%CI=1.09～6.07,B=0.943,P=0.032）。结论伴发焦虑障碍更多、抑郁程度更重是PMD区别于PRD的重要特征,其抑郁症状和血浆雌激素水平无直接相关性。

Clinical characteristics of perimenopausal depression and the association between it and plasma estrogen level

Objective This study was aimed to investigate the features of perimenopausal depression （PMD） and the association between it and plasma estrogen level.Methods Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used to assess clinical characteristics of 42 patients with PMD and 86 patients with depression first-onset during premenopause （premenopausal depression,PRD）.The chemiluminescence assay was used for detections of plasma estradiol （E2） of all patients.Differences between PMD and PRD were analyzed by group comparison and associations between clinical characteristics and E2 were analyzed by linear or Logistic regression model.Results PMD had higher mean score of HAMD weight factor than PRD （P=0.004）,and there were no statistics significance of total score and scores of other factors between two groups.PMD had higher HAMA total score （23.50 ± 8.75,18.49 ± 9.82;P=0.006） and factor scores of somatic anxiety （7.56 ± 4.32,5.66 ± 5.01;P=0.037） and psychic anxiety （15.94 ± 5.34,12.83 ± 6.34;P=0.007） than PRD.Portions of both severe depression （47.10% vs.25.7% ;P=0.041） and mild to severe anxiety （42.8% vs.28.0% ;P=0.045） of PMD were higher than PRD.Simple linear regression analysis showed total score and both two factor scores of HAMA positively related to E2.Logistic regression analysis showed menopause status （perimenopause or premenopause） was the only risk factor to severe depression （OR=2.57,95% CI=1.09 ～ 6.07,B=0.943,P=0.032）.Conclusions Comparing to premenopausal depression,perimenopausal depression is more likely to have comorbid anxiety symptoms and to develop to severe depression.Depressive symptoms of PMD are not directly associated with plasma estrogen.