难治性抑郁症患者认知功能与神经内分泌激素相关性研究

目的 探讨难治性抑郁症患者认知功能与神经内分泌激素的相关性.方法 将60例难治性抑郁症患者设为研究组,抽取同期住院的60例非难治性抑郁症患者设为对照组.检测两组血清胰岛素、皮质醇、促肾上腺皮质激素、三碘甲状腺原氨酸、游离三碘甲状腺原氨酸、甲状腺素、游离甲状腺素、促甲状腺激素等神经内分泌激素;采用威斯康星卡片分类测试、韦氏记忆量表、字色干扰实验、连线实验、语言流畅性测试、画钟实验评定两组患者的认知功能,对评定结果进行相关分析.结果 研究组血清胰岛素水平显著低于对照组,促肾上腺皮质激素水平显著高于对照组(P＜0.05或0.01);威斯康星卡片分类测试总应答数、持续错误数、随机错误数显著高于对照组(P＜0.01),正确应答数及韦氏记忆量表图片回忆、视觉再认、视觉再生、触觉因子分,词汇流畅性检测、画钟实验评分均显著低于对照组(P＜0.05或0.01).研究组血清胰岛素水平与威斯康星卡片分类测试正确应答数,韦氏记忆量表记忆商数、图片回忆、视觉再认、视觉再生因子,连线实验A,语言流畅性测试均呈显著正相关(P＜0.05或0.01);与威斯康星卡片分类测试持续错误数、随机错误数呈显著负相关(P＜0.01).皮质醇与威斯康星卡片分类测试持续错误数呈显著正相关(P＜0.05);与总应答数、正确应答数及韦氏记忆量表数字倒数,连线实验,画钟实验呈显著负相关(P＜0.05或0.01).甲状腺素与画钟实验呈显著负相关(P＜0.05).游离甲状腺素与韦氏记忆量表时空定向呈显著正相关(P＜0.05).促甲状腺激素与威斯康星卡片分类测试总应答数、韦氏记忆量表数字倒数语言流畅性测试等呈显著正相关(P＜0.05),与威斯康星卡片分类测试持续错误数、随机错误数呈显著负相关(P＜0.05).结论 难治性抑郁症患者在注意、短时记忆、执行能力等方面的认知功能缺陷更为严重,且与胰岛素等神经内分泌激素水平密切相关.

Correlation study of cognitive function and neuroendocrine hormone in patients with treatment-resistant depression

Objective To investigate the correlation of cognitive function and neuroendocrine hormone in patients with treatment-resistant depression （TRD）. Methods Sixty TRD patients were assigned to research group and 60 hospitalized non-TRD ones in the corresponding period to control group. Such neuro- endocrine hormones of both groups were detected as serum insulin, cortisol, adrenocorticotropic hormone （ACTH）, triiodothyronine, free triiodothyronine, thyroxine, free thyroxine, thyroid-stimulating hormone （TSH）; cognitive functions of both groups were evaluated with the Wisconsin Card Sorting Test （WCST）, Wechsler Memory Scale （WMS）, Stroop Test （ST）, Trails, Verbal Fluency Test （VFT） and Clock Drawing Task （CDT） and evaluation results correlatively analyzed. Results Serum insulin levels were significantly lower and ACTH higher in the research than in the econtrol group （P〈0.05 or 0.01） ; response administered（Ra）, perseverative and random errors were significantly higher （P〈 0.01）, and Rc, WMS＇s picture remembrance, visual recognition, visual reproduction and thigmesthesia score, VFT and CDT score all lower （P〈0.05 or 0.01） in the research than in the control group. In the research group, serum insulin levels were significantly positively related to Rc, memory quotient, picture recall, visual recognition, visual reproduction, Trails A and VFT（P〈0.05 or 0.01） and negatively to persevera- tive and random errors（P〈0.01）. Cortisol levels were significantly positively related to perseverative errors（P〈0.05） and negatively to Ra, Rc, WMSs digital reciprocal, Trails and CDT （P〈0.05 or 0.01）. Thyroxine levels were significantly negatively related to CDT （P〈0.05）. Free thyroxine levels were significantly positively related to WMS＇s space-time orientation （P〈0.05）. TSH levels were significantly positively related to Ra, digital reciprocal and VFT （P〈0.05） and negatively to perseverative and random errors （P〈0.05）. Conclusion TRD patients have severe cognitive function defects including attention, short-term memory and executive ability, and cognitive function defects are closely related to neuroendo- crine hormones such as insulin and so on.