产科应激事件对产后抑郁症患者神经内分泌功能影响的研究

目的:探讨产科应激事件对产后抑郁症(PPD)患者神经内分泌功能的影响。方法:选取2007年7月～2008年12月足月分娩有完整临床资料发生过产科应激事件的产妇共752例。其中,A组为发生1种产科应激事件者233例;B组为发生2种产科应激事件者180例;C组为发生3种产科应激事件者143例;D组为发生4种产科应激事件者98例;E组为发生5种产科应激事件者61例;F组为发生6种产科应激事件者37例。同时,随机抽取同期分娩未发生产科应激事件的125例产妇作为研究的对照。采用放射免疫法测定各组产妇的血清促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇水平。采用高压液相色谱/电化学法测定血浆中各单胺神经递质水平。结果:研究组中诊断为PPD的产妇98例,发生率13.03%,对照组产妇发生PPD 10例,发生率8.00%,组间差异有极显著统计学意义(P<0.01)。研究组间,产妇发生4种或4种以上产科应激事件时,其EPDS评分和PPD的发生率与发生3种或3种以下的孕产妇组相比,各组间差异有极显著统计学意义(P<0.01)。产妇发生4种或4种以上产科应激事件时,其血清CRH、ACTH、皮质醇水平显著高于发生3种或3种以下的产妇组(P<0.01)。同时,其血浆5-HT、DA、NE水平却明显低于发生3种或3种以下的产妇组(P<0.01)。发生产科应激事件产妇的血浆5-HT、DA、NE各指标间呈正相关,血清CRH、ACTH、皮质醇各指标间也呈正相关。而血浆5-HT、DA、NE与血清CRH、ACTH、皮质醇各指标则呈负相关。结论:产科应激事件,尤其是叠加的应激事件导致产妇下丘脑-垂体-肾上腺轴功能亢进,单胺类神经递质系统功能低下,是产后抑郁症的重要发病因素之一。

Study on effect of obstetric stress events on neuroendocrine function in patients with postpartum depression

Objective:To explore the effect of obstetric stress events on neuroendocrine function in patients with postpartum depression.Methods:Clinical data of 752 cases of full-term birth who delivered from July 2007 to December 2008 and underwent obstetric stress events were collected.Group A: 233 cases had one kind of obstetric stress event.Group B: 180 cases had two kinds of obstetric stress events.Group C: 143 cases had three kinds of obstetric stress events.Group D: 98 cases had four kinds of obstetric stress events.Group E: 61 cases had five kinds of obstetric stress events.Group F: 37 cases had six kinds of obstetric stress events.At the same time,125 postpartum women without obstetric stress were selected randomly as control group.The levels of corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH) and cortisol were measured by radioimmunoassay.The plasma levels of monoamine neurotransmitters were determined by high-performance liquid chromatography(HPLC)/electrochemical method.Results:98 cases(13.03%) in study group and 10 cases(8.00%) in control group were diagnosed as postpartum depression,respectively,there was significant difference(P<0.01).There were significant difference in EPDS score and incidence of postpartum depression between the groups with four or more kinds of stress obstetric events and the other groups with three or less kinds of stress obstetric events(P<0.01).The serum levels of CRH,ACTH and cortisol in the groups with four or more kinds of stress obstetric events were significantly higher than those in the groups with three or less kinds of stress obstetric events(P<0.01).At the same time,the plasma 5-HT,DA,NE levels reversed(P<0.01).There was a positive correlation among plasma 5-HT,DA,NE levels and serum CRH,ACTH,cortisol levels,respectively.However,the plasma 5-HT,DA,NE levels and serum CRH,ACTH,cortisol levels demonstrated a negative correlation.Conclusion:Obstetric stress events,in particular the superimposed stress events,leading to the hypothalamus-pituitary-adrenal axis hyperfunction and monoamine neurotransmitter system dysfunction,are risk factors of postpartum depression.