甲状腺激素及脑源性神经营养因子前体水平与抑郁症的关系研究

背景　随着对抑郁症了解的深入，人们发现其不仅是一种神经退行性疾病，同时还与下丘脑-垂体-甲状腺轴（HPT轴）密切相关，而抑郁症的神经营养因子假说则认为脑源性神经营养因子前体（proBDNF）在抑郁症的发病过程中发挥着一定作用，但抑郁症、HPT轴和proBDNF三者间的关系却鲜有研究。目的　探索甲状腺激素、proBDNF水平与抑郁症之间的关系。方法　选取2017年10月-2018年6月在云南省精神病医院住院及门诊治疗的抑郁症患者43例为病例组。同期选取本院健康体检者31例为对照组。测定并比较两组一般资料及甲状腺激素〔三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）〕、proBDNF水平；分析病例组甲状腺激素、proBDNF水平与汉密尔顿抑郁量表24项（HAMD-24）总分及其各因子评分之间的相关性，甲状腺激素与proBDNF水平的相关性。结果　两组T3、FT4水平比较，差异无统计学意义（P>0.05）；病例组T4、FT3、TSH水平低于对照组（P<0.05）。病例组FT3水平与HAMD-24总分及认知障碍评分呈正相关（P<0.05）。两组proBDNF水平比较，差异无统计学意义（P>0.05）。病例组proBDNF水平与HAMD-24总分及其各因子评分均无相关性（P>0.05）。病例组甲状腺激素水平与proBDNF水平无相关性（P>0.05）。结论　抑郁症患者更容易出现焦虑、自杀、偏执、强迫、绝望感及睡眠障碍等问题，且有并发甲状腺功能减退的可能。

Relationships of Thyroid Hormone and proBDNF with Depression

Background　With the deepening understanding of depression，it has been found that depression is not only a neurodegenerative disease，but also closely related to the hypothalamus pituitary thyroid axis（HPT axis）.The neurotrophic hypothesis of depression suggests that the precursor of brain-derived neurotrophic factor（proBDNF）plays a role in the pathogenesis of depression，but the relationships of depression with thyroid hormone and proBDNF are rarely studied.Objective　To investigate the relationships of proBDNF and thyroid hormone level with depression.Methods　Forty-three inpatients and outpatients with depression（case group）and 31 healthy examinees（control group）from the Mental Hospital of Yunnan Province were enrolled during October 2017 to June 2018.General information and levels of thyroid hormone〔triiodothyronine（T3），thyroxine（T4），free triiodothyronine（FT3），free thyroxine（FT4），thyrotropin（TSH）and proBDNF〕were collected and compared between the two groups.The relationships of levels of thyroid hormone and proBDNF with the total and subscale scores of HAMD-24 were analyzed.The correlation between thyroid hormone and proBDNF level was assayed.Results　There were no significant differences in mean T3 and FT4 levels between the two groups（P>0.05）.Mean T4，FT3 and TSH levels in the case group were lower than those in the control group（P<0.05）.The level of FT3 was positively correlated with the total score of HAMD-24 and the score of cognitive impairment subscale in the case group（P<0.05）.There was no significant difference of proBDNF level between the two groups（P>0.05）.In the case group，the proBDNF level was not correlated with the total score and subscale scores of HAMD-24（P>0.05）.And there was no correlation between thyroid hormone level and proBDNF level（P>0.05）.Conclusion　Depression patients are more prone to anxiety，suicide，paranoia，obsession，despair and sleeping problems，and may have hypothyroidism.