社会因素和性激素与围绝经期抑郁症的相关研究

目的：探讨社会因素以及性激素水平与围绝经期抑郁症高发的关系。方法采用汉密尔顿抑郁量表（ HAMD-17）及国际疾病分类（ ICD-10）中“抑郁发作”的诊断标准筛查入选研究对象。收集79名围绝经期抑郁症和58名围绝经期非抑郁症研究对象的一般资料和外周血标本。采用电化学发光法检测血清中的雌二醇（ E2）、睾酮（ T）、孕酮（ P）、黄体生成素（ LH）和卵泡刺激素（ FSH）水平。结果围绝经期抑郁症组睡眠障碍和慢性病发生率高于非抑郁症组（χ2＝4．700，P＝0．030；χ2＝4．866，P＝0．027）。围绝经期抑郁症组E2、T、P水平均低于非抑郁症组（ z＝-3．175，P＝0．001；z＝-3．726，P＜0．000；z＝-2．868，P＝0．004）。 HAMD评分与E2、T、P均存在负相关关系（ r＝-0．284，P＝0．001；r＝-0．389，P＝0．000；r＝-0．352，P＝0．000）。Logistic回归分析显示E2、T、P水平高是抑郁症发生的保护因素OR（95％CI）分别为：3．851（1．347～11．785），P＝0．014；4．580（1．298～14．132），P＝0．012；1．864（0．984～3．942），P＝0．049）]。结论睡眠障碍、慢性病、E2、T、P水平与围绝经期抑郁症的发生相关，E2、T、P水平高是围绝经期抑郁症发生的保护因素。

Relationship among social factors,sex hormone and perimenopausal depression

Objective To explore the relationship among social factors, sex hormone levels and the high incidence of perimenopausal depressive disorder.Methods Subjects were recruited with the diagnosis criteria for depressive onset in HAMD-17 and international classification of disease-10 （ICD-10）.The general data and peripheral blood samples of 79 patients with depressive disorder and those of 58 women without depressive disorder were collected to detect the levels of estrogen （ E2 ） , testosterone （ T） , progesterone （ P） , luteinizing hormone （ LH） and follicle-stimulating hormone （ FSH） with electrochemiluminescence assay.Results The incidence of sleep disorder and chronic disease in perimenopausal women with depressive disorder was higher than that in women without depressive disorder （χ2 =4.700, P=0.030;χ2 =4.866, P=0.027）.The levels of E2, T, and P in the depressive disorder group were lower than those in the group without depressive disorder （z=-3.175,P=0.001;z=-3.726,P〈0.000;z=-2.868, P=0.004）.HAMD scores were negatively correlated with E2, T, and P levels （r=-0.284,P=0.001;r=-0.389, P=0.000; r=-0.352, P=0.000）.Logistic regression analysis indicated that E2, T, and P were protective factors for the development and progression of perimenopausal depression OR（95%CI）：3.851（1.347-11.785）,P=0.014;4.580（1.298-14.132）,P=0.012;1.864（0.984-3.942）, P=0.049].Conclusion Sleep disorder, chronic diseases and the levels of E2 , T and P are correlated with the incidence of perimenopausal depressive disorder in women. E2 , T, and P are protective factors for the development and progression of perimenopausal depression.