产后抑郁症与雌激素及单胺递质水平的相关性研究

目的探讨雌二醇及单胺递质——5羟色胺、多巴胺水平与产后抑郁症的关系。方法对342例产后42d内的产妇,应用爱丁堡产后抑郁量表（EPDS）、Beck抑郁量表（BDI）、一般健康问卷（GHQ）进行评定。以EPDS总分≥13分为产后抑郁症诊断标准,并分为抑郁症组与正常组,应用放射免疫法测定两组妇女血浆雌二醇和5羟色胺、多巴胺水平。结果（1）发生率：产后抑郁症发生率为16．7％（57／342）。发生率最高的年龄段为35岁以上（22．2％）;23岁以下发生率最低（12．5％）,两者比较,差异有统计学意义（P〈0．01）。本科及以上学历的发生率较高,为21．3％,文化程度为大专及中专者发生率仅7．9％,两者比较,差异有统计学意义（P〈0．01）。（2）生物学指标测定：抑郁症组妇女雌二醇水平为（64．39±0．22）pmol／L,明显低于正常组的（126．18±0．47）pmol／L,两组比较,差异有统计学意义（P〈0．01）;抑郁症组妇女5羟色胺水平为（1．09±0．21）μmol／L,明显低于正常组的（2．67±0．36）μmol／L,两组比较,差异有统计学意义（P〈0．01）;抑郁症组妇女多巴胺水平为（5．21±0．54）μmol／L,明显高于正常组的（3．16±0．98）μmol／L,两组比较,差异有统计学意义（P〈0．01）。（3）雌二醇水平与EPDS、BDI、GHQ量表分值呈负相关（相关系数分别为-0．53,-0．76,-0．35;P〈0．05）,即雌二醇水平越低,产后EPDS、BDI、GHQ量表分值越高;5羟色胺水平与EPDS、BDI、GHQ量表分值呈负相关（相关系数分别为-0．18,-0．28,-0．11;P〈0．05）,即5羟色胺水平越低,产后EPDS、BDI、GHQ量表分值越高;多巴胺水平与EPDS、BDI量表分值呈正相关,与GHQ量表分值呈无相关性（相关系数分别为0．12,0．07,0．00;P〉0．05）。结论EPDS、BDI、GHQ量表评定可作为筛选产后抑郁症的依据,雌二醇及5羟色胺、多巴胺水平的测定可为产后抑郁症的诊断提供客观的生物学指标。

Relationship between the levels of estradiol and monoamine neurotransmitters and postpartum depression

OBJECTIVE: To explore the relationship of estradiol (E(2)), monoamine neurotransmitters 5-hydroxytryptamine (5-HT), dopamine (DA) and postpartum depression. METHODS: Totally 342 women within 42 days after childbirth were assessed with Edinburgh postnatal depression scale (EPDS), Beck depression inventory (BDI), and general health questionnaire (GHQ). Above or equal to 13 of overall score of EPDS was the diagnosis standard of postpartum depression, and the women tested were divided into depression group and normal group accordingly, using the reagent box of radio immunoassay to test estradiol and 5-HT and DA level in the serum. RESULTS: (1) Incidence: the incidence of postpartum depression was 16.7% (57/342). The highest incidence occurred in patients above 35 (22.2%); the incidence among women under 23 years old was lowest (12.5%), with a significant difference between them (P < 0.01); the incidence in persons with a bachelor degree and above (21.3%) was higher than that of persons with a lower degree of education (7.9%), with a significant difference between the two groups. (2) Biological indicator: the levels of E(2), and 5-HT in depression group (64.39 +/- 0.22) pmol/L, (1.09 +/- 0.21) micromol/L were significantly lower than those in the normal group (126.18 +/- 0.47) pmol/L, (2.67 +/- 0.36) micromol/L (P < 0.01); whereas the level of DA in depression group (5.21 +/- 0.54) micromol/L was significantly higher than that in the normal group (3.16 +/- 0.98) micromol/L (P < 0.01). (3) The levels of E(2) and 5-HT were negatively correlated with the score of EPDS, BDI, GHQ (P < 0.05); but the level of DA was positively related to the scores of EPDS and BDI (P < 0.05), while it had no relationship with GHQ (P > 0.05). CONCLUSIONS: Evaluation scales such as EPDS, BDI, and GHQ should be used to screen for postpartum depression. The measurement of estradiol and monoamine neurotransmitter (5-HT, DA) level can be used as biological objective indicators for prevention and treatment of postpartum depression.