卒中后抑郁患者下丘脑-垂体-甲状腺轴功能改变及其意义

目的探讨脑卒中后抑郁(PSD)患者下丘脑-垂体-甲状腺(HPT)轴功能的改变及其在PSD发病中的意义。方法轻、中度急性脑卒中患者43例,观察入院0,1,7,14,21 d及3个月后血T3、T4、FT3、FT4和TSH变化,第7天清晨给予促甲状腺激素释放激素(TRH)兴奋试验检测,观察30 min后TSH水平变化。入院7 d时应用Zung抑郁焦虑量表初筛后,采用HAMD量表测评后,分为单纯卒中亚组(<8分)及卒中后抑郁亚组(PSD亚组)(≥8分)。对照组16例为年龄、性别匹配的健康体检者,采血1次测定上述指标。比较3组甲状腺功能,分析PSD患者HPT功能改变的特征,并将HAMD评分与甲状腺功能改变做相关性分析。结果卒中组患者入院0～14 d血FT3低于对照组(P<0.05),血TSH高于对照组(P<0.05),血T3、T4和FT4与对照组比较无显著性差异(P均>0.05);21 d及3个月时,卒中组血T3、T4、FT3、FT4和TSH与对照组比较,无显著性差异(P均>0.05)。与单纯卒中亚组患者比较,PSD亚组0～21 d血FT3、TSH较低(P<0.05),血FT4较高(P均<0.05);3个月时,2亚组间血FT3、FT4、TSH无显著性差异(P均>0.05);在各时间点,2亚组血T3、T4与对照组比较,均无显著性差异(P均>0.05)。TRH兴奋试验显示,两亚组对TRH刺激均有明显反应,TSH明显升高,但PSD亚组的反应较单纯卒中组弱,有显著性差异(P<0.05)。相关分析显示,PSD亚组患者血TSH水平与HAMD评分密切相关(r=-0.35,P<0.01)。结论与普通脑卒中患者比较,PSD患者HPT轴功能的改变时间久、程度重,这可能是出现卒中后抑郁的重要机制。

Significance of hypothalamus-pituitary-thyroid Axis function change in patients with post-stroke depression

Objective It is to investigate the changes of hypothalamic-pituitary-thyroid(HPT) axis function in patients with post-stroke depression(PSD) and its significant in development of PSD.Methods Patients with diagnosis of mild to moderate stroke were selected in stroke group.The changes of T3,T4,FT3,FT4 and TSH in serum were observed at day 0,1,7,14,21 and 3 months.In morning at day 7,all patients received thyroid hormone releasing hormone(TRH) stimulation test and their serum TSH levels were detected after 30 min.After primarily assessed using the Zung Depression scale at day 7 after admission,patients were evaluated with the anxiety scale screening using the HAMD scale assessment,and were divided into 2 groups: simple stroke sub-group(<8 points) and PSD sub-group(≥ 8 points).The objectives in control group for age,sex matched were healthy subjects.The relationships between the HPT characteristics changes and HAMD scores in the PSD group were analyzed.Results Patients in stroke group had lower FT3(P<0.05) and higher serum TSH(P<0.05) than patients in control group at day 0,1,7 and 14,but the differences in T3,T4 and FT4 between the both groups were not statistically significant(P> 0.05).At day 21 and month 3,there was no significant different between stroke group and control group in levels of T3,T4,FT3,FT4 and TSH(all P>0.05).However,patients in PSD sub-group had lower FT3,TSH levels and higher FT4 levels at day 0,1,7,14 and 21 than the patients in simple stroke group(P<0.05).At month 3,FT3,FT4 and TSH levels in the two sub-groups had no significant difference(P>0.05).At each time point,there was no significant difference between two sub-groups and control group in T3,T4 levels(P>0.05).TRH stimulation test showed that the two sub-groups had overt responses to the TRH,that is,TSH levels were significantly increased.However,the responses from the PSD sub-group were much weaker than those in simple stroke sub-group(P<0.05).Correlation analysis showed that HAMD scores were closely related with TSH levels in PSD subgroup(r=-0.35,P<0.01).Conclusion Compared with non-post-stroke depression patients,PSD patients have a HPT axis function change of long and severe,which may play a crucial role in the pathogenesis of PSD.