干燥综合征并发抑郁的神经内分泌病因分析

摘要

Objective To explore the causes of Sjogren syndrome (SS) complicated by depression and the relationship with neurologic and endocrine changes.Methods Two hundred and twenty-five patients with SS who were admitted to the Department of Clinical Psychology and Department of Rheumatology in the First People's Hospital of Yunnan Province from July 2015 to July 2017 were selected.The patients were divided into a depression group,consisting of 59 patients with depressive episodes,and a control group,consisting of 166 patients.Cranial magnetic resonance imaging-weighted and magnetic sensitive-weighted scans were performed on the frontal lobe,temporal lobe,occipital lobe,cerebellum,brainstem,and basal ganglia to detect ischemic cerebrovascular disease,as well as hemorrhagic cerebrovascular disease.Thyroid function,including thyrotropin (TSH),tetraiodothyronine (T4),triiodothyronine (T3),free tetraiodothyronine (FT4),free triiodothyronine (FT3),thyroglobulin antibody (aTG),thyroid peroxidase antibody (TPOAb),was measured.The incidence of liver damage,renal impairment,chronic heart failure,and pulmonary fibrosis was also recorded.Results The incidence of ischemic cerebrovascular disease in the frontal lobe,temporal lobe,occipital lobe,cerebellum,and basal ganglia was higher in the depression group than the control group (P<0.05).In the depression group,the incidence of ischemic cerebrovascular disease in the frontal lobe was higher than temporal lobe,the occipital lobe,cerebellum,and brainstem and basal ganglia,and the incidence of ischemic cerebrovascular disease in the temporal lobe and basal ganglia was higher than cerebellum (P<0.05).The incidence of hemorrhagic cerebrovascular disease in the frontal lobe,temporal lobe,occipital lobe,and basal ganglia was higher in the depression group than the control group (P<0.05).In the depression group,the incidence of hemorrhagic cerebrovascular disease in the frontal lobe of patients with depression was higher than the occipital lobe,cerebellum,and brainstem (P<0.05). The levels of TSH,aTG,and TPOAb in the depression group were higher than the control group,while the levels of T3and FT3 were lower than the control group (P<0.05).The incidence of pulmonary fibrosis in the depression group was higher than the control group (P<0.05).Conclusion SS complicated with depression may be associated with cerebral vascular damage caused by SS,which may be related to cerebral ischemia and bleeding related to emotion.And it may be related to SS causing thyroid dysfunction and complicated vital organ damage,thus affecting the quality of life.%目的 探索干燥综合征(SS)并发抑郁的原因及与神经、内分泌改变等因素的关系.方法 选取2015年7月—2017年7月云南省第一人民医院临床心理科与风湿免疫科收治的SS患者225例,将存在抑郁的SS患者59例纳入抑郁组,其余166例患者纳入对照组.患者额叶、颞叶、枕叶、小脑、脑干、基底节区行颅脑磁共振平扫加权与磁敏感加权扫描检测缺血性脑血管疾病、出血性脑血管疾病,检测甲状腺功能〔包括促甲状腺素(TSH)、四碘甲状腺原氨酸(T4)、三碘甲状腺原氨酸(T3)、游离四碘甲状腺原氨酸(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺球蛋白抗体(aTG)、甲状腺过氧化物酶抗体(TPOAb)〕,记录肝脏损伤、肾功能损伤、慢性心力衰竭、肺纤维化发生率.结果 抑郁组额叶、颞叶、枕叶、小脑、基底节区的缺血性脑血管疾病发生率均高于对照组(P<0.05);抑郁组患者额叶的缺血性脑血管疾病发生率均高于颞叶、枕叶、小脑、脑干、基底节区,颞叶、基底节区均高于小脑(P<0.05).抑郁组额叶、颞叶、枕叶、基底节区的出血性脑血管疾病发生率均高于对照组(P<0.05);抑郁组患者额叶部位的出血性脑血管疾病发生率均高于枕叶、小脑、脑干(P<0.05).抑郁组TSH、aTG、TPOAb水平均高于对照组,T3、FT3水平均低于对照组(P<0.05);抑郁组肺纤维化发生率高于对照组(P<0.05).结论 SS并发抑郁可能与SS造成脑血管损伤,导致与情绪相关脑区缺血、出血有关;可能与SS造成甲状腺功能异常和并发重要脏器损伤,从而影响生活质量有关.