单、双相抑郁症临床特征及血清甲状腺激素水平比较

摘要

Objective To explore the differences for clinical characteristics and serum levels of thyroid hormones in patients with unipolar and bipolar depression.Methods A total of 42 patients with bipolar depression in bipolar depression group, 77 patients with unipolar depression in unipolar depression group and 69 health person in control group were included in the study and the serum triodothyronine (T3), thyroxin(T4), free-triiodothyronine(T3), thyroxin(T4) and thyroid stimulating hormone ( TSH) levels of all subjects were measured using electrochemiluminescence immunoassay.The patients with depression were assessed with Hamilton Depression Scale ( HAMD) for the clinical symptoms to explore the differences for serum levels of thyroid hormones between bipolar depression group, unipolar depression group and control group, and the relationship between serum levels of thyroid hormones and depressive symptoms in bipolar depression group and unipolar depression group.Results The age of onset in bipolar depression group was significantly lower than that in unipolar depression group ( P <0.05 ) .There were significantly more premorbid predisposition in unipolar depression group than those in bipolar depression group(P<0.05).There was no significant difference in the total score of HAMD between bipolar depression group and unipolar depression group, and the score of congnition factor on HAMD in uniporlar group was significantly higher than that in bipolar depression(P<0.05).There were no significant differences in serum levels of T3, T4 and TSH between unipolar depression group, bipolar depression group and control group.The levels of FT3 in unipolar depression group were all significantly lower than those in control group and bipolar depression group (P<0.05).The levels of FT4 in bipolar depression group were significantly higher than those in control group and unipolar depression group (P<0.05).The total scores of HAMD were not related to the serum levels of thyroid hormones in unipolar and bipolar depression group, and the retardant factor scores of HAMD were positively related to the serum levels of T4 in unipolar depression patients(P<0.05).Conclusion There are some differences in sclinical characteristics between unipolar and bipolar depression.There may be thyroid disfunction in the patients with unipolar depression and it may be biological marker for the serum level of FT4 in the patients with bipolar depression.%目的：分析单、双相抑郁症患者临床特征及血清甲状腺激素水平的差异。方法采用电化学发光免疫分析法分别测定42例双相障碍抑郁症患者、77例单相抑郁症患者和69名正常对照组健康人的血清三碘甲状腺原氨酸（ T3）、甲状腺素（T4）、游离甲状腺激素（FT3、FT4）和促甲状腺激素（TSH）水平，采用汉密尔顿抑郁量表（HAMD）评估临床症状及抑郁的严重程度，并分析三组间甲状腺功能的差异，以及单相、双相抑郁患者甲状腺素水平与其HAMD各项评分的相关性。结果双相抑郁组患者的起病年龄低于单相抑郁组（P＜0．05），发病前有明显诱因者少于单相抑郁组（P＜0．05）。单相抑郁组和双相抑郁组HAMD总分差异无统计学意义（P＞0．05），单相抑郁组的认知障碍因子分高于双相抑郁组（P＜0．05）。三组间血清T3、T4、TSH水平比较差异无统计学意义（P＞0．05），单相抑郁组的FT3低于双相抑郁组及正常对照组（P＜0．05），双相抑郁组血清FT4高于单相抑郁组及对照组（P＜0．05）。相关分析显示，单相、双相抑郁组血清甲状腺素水平与HAMD总分无相关性（P＞0．05），单相抑郁组血清T4水平与阻滞因子分成正相关（P＜0．05）。结论单相抑郁和双相抑郁患者的临床特征有所不同，单相抑郁症患者可能伴有甲状腺功能减退，血清FT4可能是双相抑郁症的生物学标记。