倪敏 吴琪

[摘要] 目的 探讨抑郁症患者甲状腺激素水平的变化规律。 方法 采用化学发光免疫法检测78例单相抑郁症患者（其中首发抑郁症患者48例和复发抑郁症患者30例）与同期体检中心61例健康组人群静脉血进行对照，测定TSH、FT3、T3、FT4、T4水平。同时对首发抑郁症患者进行SCL-90、HAMD抑郁评定，分析甲状腺激素水平与抑郁临床症状之间的关系。 结果 抑郁症组与健康组甲状腺功能均在正常范围内，抑郁症组T3、TSH值较健康组水平低，差异有统计学意义（P<0.05）。首发组TSH水平较复发组低，差异有统计学意义（P<0.05）。FT4与HAMD总分、SCL-90强迫因子、抑郁因子、焦虑因子、恐怖因子呈正相关，T4与SCL-90强迫因子、抑郁因子、焦虑因子、恐怖因子呈正相关，FT3与SCL-90强迫因子、敌对因子呈正相关（P<0.05）。 结论 抑郁症存在甲状腺功能紊乱，首发患者较复发患者更明显，抑郁症严重程度与血清甲状腺激素水平间存在一定相关性。

[关键词] 抑郁症首发;抑郁症状;甲状腺功能;神经内分泌

[中图分类号] R749.4          [文献标识码] A          [文章编号] 1673-9701（2020）10-0015-04

[Abstract] Objective To investigate the law of changes of thyroid hormone levels in patients with depression. Methods The TSH， FT3， T3， FT4， T4 levels of 78 patients with unipolar depression （48 patients with first-episode depression and 30 patients with recurrent depression） were measured by chemiluminescence immunoassay， and were compared with those in venous blood from 61 healthy people in the same physical examination center. At the same time， SCL-90 and HAMD were used to evaluate depression in patients with first-episode depression. And the relationship between thyroid hormone levels and clinical symptoms of depression was analyzed. Results The thyroid function of the depression group and the healthy group was within the normal range. The T3 and TSH values of the depression group were lower than those of the healthy group， and the difference was statistically significant （P<0.05）. The level of TSH in the first depression group was lower than that in recurrent depression group， and the difference was statistically significant（P<0.05）. FT4 was positively correlated with HAMD total score， SCL-90 forcing factor， depression factor， anxiety factor and terror factor. T4 was positively correlated with SCL-90 forcing factor， depression factor， anxiety factor and terror factor. FT3 was positively correlated with SCL-90 forcing factor， hostile factors（P<0.05）. Conclusion There is thyroid dysfunction in depression. The thyroid dysfunction of first-episode depression patients is more obvious than that of the recurrent depression patients. There is a certain correlation between the severity of depression and serum thyroid hormone levels.

[Key words] First-episode depression; Depressive symptoms; Thyroid function; Neuroendocrine

抑郁癥是一种临床常见的精神心理疾病，主要临床表现为情绪低落、睡眠障碍、食欲下降、活动减少、悲观厌世等。患者病情反复、治疗周期长、社会危害较大。而甲状腺激素通过诱导5-HT受体的敏感性变化，影响神经递质的传导变化。甲状腺功能不足时会导致5-HT等神经递质传导减慢、功能减退[1]。抑郁与5-HT的关系极为密切。目前对抑郁症发病机制的研究在神经生化方面下丘脑-垂体-甲状腺（HPT）的异常较为被大家所接受[2]，但具体的作用机制仍未完全明了。本研究通过比较抑郁症与健康人的甲状腺激素水平变化、首发与复发抑郁症患者的甲状腺激素水平变化、首发抑郁症患者的症状严重程度与甲状腺激素水平关系，探讨抑郁症与甲状腺激素功能之间的关系，现报道如下。

1 对象与方法

1.1 研究对象

选择2017年5月～2018年5月就诊于我院精神科的抑郁症患者共78例，其中首发患者48例和复发患者30例。……