本文關(guān)鍵詞： 首發(fā)抑郁癥 復(fù)發(fā)抑郁癥 性激素 甲狀腺激素　出處：《鄭州大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 探討首發(fā)抑郁癥、復(fù)發(fā)抑郁癥患者血清甲狀腺激素和性激素水平的變化,了解抑郁癥的發(fā)病機制并為其臨床治療提供理論依據(jù)。 方法 采用病例對照研究的方法,按照《國際疾病和相關(guān)健康問題統(tǒng)計分類第十版》(ICD-10)診斷標(biāo)準(zhǔn)收集HAMD-2420分的118例抑郁癥患者(實驗組)和HAMD8分的60例健康者(對照組),其中實驗組有63例首次抑郁癥發(fā)作患者、55例病情復(fù)發(fā)兩次及以上患者,將實驗組和健康對照組按性別分為男性和女性兩個亞組。 采用電化學(xué)發(fā)光免疫分析法測定血清游離三碘甲狀腺原氨酸(FT3)、游離甲狀腺素(FT4)、促甲狀腺激素(TSH)、雌激素(E2)、孕酮(P)、睪酮(T)的水平(月經(jīng)期者于月經(jīng)干凈3天后抽血,以減少激素受月經(jīng)周期的影響而產(chǎn)生誤差)。 統(tǒng)計方法采用卡方檢驗、兩樣本t檢驗,β=0.05、P0.05表示差異有統(tǒng)計學(xué)意義。 結(jié)果 1首發(fā)、復(fù)發(fā)組和對照組三組間性激素比較 (1)首發(fā)與對照組比較：首發(fā)組男性、女性抑郁癥患者血清雌二醇水平均顯著低于正常對照組(P0.01； P0.01)；首發(fā)男性患者的睪酮水平顯著低于正常對照組(P=-0.034),而首發(fā)女性患者的睪酮水平與正常對照組相比無顯著差異(P=0.612)。男、女首發(fā)抑郁患者的睪孕酮水平與對照組相比無顯著變化(P=0.383、P=0.842)。 (2)復(fù)發(fā)與對照組比較：復(fù)發(fā)組男性、女性抑郁癥患者血清雌二醇均顯著低于正常對照組(P0.01； P0.01)；復(fù)發(fā)男性患者的睪酮水平顯著低于正常對照組(P=0.024),而復(fù)發(fā)女性患者的睪酮水平與正常對照組相比無顯著差異(P=0.542);男、女首發(fā)抑郁患者的孕酮水平與對照組相比無顯著變化(P=0.132、P=0.319)。 (3)首發(fā)與復(fù)發(fā)抑郁癥組比較：復(fù)發(fā)組男性雌二醇水平較首發(fā)組減低,但兩組對照無顯著差異(P=0.124),而復(fù)發(fā)組女性雌二醇水平明顯低于首發(fā)組(P=0.007)；復(fù)發(fā)組男性睪酮較首發(fā)組稍減低,兩組間比較無顯著差異(p=0.294),復(fù)發(fā)組女性睪酮水平與首發(fā)組相比無顯著差異(P=0.730)；男、女首發(fā)抑郁癥患者孕酮水平與復(fù)發(fā)組相比差異無顯著變化(P=0.378、P=0.626)。 2首發(fā)、復(fù)發(fā)組和對照組甲狀腺激素比較 (1)首發(fā)與對照組比較：男、女首發(fā)組FT3較對照組升高,但無顯著差異(P=0.682、P=0.735)；男、女首發(fā)組FT4與對照組相比有顯著差異(P=0.025、P=0.034)男、女首發(fā)組TSH較對照組偏低,但無顯著差異(P=0.845、P=0.503)。 (2)復(fù)發(fā)與對照組比較：男、女復(fù)發(fā)組FT3與對照組相比有顯著差異(P=0.012、P=0.027)；男、女復(fù)發(fā)組FT4與對照組相比有顯著差異(P=0.038、P=0.022)；男、女復(fù)發(fā)組TSH與對照組相偏低,但無顯著差異(P=0.734、P=0.725)。 (3)首發(fā)與復(fù)發(fā)組比較：男、女復(fù)發(fā)組FT3均較首發(fā)組升高,但無顯著差異(P=0.527、P=0.633)；男、女復(fù)發(fā)組FT4較首發(fā)組顯著升高(P=0.007、P=0.019)；男、女復(fù)發(fā)組TSH較首發(fā)組高,但無顯著差異(P=0.283、P=0.175)。 結(jié)論 (1)抑郁癥患者體內(nèi)雌二醇水平下降,反復(fù)發(fā)作女性抑郁癥患者體內(nèi)雌二醇下降更明顯,提示雌二醇下降可能是抑郁癥的危險因素； (2)睪酮水平下降可能導(dǎo)致男性抑郁癥的發(fā)生； (3)反復(fù)發(fā)作的抑郁癥患者FT4水平顯著下降,可能存在更為明顯的甲狀腺系統(tǒng)水平異常。
[Abstract]:Purpose To investigate the changes of serum thyroid hormones and sex hormone levels in the patients with first depression and recurrent depression , and to understand the pathogenesis of depression and provide theoretical basis for its clinical treatment . method A case - control study was conducted to collect 60 healthy controls ( control group ) of 118 patients with depression ( experimental group ) and HAMD8 score ( control group ) , which were divided into two subgroups : male and female in the experimental group and the healthy control group . The levels of serum free triiodide ( FT3 ) , free thyroid hormone ( FT4 ) , thyroid stimulating hormone ( TSH ) , estrogen ( E2 ) , progesterone ( P ) and testosterone ( T ) were measured by electrochemical luminescence immunoassay . Statistical significance was expressed by Chi - square test , two - sample t - test , 尾 = 0.05 and P0.05 . Results Comparison of sex hormone among three groups of primary , recurrent and control groups ( 1 ) Compared with the control group , the level of serum estradiol in the first group was significantly lower than that in the control group ( P0.01 ) . The testosterone level in the first group was significantly lower than that in the control group ( P = - 0.034 ) . ( 2 ) Compared with the control group , the serum estradiol levels in the patients with recurrent male and female depression were significantly lower than those in the normal control group ( P0.01 ) . The levels of testosterone in the patients with recurrent male depression were significantly lower than those in the control group ( P = 0 . 542 ) . There was no significant difference between the two groups ( P = 0.294 ) . There was no significant difference between the two groups ( P = 0.294 ) . There was no significant difference between the two groups ( P = 0.294 ) . There was no significant difference between the two groups ( P = 0.378 , P = 0.626 ) . Comparison of thyroid hormones in primary , recurrent and control groups ( 1 ) Compared with the control group , the FT3 of male and female was higher than that of the control group ( P = 0.682 , P = 0.735 ) , but there was no significant difference between FT4 and control group ( P = 0.025 , P = 0.034 ) , but there was no significant difference ( P = 0.845 , P = 0.503 ) . ( 2 ) Compared with the control group , there was significant difference between the relapse group and the control group ( P = 0.012 , P = 0.027 ) ; the male and female relapse group FT4 had significant difference compared with the control group ( P = 0 . 38 , P = 0 . 022 ) ; the TSH of the male and female relapse group was lower than that of the control group , but there was no significant difference ( P = 0.734 , P = 0.725 ) . ( 3 ) Compared with the recurrence group , the FT3 of male and female relapse group was higher than that in the first group ( P = 0.527 , P = 0.633 ) , but there was no significant difference between male and female relapse group FT4 ( P = 0.007 , P = 0.019 ) , but there was no significant difference between male and female relapse group ( P = 0.283 , P = 0.175 ) . Conclusion ( 1 ) The level of estradiol in the patients with depression decreased , and the decrease of estradiol in the patients with recurrent female depression was more obvious , suggesting that the decrease of estradiol could be a risk factor for depression ; ( 2 ) The decrease of testosterone level may lead to depression of male ; ( 3 ) The level of FT4 in patients with recurrent depression was significantly decreased , and there might be a more obvious level abnormality of thyroid system .

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.4

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