本文關(guān)鍵詞：抑郁癥共病代謝綜合征患者執(zhí)行功能研究，由筆耕文化傳播整理發(fā)布。

        目的：分析抑郁癥共病代謝綜合征患者執(zhí)行功能(認知靈活性，注意轉(zhuǎn)移能力，抑制控制能力，計劃能力)情況及其與抑郁、焦慮水平和代謝指標(biāo)的關(guān)系。方法：于2013年4月到12月，從四川省精神衛(wèi)生中心體檢中心、門診部及住院部收集41例抑郁癥患者(抑郁癥組)、34例代謝綜合征患者（代謝綜合征組）、25例抑郁癥共病代謝綜合征患者(共病組)，以及30名正常人作為對照組（正常人組），共130例。對四組受試者進行血壓，腹圍，漢密頓抑郁量表（HAMD），漢密頓焦慮量表（HAMA），威斯康辛卡片分類測試（WCST），連線測試A和B（TMT），倫敦塔測試（TOL）和Stroop色詞測試（SCWT）檢查，并抽取靜脈血液進行甘油三脂，高密度脂蛋白，空腹血糖及糖負荷后2小時血糖水平測定。結(jié)果：1. HAMD認識障礙、阻滯、絕望感因子分及總分四組之間比較差異有統(tǒng)計學(xué)意義（P均<0.05），共病組得分最高，其次為抑郁癥組，再次為代謝綜合征組，最后為正常人組。HAMD焦慮/軀體化因子分共病組高于抑郁癥組、代謝綜合征組，抑郁癥組、代謝綜合征組高于正常人組（P<0.05）；日夜變化因子分共病組、抑郁癥組高于代謝綜合征組、正常人組（P<0.05）；睡眠障礙因子分共病組高于抑郁癥組，抑郁癥組高于代謝綜合征組、正常人組；體重因子分四組之間比較無統(tǒng)計學(xué)差異（P>0.05）。HAMA精神焦慮因子分、總分四組之間比較差異有統(tǒng)計學(xué)意義（P均<0.05）,其中共病組得分最高，其次為抑郁癥組，再次為代謝綜合征組，最后為正常人組。HAMA軀體焦慮因子分四組之間比較差異有統(tǒng)計學(xué)意義（P<0.05），其中共病組得分高于抑郁癥組和代謝綜合征組（P<0.05），抑郁癥組和代謝綜合征組高于正常人組（P<0.05）。2.代謝綜合征各診斷指標(biāo)四組之間比較差異有統(tǒng)計學(xué)意義（P均<0.05），其中腰圍、收縮壓、舒張壓、空腹血糖、糖負荷后2小時血糖及甘油三脂水平共病組、代謝綜合征組高于抑郁癥組、正常人組（P<0.05），高密度脂蛋白共病組、代謝綜合征組低于抑郁癥組、正常人組（P<0.05）。3.WCST總應(yīng)答次數(shù)，隨機錯誤數(shù)及持續(xù)錯誤數(shù)四組之間比較差異有統(tǒng)計學(xué)意義（P<0.05），共病組、抑郁癥組高于代謝綜合征組、正常人組（P<0.05）。連線測試A完成時間及錯誤數(shù)四組之間比較差異無統(tǒng)計學(xué)意義（P>0.05）。連線測試B完成時間及錯誤數(shù)四組之間比較差異有統(tǒng)計學(xué)意義（P<0.05），共病組、抑郁癥組多于代謝綜合征組、正常人組(P<0.05)。格式塔測試完成時間，錯誤數(shù)及正確數(shù)四組之間比較差異有統(tǒng)計學(xué)意義（P<0.05），其中完成時間及錯誤數(shù)共病組、抑郁癥組、代謝綜合征組多于正常人組(P<0.05)，正確數(shù)共病組、抑郁癥組、代謝綜合征組少于正常人組(P<0.05)。stroop實驗字、色測試正確數(shù)及錯誤數(shù)四組之間比較差異無統(tǒng)計學(xué)意義（P>0.05）。stroop實驗字色不一測試正確數(shù)四組之間比較差異有統(tǒng)計學(xué)意義（P<0.05），共病組、抑郁癥組多于代謝綜合征組、正常人組(P<0.05)。4.共病組WCST總應(yīng)答次數(shù)與HAMD總分，甘油三脂和糖負荷后兩小時血糖正相關(guān)(r=0.40～0.43，P<0.05)，與HAMA總分及其他代謝綜合征指標(biāo)不相關(guān)。在控制糖負荷后兩小時血糖、甘油三脂影響時，WCST總應(yīng)答次數(shù)與HAMD總分正相關(guān)（r=0.46,P<0.05）。共病組連線測試B完成時間與HAMD總分、HAMA總分及代謝綜合征各診斷指標(biāo)不相關(guān)(P>0.05)。共病組格式塔實驗完成時間與HMAD總分、HAMA總分及代謝綜合征各診斷指標(biāo)不相關(guān)(P>0.05)。共病組stroop字色不一測試正確數(shù)與HAMD總分負相關(guān)(r=-0.46，P<0.05)，與HAMA總分及代謝綜合征診斷指標(biāo)不相關(guān)(P>0.05)。結(jié)論：1.抑郁癥共病代謝綜合征患者抑郁及焦慮程度比單患其中一種疾病更嚴重。2.抑郁癥共病代謝綜合征患者，抑郁癥患者，代謝綜合征患者執(zhí)行功能均有損害，但損害維度不同。共病患者，抑郁癥患者執(zhí)行功能損害主要表現(xiàn)在認知靈活性，注意轉(zhuǎn)移能力，抑制控制能力，計劃能力。代謝綜合征患者的執(zhí)行功能損害主要表現(xiàn)在計劃能力。抑郁癥共病代謝綜合征患者計劃能力損害程度不比單患其中一種疾病更嚴重。3.可能抑郁癥共病代謝綜合征患者抑郁水平越高，認知靈活性和抑制控制能力損害越嚴重。

    Objective: To analyse the executive function(cognitive flexibility，shifting of attention, inhibitory control, plan ability)in patients with comorbiddepression and metabolic syndrome.To analyse the correlation of theexecutive function with the level of depression、anxiety and metabolicindicator.Methods: From April2013to December2013in physical examinationcenter, outpatient and inpatient department of the Mental Health Center ofSichuan Province,41patients meeting with the diagnostic criteria fordepression of the Chinese Classification and Diagnostic Criteria for MentalDisorders，Third Edition (CCMD-3) were selected;34patients meeting withthe diagnostic criteria for metabolic syndrome were selected;25patientsmeeting with the diagnostic criteria for depression of the ChineseClassification and Diagnostic Criteria for Mental Disorders，Third Edition(CCMD-3) and metabolic syndrome were selected;30normal control groupwere selected. A total of130cases were divided into depression group,metabolic syndrome group, comorbid group and normal control group. Thefour groups were measured and assessed with blood pressure, waist, HamiltonDepression Rating Scale, Hamilton Anxiety Scale, Wisconsin Card Sorting,Trail Making Test A and B, Tower of London and Stroop Color Word Test,and their venous blood were collected for triglyceride, high densitylipoprotein, fasting blood glucose, and OGTT two hour postprandial bloodglucose. Results:1.The total scores of HAMD, the scores of cognitive problem，retardation factor points, and hopelessness were different in the four groups，with statistical significance(P<0.05)，and the scores of comorbid group werethe highest, followed by depression group, again for metabolic syndromegroup and finally normal group. The scores of anxiety/somatization factor ofHAMD comorbid group was higher than depression group and metabolicsyndrome group, depression group and metabolic syndrome group was higherthan normal group(P<0.05). The scores of day and night factor of HAMD ofcomorbid group and depression group were higher than metabolic syndromegroup and normal group(P<0.05), and the scores of sleep disturbance factor ofcomorbid group were higher than depression group, depression group werehigher than metabolic syndrome group and normal group. And the scores ofweight factor had no statistical difference in four groups (P>0.05).The total scores of HAMA, the scores of mental anxiety were different infour groups, with statistical significance(P<0.05) and the scores of comorbidgroup，were the highest, followed by depression group, again for metabolicsyndrome group and finally normal group. The scores of somatic anxiety ofHAMA were different in four groups, with statistical significance(P<0.05)and the scores of somatic anxiety of comorbid group were higher thandepression group、metabolic syndrome group(P<0.05), and the scores ofsomatic anxiety of depression group and metabolic syndrome group werehigher than normal group（P<0.05）.2.The metabolic indicators were different in four groups，with statisticalsignificance(P<0.05).The level of waist circumference, systolic pressure,diastolic pressure, FPG, OGTT two hour postprandial blood glucose andtriglycerides of comorbid group, metabolic syndrome group was higher than depression group and normal group(P<0.05). The level of high densitylipoprotein of comorbid group, metabolic syndrome group was lower thandepression group and normal group (P<0.05).3. The total response numbers，perseverative error numbers，non-perseverative error numbers of WCST were different in four groups，withstatistical significance (P <0.05)，and comorbid group、depression group werehigher than metabolic syndrome group、normal group (P <0.05).There were no statistical differences in the completion time and errornumbers of Trail Making Test A in four groups(P>0.05). The completion timeand error numbers of Trail Making Test B were different in four groups，withstatistical significance（P<0.05），and comorbid group、depression groupwere higher than metabolic syndrome group、normal group(P <0.05).The completion time, error numbers and correct numbers of Tower ofLondon were different in four groups，with statistical significance（P <0.05）.The completion time and error numbers of comorbid group、depression groupand metabolic syndrome group were higher than normal group (P<0.05)，andthe correct numbers of comorbid group，，depression group and metabolicsyndrome group were lower than normal group(P <0.05).There were no statistical differences in correct numbers and errornumbers of Stroop Color Word Test word and color in fourgroups(P>0.05).When word and color were different, the correct numbers ofStroop Color Word Test were different in four groups，with statisticalsignificance（P<0.05），and comorbid group、depression group were higherthan metabolic syndrome、normal group(P<0.05).4.The total response numbers of WCST of comorbid group were positively correlated with the total scores of HAMD, triglyceride and OGTTtwo hour postprandial blood glucose(r=0.40～0.43，P<0.05),but were notcorrelated with the total scores of HAMA and other metabolic indicator.WhenOGTT two hour postprandial blood glucose and TG controled，The totalresponses numbers of WCST were positively correlated with the total scoresof HAMD（r=0.46, P <0.05）.The completion time of Trail Making Test B of comorbid group were notcorrelated with the total scores of HAMD, the total scores of HAMA andmetabolic indicator(P>0.05).The completion time of Tower of London of comorbid group were notcorrelated with the total scores of HAMD, the total scores of HAMA andmetabolic indicator(P>0.05).When word and color were different,the correct numbers of StroopColor Word Test were negatively correlated with the total scores ofHAMD(r=-0.46,P<0.05),were not correlated with the total scores of HAMAand metabolic indicator(P>0.05).Conclusion:1.The patients with comorbid depression and metabolicsyndrome might have severer depressive and anxiety symptoms than thepatients with depression or metabolic syndrome.2.The executive function ofpatients with comorbid depression and metabolic syndrome, depression ormetabolic syndrome all were impaired, but had diffirent dimensions. Theexecutive function of patients with comorbid depression and metabolicsyndrome or depression were impaired mainly in cognitive flexibility，shiftingof attention, inhibitory control ability and plan ability. The executive functionof patients with metabolic syndrome were impaired mainly in plan ability.The plan ability of patients with comorbid depression and metabolic syndrome were not worse than the patients with depression or metabolicsyndrome.3.Probably the patients with comorbid depression and metabolicsyndrome had severer depressive symptoms, the cognitive flexibility andinhibitory control ability were worse.

抑郁癥共病代謝綜合征患者執(zhí)行功能研究

致謝4-5摘要5-8Abstract8-12前言14-18對象與方法18-25結(jié)果25-37討論37-44結(jié)論44-45參考文獻45-52綜述：抑郁癥共病代謝綜合征的相關(guān)研究52-65    參考文獻61-65附錄65-66個人簡歷66-67攻讀碩士學(xué)位期間發(fā)表的學(xué)術(shù)論文67

  本文關(guān)鍵詞：抑郁癥共病代謝綜合征患者執(zhí)行功能研究，由筆耕文化傳播整理發(fā)布。