本文選題：甲狀腺 + 抑郁��； 參考：《大連理工大學(xué)》2013年博士論文

【摘要】：甲狀腺功能異常與抑郁障礙密切相關(guān),甲狀腺功能亢進(jìn)或減退都可導(dǎo)致抑郁障礙；甲減與抑郁癥具有相似的臨床表現(xiàn),兩者都可引起認(rèn)知障礙。甲狀腺功能異常引發(fā)抑郁障礙的機(jī)制尚不完全清楚,為探討甲狀腺功能與抑郁障礙的關(guān)系我們進(jìn)行了以下研究： 1、在動(dòng)物實(shí)驗(yàn)部分采用曠野試驗(yàn)及蔗糖試驗(yàn)評(píng)價(jià)甲狀腺功能減退大鼠的行為改變,18F-FDG micro PET顯像評(píng)價(jià)腦葡萄糖代謝的變化,分析行為表現(xiàn)與特定腦區(qū)代謝活性的關(guān)系。結(jié)果發(fā)現(xiàn),甲減大鼠體重、蔗糖偏好度、曠野實(shí)驗(yàn)中排便粒數(shù)和直立跨格數(shù)明顯低于對(duì)照組：雙側(cè)尾狀核/豆?fàn)詈�、扣帶回皮質(zhì)、伏隔核、額葉聯(lián)合部及運(yùn)動(dòng)皮質(zhì)葡萄糖代謝減低,尾狀核/豆?fàn)詈思胺艉舜x變化與蔗糖偏好度變化顯著相關(guān)。 2、131I治療后出現(xiàn)亞臨床甲減的患者中抑郁癥的發(fā)病率(23.5%)顯著高于甲狀腺功能正常者(7.3%)；對(duì)亞臨床甲減組中TSH超過(guò)10mIU/L的部分患者用左旋甲狀腺素進(jìn)行治療,結(jié)果HAMD得分顯著降低,說(shuō)明替代治療可使這部分患者受益。 3、選擇臨床確診的Graves'病患者,通過(guò)量表評(píng)分及臨床資料分析,探討甲亢伴發(fā)抑郁、焦慮的危險(xiǎn)因素,并對(duì)SF-36量表在甲亢患者中的適用性進(jìn)行評(píng)價(jià)。結(jié)果表明,FT3、FT4、TRAb和眼癥是Graves'病伴發(fā)抑郁的危險(xiǎn)因素,FT3、心率和甲狀腺腫大是Graves’病伴發(fā)焦慮的危險(xiǎn)因素；SF-36量表能準(zhǔn)確反映甲亢患者的生存質(zhì)量。 4、用SPECT腦血流顯像評(píng)價(jià)抑郁及甲減患者局部腦血流變化,用Go/No go實(shí)驗(yàn)評(píng)價(jià)認(rèn)知功能。結(jié)果發(fā)現(xiàn)抑郁患者雙側(cè)尾狀核、右側(cè)扣帶回血流顯著降低,甲減患者雙側(cè)前額葉、中央前回、中央后回、海馬、頂上小葉及扣帶回血流顯著降低。兩組HAMD得分均顯著高于對(duì)照組,抑郁組HAMD得分與雙側(cè)扣帶回及尾狀核相對(duì)rCBF顯著負(fù)相關(guān),而甲減組HAMD得分與扣帶回相對(duì)rCBF顯著負(fù)相關(guān)；抑郁及甲減患者均存在認(rèn)知障礙,抑郁組Go/No go認(rèn)知試驗(yàn)正確率與前額葉皮質(zhì)相對(duì)rCBF顯著正相關(guān),甲減組Go/No go認(rèn)知試驗(yàn)正確率與前額葉及海馬相對(duì)rCBF顯著正相關(guān)。 結(jié)論：甲減大鼠腦局部葡萄糖代謝降低,代謝異常與抑郁癥狀密切相關(guān),甲狀腺激素缺乏通過(guò)影響邊緣系統(tǒng)的功能導(dǎo)致抑郁障礙；甲減與抑郁均引起局部腦血流異常,兩者存在部分重疊,甲減與抑郁患者的情感、認(rèn)知障礙具有相似的神經(jīng)機(jī)制；亞臨床甲減增加了抑郁癥的發(fā)病率,甲狀腺激素替代治療能夠改善亞臨床甲減患者的抑郁癥狀；FT3、FT4、TRAb和眼癥是Graves'病伴發(fā)抑郁的危險(xiǎn)因素,FT3、心率和甲狀腺腫大是Graves'病伴發(fā)焦慮的危險(xiǎn)因素,SF-36量表能準(zhǔn)確反映甲亢患者的生存質(zhì)量。
[Abstract]:Hyperthyroidism or hypothyroidism can lead to depressive disorder, and hypothyroidism has similar clinical manifestations with depression, both of which can cause cognitive impairment. The mechanism of depressive disorder caused by abnormal thyroid function is not fully understood. In order to explore the relationship between thyroid function and depressive disorder, we conducted the following research: 1. In animal experiment, the behavioral changes of hypothyroidism rats were evaluated by field test and sucrose test. The changes of glucose metabolism in brain were evaluated by 18F-FDG micro PET imaging, and the relationship between behavior and metabolic activity in specific brain regions was analyzed. The results showed that the weight, sucrose preference, defecation grain number and vertical translattice number of hypothyroidism rats were significantly lower than those of the control group: bilateral caudate nucleus / lentiform nucleus, cingulate cortex, accumbent septal nucleus. Glucose metabolism in the frontal cortex and motor cortex decreased. The metabolic changes of caudate nucleus / lentiform nucleus and nucleus accumbens were significantly correlated with sucrose preference. The incidence of depression in patients with subclinical hypothyroidism after 2131I treatment was significantly higher than that in patients with normal thyroid function, and the HAMD scores of patients with subclinical hypothyroidism whose TSH exceeded 10mIU/L were significantly lower than those of subclinical hypothyroidism group. It is suggested that replacement therapy can benefit this group of patients. 3. The risk factors of depression and anxiety in patients with hyperthyroidism were investigated by scale score and clinical data analysis, and the applicability of SF-36 scale in patients with hyperthyroidism was evaluated. The results showed that FT3 / FT4TRAb and eye syndrome were risk factors for depression in Graves' disease. Heart rate and goiter were the risk factors of anxiety in Graves' disease. SF-36 scale could accurately reflect the quality of life of patients with hyperthyroidism. 4. The changes of regional cerebral blood flow in patients with depression and hypothyroidism were evaluated by SPECT cerebral blood flow imaging, and cognitive function was evaluated by Go/No go experiment. The results showed that the blood flow of bilateral caudate nucleus and right cingulate gyrus decreased significantly in patients with depression, and that in hypothyroidism patients with bilateral prefrontal lobe, precentral gyrus, posterior central gyrus, hippocampus, superior parietal lobule and cingulate gyrus. The HAMD score of both groups was significantly higher than that of the control group. The HAMD score of depression group was negatively correlated with the relative rCBF of bilateral cingulate gyrus and caudate nucleus, while the HAMD score of hypothyroidism group was negatively correlated with relative rCBF of cingulate gyrus, and there were cognitive impairment in depression and hypothyroidism. In depression group, the correct rate of Go/No go cognitive test was positively correlated with relative rCBF in prefrontal cortex, and that in hypothyroidism group was positively correlated with relative rCBF in prefrontal lobe and hippocampus. Conclusion: the regional glucose metabolism in hypothyroidism rats is decreased, and the abnormal metabolism is closely related to the depression symptoms. The hypothyroidism and depression cause depressive disorder by affecting the function of the limbic system, both hypothyroidism and depression cause abnormal regional cerebral blood flow. There is a partial overlap between hypothyroidism and depression, cognitive impairment has similar neural mechanism, subclinical hypothyroidism increases the incidence of depression, Thyroid hormone replacement therapy can improve depressive symptoms in patients with subclinical hypothyroidism. FT3FT-4TRAb and ophthalmopathy are risk factors for Graves' disease with depression. Heart rate and goitre are risk factors for Graves' disease with anxiety. SF-36 scale can accurately reflect the risk factors of Graves' disease with anxiety. Quality of life of patients with hyperthyroidism.
【學(xué)位授予單位】：大連理工大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R581.1;R749.4

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