【摘要】：目的探討頭發(fā)、血漿皮質(zhì)醇水平在抑郁癥發(fā)病過程中的特點(diǎn)及抗抑郁治療前后的變化。方法納入抑郁癥患者47例和正常對(duì)照47名。抑郁癥組給予選擇性5-羥色胺再攝取抑制劑治療4周,分別于治療前、治療4周后檢測頭發(fā)、血漿皮質(zhì)醇水平,分別采用漢密爾頓抑郁量表17項(xiàng)(Hamilton Depression Rating Scale-17,HAMD-17)和漢密爾頓焦慮量表(Hamilton anxiety scale,HAMA)評(píng)估抑郁癥狀和焦慮癥狀的嚴(yán)重程度及療效。對(duì)照組不予干預(yù),于入組時(shí)檢測頭發(fā)、血漿皮質(zhì)醇水平。結(jié)果抑郁癥組治療前頭發(fā)皮質(zhì)醇水平高于對(duì)照組[(17.42±12.40)nmol/L vs.(10.22±8.00)nmol/L,P0.01],血漿皮質(zhì)醇水平兩組間無統(tǒng)計(jì)學(xué)差異(P0.05)。抑郁癥組治療后HAMD-17總分[(10.60±4.57)vs.(24.00±4.86)]和HAMA總分[(6.30±4.86)vs.(15.78±5.45)]較治療前均降低(P0.01),治療后頭發(fā)皮質(zhì)醇水平較治療前增高[(30.53±25.75)nmol/L vs.(16.02±11.77)nmol/L,P0.05],血漿皮質(zhì)醇水平治療前后差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后達(dá)到臨床痊愈的患者治療前血漿皮質(zhì)醇水平高于非臨床痊愈的患者[(27.47±14.48)nmol/L vs.(18.30±7.11)nmol/L,P0.05]。抑郁癥組治療前血漿皮質(zhì)醇水平與HAMD-17中的胃腸道癥狀因子分呈正相關(guān)(r=0.335,P=0.023),與HAMD-17總分及其他因子的相關(guān)性均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論抑郁癥患者頭發(fā)皮質(zhì)醇水平高于正常對(duì)照,經(jīng)抗抑郁藥治療后頭發(fā)皮質(zhì)醇水平較治療前升高。治療前血漿皮質(zhì)醇水平高的患者可能對(duì)抗抑郁藥治療更敏感,可獲得更好的臨床療效。
[Abstract]:Objective to investigate the characteristics of hair and plasma cortisol levels in the pathogenesis of depression and the changes of cortisol levels before and after antidepressant treatment. Methods 47 patients with depression and 47 normal controls were included. The depression group was treated with selective serotonin reuptake inhibitor for 4 weeks. Hair and plasma cortisol levels were measured before and 4 weeks after treatment. Hamilton depression scale 17 items (Hamilton Depression Rating Scale-17, were used respectively. HAMD-17) and Hamilton anxiety scale (Hamilton anxiety scale,HAMA) were used to evaluate the severity and efficacy of depression and anxiety. The control group did not intervene, and the levels of cortisol in hair and plasma were measured at the time of admission. Results the level of cortisol in hair of depression group was higher than that of control group before treatment [(17.42 鹵12.40) nmol/L vs. (10.22 鹵8.00) nmol/L,P0.01], but there was no significant difference in plasma cortisol level between the two groups (P 0.05). After treatment, the total scores of HAMD-17 and HAMA in depression group [(10.60 鹵4.57) vs. (24.00 鹵4.86)] and (6.30 鹵4.86) vs. (15.78 鹵5.45) were lower than those before treatment (P 0.01). After treatment, the level of cortisol in hair was higher than that before treatment [(30.53 鹵25.75) nmol/L vs. (16.02 鹵11.77) nmol/L,P0.05], but there was no significant difference in plasma cortisol level before and after treatment (P 0.05). The plasma cortisol level in patients with clinical recovery after treatment was higher than that in patients with non-clinical recovery [(27.47 鹵14.48) nmol/L vs. (18.30 鹵7.11) nmol/L,P0.05]. In depression group, plasma cortisol level was positively correlated with gastrointestinal symptom factor score in HAMD-17 before treatment (r 鈮，

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