摘要
目的应用队列研究方法探讨脑卒中后抑郁(post-stroke depression,PSD)患者甲状腺功能改变及其在PSD发病中的地位。方法卒中组入选者为2009年1月至2009年12月就诊的轻、中度急性脑卒中患者,观察入院1 d内、1 d7、d、14 d2、1 d及90 d后血三碘甲状腺氨酸(T3)、甲状腺素(T4)、游离T3(FT3)、游离T4(FT4)和TSH变化。入院7 d时采用汉密尔顿(HAMD)评分量表测评后,再分为单纯卒中亚组(<8分)、卒中后抑郁亚组(PSD亚组)(≥8分)。对照组为年龄、性别构成比匹配的健康体检者(只采血1次)。比较3组甲状腺功能,分析PSD患者下甲状腺功能改变的特征,并将HAMD评分与甲状腺功能改变做相关性分析。结果单纯卒中亚组、PSD亚组、对照组例数分别为25例、18例1、6例。卒中组患者入院1 d内1、d7、d1、4 d血FT3低于对照组(P均<0.05),血促甲状腺激素(TSH)高于对照组(P均<0.05),血T3、T4和FT4与对照组比较,差异无显著性(P>0.05);21 d及90 d时,卒中组血T3、T4、FT3、FT4和TSH与对照组比较,差异无显著性(P>0.05)。与单纯卒中亚组患者比较,PSD亚组1 d内1、d7、d、14 d2、1 d血FT3、TSH较低(P均<0.05),血FT4较高(P均<0.05)9,0 d时,两亚组间血FT3、FT4、TSH差异无显著性(P均>0.05);在各时间点,两亚组间血T3、T4与对照组比较,差异均无显著性(P均>0.05)。相关分析显示,PSD亚组患者血TSH与HAMD评分密切相关(r=-0.35,P<0.01)。结论与普通脑卒中患者比较,PSD患者甲状腺功能的改变时间久、程度重,这可能是出现卒中后抑郁的重要机制。
To study changes of thyroid function in patients with post - stroke depression （PSD）. Methods Patients with mild and moderate acute stroke admitted to this hospital during January 2009 to November 2009 were allocated into stroke group. Blood levels of T3 , T4, FT3 , FT4 and TSH were examined at day 0, 1 st, 7th, 14th, 21st and 3 months later. At 7th day after admission, all these patients were evaluated with anxiety scale screened by using HAMD scale assessment, and they were divided into 2 subgroups ： simple stroke subgroup （ 〈 8 points）, and PSD subgn3up （ ≥8 points）. The age and sex ratio in healthy controls were correspondent to those of stroke group. The relationship between characteristic changes of thyroid function＂ and HAMD scores in PSD group was analyzed. Results The numbers of patients in simple stroke subgroup, PSD subgroup and control group were 25, 18 and 16 respectively. Patients in stroke group presented lower FT3 at day 0, 1st, 7th and lgth （ P 〈0.05 ） and higher serum TSH （ P 〈0.05 ） than those of patients in control group. The difference in levels of T3 , T4 and FT4 between these 2 groups was not statistically significant （ P 〉 0.05 ） ; and levels of T3 , 3＂4, FT3 , FT4 and TSH in stroke group at day 21st and 3 months later were not different from those of control group （ P 〉 0.05 ）. However, patients in PSD subgroup presented lower levels of FT3 and TSH and higher level of FT4 at day 0, 1st, 7th, 14th and 21st than those of patients in simple stroke group （ P 〈 0.05 ）. At 3 months later, levels of FT3 , FF4 and TSH in these two subgroups were not significantly different （ P 〉 O. 05 ）. At each time point, there was no significant difference in levels of T3 and T4 between these two subgroups and control group （ P 〉 0.05 ）. Correlation analysis showed HAMD scores were closely related to level of TSH in PSD subgroup （ r = - 0.35, P 〈 0.01 ）. Conclusion In comparison with non - poststroke depression patients, PSD patients present
出处
《临床和实验医学杂志》
2011年第19期1491-1493,共3页
Journal of Clinical and Experimental Medicine
