摘要
目的:探讨儿童期受虐与抑郁症患者血浆瘦素水平及下丘脑-垂体-肾上腺轴功能之间的相关性。方法:选取首发抑郁症患者152例,使用儿童受虐问卷(CTQ)、汉密顿抑郁量表-24(HAMD-24)、汉密顿焦虑量表(HAMA)评定儿童期受虐状况及抑郁与焦虑严重程度;根据儿童受虐问卷评分将受试者分为受虐组(55例),无受虐组(97例)。采用酶联免疫吸附法测定血浆瘦素水平。各组行地塞米松抑制试验(DST),测量各组血浆皮质醇浓度,并计算各组脱抑制率。结果:152例入组患者中55例(36.18%)有儿童期受虐史。儿童期有无受虐组在首次发病年龄、性别比、HAMD-24总分、HAMA总分等方面差异均有统计学意义。儿童期受虐组的血浆瘦素水平[(5.164±2.754)ug/L]低于无受虐组[(7.234±4.892)ug/L;P<0.05]和正常对照组[(9.791±7.433)ug/L;P<0.000],无受虐组的血浆瘦素水平低于正常对照组(P<0.01)。儿童期受虐组和无受虐组DST前后皮质醇水平[(578±126,374±139)ng/L和(562±131,333±135)ng/L]和脱抑制率(71%和68%)高于对照组[(416±104,225±86)ng/L;43%],差异均有统计学意义(均P<0.05)。结论:抑郁症患者血浆瘦素及HPA轴均存在明显异常,有儿童期虐待者表现更严重,儿童期受虐导致血浆瘦素水平下降及HPA轴异常可能是成年后罹患抑郁症的可能机制。
Objective:To explore the correlation between childhood abuse and the leptin level in blood plasma and the functions of HPA axis for depression patients.Method:152 first-onset depression patients were included in this study.The severity of their childhood abuse,depression and anxiety were assessed with Childhood Trauma Questionnaire(CTQ),Hamilton rating scale for depression(HAMD)and Hamilton rating scale for anxiety(HAMA).Subjects were divided into the abuse group(n=55)and non-abuse group(n=97)according to CTQ scores.Leptin level was determined by using the Enzyme Linked Immunosorbent Assay.Each group underwent Dexamethasone Suppression Tests(DST)in order to measure the cortisol concentration in blood plasma and to calculate the rate of derepression.Results:55 in 152 patients(36.18%)included in this study had the experience of being abused in their childhood according to the CTQ scores.There were significant differences between the abuse group and the non-abuse group in the age of the onset ages,sex ratio and the total score of HAMD-24 and HAMA.Leptin levels of patients in the abuse group[(5.164±2.754)ug/L]were lower than those in non-abuse group((7.234±4.892)ug/L;P<0.05)and those in the control group((9.791±7.433)ug/L;P<0.000).Leptin levels of patients in the non-abuse group were lower than those in control group(P<0.01).Before and after undergoing DST,the cortisol levels of patients in the abuse and non-abuse group[(578±126),(374±139)ng/L and(562±131),(333±135)ng/L]and the rate of derepression of patients in the abuse and non-abuse group(71%and 68%)were higher than those in the control group[(416±104),(225±86)ng/L;43%]with the differences statistically significant(P<0.05).Conclusion:Obvious disorders in plasma leptin and HPA axis exist in depression patients and it can be more serious for patients with childhood abuse experience.The declined plasma leptin level and the HPA axis disorder caused by childhood abuse are likely to be the mechanism of developing depression in adult.
作者
汪卫华
隋云川
刘丽
刘羽
周蓉
赵汉清
WANG Wei hua;SUI yun-chuan;LIU Li;Liu Yu;ZHOU Rong;ZHAO Han-qing(th Hospital of PLA,Changzhou 213003,China)
出处
《临床精神医学杂志》
2019年第5期336-338,共3页
Journal of Clinical Psychiatry
基金
全军医药卫生基金资助项目(14MS014)
