伴无症状性脑梗塞抑郁症血清皮质醇变化研究.docVIP

伴无症状性脑梗塞抑郁症血清皮质醇变化研究 张静霞 张兰2 目的：抑郁症被世界卫生组织确定为到2020年影响人们正常社会生活的第二大疾病。血管性抑郁作为抑郁症的一种亚型，在临床表现、影像学特征和治疗转归等方面均有特殊性。本课题通过检测伴无症状性脑梗塞（asymptomatic cerebral infarction ）抑郁症患者治疗前后血清皮质醇水平含量，分析血管性抑郁神经内分泌改变。 方法：采用病例对照研究，抑郁症患者66例为病例组，依照CT检查结果分为：伴无症状性脑梗塞（ACI+）的抑郁症组31例；无脑梗塞 (ACI-)的抑郁症组35例，同时以健康体检者35人为正常对照。用放射免疫法测皮质醇。采用HAMD抑郁量表评定抑郁程度。 结果：1.抑郁症组皮质醇水平较正常对照组高，差异显著（p＜0.05）；2.治疗前、后伴无症状性脑梗塞（ACI+）的抑郁症组与无脑梗塞 (ACI-)的抑郁症组血清皮质醇水平比较差异无显著性（p＞0.05）；3.盐酸帕罗西汀治疗后ACI（+）组血清皮质醇降低（p＜0.05），ACI（-）血清皮质醇降低（p＜0.01）；4.治疗前及治疗后ACI（+）组较ACI（-）组HAMD评分高（p＜0.01），治疗6周时ACI（+）组治愈率低于ACI（-）组；5.两组血清皮质醇水平与HAMD各因子无相关性。 结论：1.伴无症状性脑梗塞抑郁症患者存在下丘脑-垂体-肾上腺轴的改变，与其他抑郁相比这种改变存在一致性。2.伴无症状性脑梗塞抑郁症患者抑郁程度更重，疗效较差。 关键词：血管性抑郁；无症状性脑梗塞；皮质醇； An analysis of serum Cortisol abnormalities in patients with major depression and asymptomatic cerebral infarction Objective: Major depression is a serious and disabling illness, estimated by the World Health Organization to be the second most important world -wide cause ofloss in disability adjusted life years by 2020. As a subtype of depression,vascular depression has its particularity in clinical manifestation,neuro-imaging characteristics,and treatment outcome.To investigated the changes of serum cortisol in depressed patients with asymptomatic cerebral infarction. Methods: We classified 66 depression patients into two groups-those withACI(+)(N=31) and ACI(-)(N=35),Over the age of 50 underwent the brain CT.The two group patients were compared on serum cortisol.Cortisol conducted by PEG. Hamilton Depression Scale (HAMD) was used to assess the depressive symptoms before and after treatment.Results: 1. patients group was higher than normal controls before treatment in serum cortisol（p＜0.05）.2. No significant differenced was founded after paroxetine was taken 2 weeks between the ACI(+) group and ACI(-) group in serum cortisol（p＞0.05）. 3. Serum cortisol decreased after trentment in ACI(+)group and ACI(-) group(p＜0.05, p＜0.01).4. The ACI(+) group HAMD Scores was higher than ACI(-) before and after trentme