• 四川大學(xué)華西心理衛(wèi)生中心（成都 610041）;

目的 　探討難治性抑郁癥患者認(rèn)知功能的特點(diǎn)以及與神經(jīng)內(nèi)分泌之間的相關(guān)性。
方法 　以符合ICD-10抑郁發(fā)作診斷標(biāo)準(zhǔn)且已經(jīng)使用過兩種以上不同種類抗抑郁藥物，目前仍符合抑郁發(fā)作診斷標(biāo)準(zhǔn)的41例難治性抑郁癥患者為試驗(yàn)組，40例符合ICD-10抑郁發(fā)作診斷標(biāo)準(zhǔn)，未經(jīng)抗抑郁藥物治療或曾經(jīng)使用過一種抗抑郁藥治療有效的非難治性抑郁癥患者為對照組，使用全套WAIS智力測驗(yàn)（WAIS-RC）、STROOP、詞匯流暢性（VF）、延線測驗(yàn)A、B（TRAILS A，B）、漢諾塔（TOH）、威斯康辛卡片分類測驗(yàn)改良版（M-WCST）進(jìn)行評測，同時(shí)進(jìn)行血清皮質(zhì)醇、促腎上腺皮質(zhì)激素（ACTH）、三碘甲狀腺原氨酸（T3）、游離三碘甲狀腺原氨酸（FT3）、甲狀腺素（T4）、游離甲狀腺素（FT4）、促甲狀腺激素刺激激素（TSH）的濃度測定。
結(jié)果 　難治性抑郁組同非難治性抑郁組比較，在VF方面差異有統(tǒng)計(jì)學(xué)意義，提示在短時(shí)記憶、注意、干擾抑制能力方面難治性抑郁損害更嚴(yán)重。在神經(jīng)內(nèi)分泌指標(biāo)方面，難治性抑郁組同非難治性抑郁組比較，ACTH水平差異有統(tǒng)計(jì)學(xué)意義，提示難治性抑郁的下丘腦-垂體-腎上腺軸（HPA軸）損害可能更嚴(yán)重，主要是記憶和注意缺損。
結(jié)論 　難治性抑郁患者的皮質(zhì)醇、ACTH、TSH、FT3以及T4水平的變化同認(rèn)知功能損害可能相關(guān)。

引用本文： 李喆,孫學(xué)禮,黃頤,張波. 難治性抑郁癥患者認(rèn)知功能特點(diǎn)及其與神經(jīng)內(nèi)分泌的相關(guān)性研究. 中國循證醫(yī)學(xué)雜志, 2007, 07(8): 575-579. doi: 復(fù)制

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  1. 1. J Affect Disord, 2002, 68(223): 261-271.
  2. 2. Gen Hosp Psychiatry, 2004, 26(4):302-309.
  3. 3. J Gerontol B Psychol Sci Soc Sci, 1998, 53(4): 234-239.
  4. 4. J Gerontol A Biol Sci Med Sci, 1999, 54(3): 111-116.
  5. 5. Howland RH, Gewirtz GR, Guscott R. Compiled by Fu SJ. Dysthyreosis and refractory depression. Foreign Medical Sciences, Section of Psychiatry, 1994, 21(1): 40-43.
  6. 6. Fossati P, Coyette F, Ergis AM: Influence of age and executive functive functioning on verbal memory of inpatients with depression.
  7. 7. Fraser SA, Kroenke K, Callahan CM, et al. Low yield of thyroid-stimulating hormone testing in elderly patients with depression.
  8. 8. Ehnvall A, Sjogren M, Zachrisson OC, et al. HPA axis activation determined by the CRH challenge test in patients with few versus multiple episodes of treatment- refractory Depression. Eur Arch Psychiatry Clin Neurosci, 2004, 254(6): 349.
  9. 9. Kirkegaard C, Faber J. The role of thyroid hormones in depression. Eur J Endocrinology, 1998, 138(1): 1-9.
  10. 10. Wahlin A，Wahlin TB, Small BJ, et al. Influences of thyroid stimulating hormone on cognitive functioning in very old age.
  11. 11. Prinz PN, Scanlan JM, Vitaliano PP, et al.Thyroid hormones: Positive relationships with cognition in healthy, euthyroid older men.
  12. 12. Howland RH, Gewirtz GR, Guscott R. 符少劍, 編譯. 甲狀腺功能障礙與難治性抑郁癥. 國外醫(yī)學(xué)精神病學(xué)分冊, 1994, 21(1): 40~43.