女性精神分裂癥患者垂體-甲狀腺軸和垂體-腎上腺軸功能研究

朱云程,王芳,劉麗,曽婷

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女性精神分裂癥患者垂體-甲狀腺軸和垂體-腎上腺軸功能研究

朱云程,王芳,劉麗,曽婷

目的探討女性精神分裂癥患者神經(jīng)內(nèi)分泌的病理生理及其與臨床癥狀的相關(guān)性。方法采用病例-對照研究方法將106例女性精神分裂癥急性期發(fā)作患者(精神分裂癥組)及40名性別、年齡相匹配的健康對照者(健康對照組)進(jìn)行血液促甲狀腺激素(TSH)、游離三碘甲狀腺原氨酸(FT3)、游離甲狀腺激素(FT4)、三碘甲狀腺原氨酸(TT3)、甲狀腺激素(TT4)、促腎上腺皮質(zhì)激素(ACTH)及皮質(zhì)醇(COR)水平檢測和比較；分析患者神經(jīng)內(nèi)分泌與年齡、病程、陽性與陰性癥狀量表(PANSS)評分的關(guān)系。結(jié)果精神分裂癥組TSH[(2.71±1.98)mIU/L]、COR[(478.03±225.26)nmol/L]較健康對照組[(1.83±0.94)mIU/L、(365.83±92.52)nmol/L]顯著升高(t=3.613,3.816；P均<0.05)；患者的病程與甲狀腺激素水平呈正相關(guān)(r=0.211～0.305,P均<0.05)；PANSS的陰性癥狀分與TT3水平呈負(fù)相關(guān)(r=-0.389,P<0.05),與FT4水平呈正相關(guān)(r=0.363,P<0.05)；一般精神病理分與TT3、FT3水平呈負(fù)相關(guān)(r=-0.542，r=-0.426,P均<0.05),與COR水平呈正相關(guān)(r=0.477,P<0.05)。結(jié)論女性精神分裂癥急性期發(fā)作患者的甲狀腺激素水平降低,腎上腺激素水平升高；神經(jīng)內(nèi)分泌改變可能與疾病病程、精神癥狀相關(guān)。

精神分裂癥； 甲狀腺功能測驗； 腎上腺功能測驗； 神經(jīng)內(nèi)分泌

Abstract：Objective： To investigate the neuroendocrinal pathophysiology in female patients with schizophrenia and the correlation with clinical symptoms.Method：The present case-control study was processed to test the haemoconcentrations of thyroid stimulating hormone(TSH),triiodothyronine(TT3),thyroxin(TT4),free triiodothyronine(FT3),free thyroxin(FT4),adrenocoticotropic hormone( ACTH) and cortisol(COR) in a total of 106 female schizophrenia patients(study group) and 40 age,gender matched healthy controls(HC).The relationship between neuroendocrine and age,course,positive and negative symptoms scale(PANSS) were analyzed by Pearson's correlation analysis.Results：TSH[(2.71±1.98)mIU/Lvs.(1.83±0.94)mIU/L,t=3.613]and COR[(478.03±225.26)nmol/Lvs.(365.83±92.52)nmol/L,t=3.816]of study group were higher than HC with statisitical significance(allP<0.05).Psychiatric course showed positive correlations with thyroid hormones (r=0.211～0.305,allP<0.05).PANSS negative subscale and TT3 level showed negative correlation(r=-0.389,P<0.05) whiles FT4 level showed positive correlation(r=0.363,P<0.05).PANSS mental pathological subscale and TT3 and FT3 levels showed negative correlation(r=-0.542，r=-0.426;allP<0.05) whiles COR level showed positive correlation(r=0.477,P<0.05).Conclusion： The decreased level of thyroid hormone and the increased level of adrenal hormone indicated neuroendocrinal pathophysiology plays a different role in female patients with schizophrenia.Neuroendocrinal changes may be corelated with psychiatric course and mental symptoms.

Keywords： schizophrenia; thyroid function test; adrenal function test; neurosecretory system

神經(jīng)內(nèi)分泌功能變化和精神疾病發(fā)病機(jī)制的臨床研究結(jié)論缺乏一致性。下丘腦、垂體、腺體組成的一個完整的神經(jīng)內(nèi)分泌功能環(huán)路系統(tǒng),調(diào)節(jié)相應(yīng)的腺體激素分泌。任何能導(dǎo)致腺體功能的儲存、分泌、活性、旁路代謝的綜合改變的失調(diào)都會影響正常神經(jīng)組織的功能,神經(jīng)內(nèi)分泌紊亂由此能產(chǎn)生典型的精神癥狀。下丘腦-垂體-甲狀腺軸(HPTA)與精神疾病發(fā)病期患者的情緒調(diào)節(jié)、整體認(rèn)知功能改變顯著相關(guān)[1]；下丘腦-垂體-腎上腺軸(HPAA)與神經(jīng)心理應(yīng)激和神經(jīng)組織活性的關(guān)系中同樣扮演重要角色[2]。HPTA與HPAA的神經(jīng)內(nèi)分泌參與并調(diào)節(jié)急性應(yīng)激反應(yīng)過程中情緒、情感以及認(rèn)知行為[3]。HPTA系統(tǒng)研究[4]中發(fā)現(xiàn),在排除藥物干擾的情況下,伴隨泌乳素升高；……