CAJ | 학술논문

目的：探讨难治性抑郁症的临床特征与血清甲状腺激素相关性。方法对43例难治性抑郁症患者和48例非难治性抑郁症患者采用汉密尔顿抑郁量表17项（ HAMD17）和汉密尔顿焦虑量表（ HAMA）进行评估，采用放射免疫法测定两组患者血清TSH、TT3、TT4、FT3、FT4水平；组间比较采用χ2检验、t检验；验证FT3与是否患TRD的关系：logistic回归分析中以FT3为自变量，是否患TRD为因变量，分析FT3的降低程度与发生TRD风险大小之间的量化关系；通过ROC曲线评价FT3在TRD中的诊断价值。结果难治性抑郁症组（TRD组）与非难治性抑郁症组（非TRD组）比较，起病年龄TRD组[（16．98±2．25）岁]比非TRD组[（23．50±3．38）岁]更早，受教育年限TRD组[（8．53±1．72）年]比非TRD组[（11．04±2．07）年]更短，总病程及本次发病病程TRD组[（10．14±6．47）年，（60．35±23．64）月]比非TRD组[（5．48±4．15）年，（5．00±3．40）月]更长，HAMD总分及其行为阻滞因子分TRD组[（19．09±1．59）分，（8．72±0．98）分]比非TRD组[（15．69±2．38）分，（4．98±1．63）分]更高，甲状腺激素中FT3值TRD组[（3．92±0．15）pmol／L]比非TRD组[（4．16±0．20）pmol／L]更低，差异均有统计学意义（P＜0．05）。 Logistic回归分析显示FT3每降低0．1 pmol／L，发生TRD的危险性上升1．006倍[ OR＝2．006，95％CI ＝（1．501，2．681）]。 ROC曲线下面积为0．821（P＜0．001），其95％置信区间为（0．734，0．907）。结论难治性抑郁症患者病程更长，起病更早，文化水平更低，HAMD总分更高，阻滞症状更重，血清FT3水平更低；FT3对诊断TRD有较高的参考价值。
목적：탐토난치성억욱증적림상특정여혈청갑상선격소상관성。방법대43례난치성억욱증환자화48례비난치성억욱증환자채용한밀이돈억욱량표17항（ HAMD17）화한밀이돈초필량표（ HAMA）진행평고，채용방사면역법측정량조환자혈청TSH、TT3、TT4、FT3、FT4수평；조간비교채용χ2검험、t검험；험증FT3여시부환TRD적관계：logistic회귀분석중이FT3위자변량，시부환TRD위인변량，분석FT3적강저정도여발생TRD풍험대소지간적양화관계；통과ROC곡선평개FT3재TRD중적진단개치。결과난치성억욱증조（TRD조）여비난치성억욱증조（비TRD조）비교，기병년령TRD조[（16．98±2．25）세]비비TRD조[（23．50±3．38）세]경조，수교육년한TRD조[（8．53±1．72）년]비비TRD조[（11．04±2．07）년]경단，총병정급본차발병병정TRD조[（10．14±6．47）년，（60．35±23．64）월]비비TRD조[（5．48±4．15）년，（5．00±3．40）월]경장，HAMD총분급기행위조체인자분TRD조[（19．09±1．59）분，（8．72±0．98）분]비비TRD조[（15．69±2．38）분，（4．98±1．63）분]경고，갑상선격소중FT3치TRD조[（3．92±0．15）pmol／L]비비TRD조[（4．16±0．20）pmol／L]경저，차이균유통계학의의（P＜0．05）。 Logistic회귀분석현시FT3매강저0．1 pmol／L，발생TRD적위험성상승1．006배[ OR＝2．006，95％CI ＝（1．501，2．681）]。 ROC곡선하면적위0．821（P＜0．001），기95％치신구간위（0．734，0．907）。결론난치성억욱증환자병정경장，기병경조，문화수평경저，HAMD총분경고，조체증상경중，혈청FT3수평경저；FT3대진단TRD유교고적삼고개치。
Objective To explore the clinical characteristics of treatment?resistant depression ( TRD) and of its relevance with thyroid hormones. Methods 43 patients with TRD and 48 patients with non?TRD were as?sessed with 17?item Hamilton depression scale ( HAMD?17) and Hamilton anxiety scale ( HAMA) . The serum lev?el of thyroid?stimulating hormone ( TSH) ,total triodothgronine ( TT3) ,total thyroxine ( TT4) ,free triodothgronine ( FT3) and free thyroxine ( FT4) were determined by radioimmunoassay. χ2 test and t test were used for statistic a?nalysis. The quantitative relation of FT3 level with TRD was analyzed and the value of FT3 level in TRD diagnosis was evaluated by ROC curve.Results Compared with non?TRD patients,the TRD patients showed a younger dis?ease onset age ((16.98±2.25)years vs (23.50±3.38)years) and a longer disease course ((10.14±6.47)years vs (5.48±4.15)years) for total disease course;(60.35±23.64)months vs (5.00±3.40)months for current disease course),and had shorter education years ((8.53±1.72)years vs (11.04±2.07)years) and higher HAMD total scores (19.09±1.59 vs 15.69±2.38) and behavior retarding factor scores (8.72±0.98 vs 4.98±1.63). In addition, the FT3 level of TRD patients was lower than that of non?TRD patients ((3.92±0.15)pmol/L vs (4.16±0.20) pmol/L).All the above differences between two groups were statistically significant (P<0.05). The logistic regres?sion analysis showed that the risk of suffering TRD increased by 1. 006?fold when FT3 level reduced 0. 1 pmol/L (OR=2.006,95%CI=(1.501,2.681). The area under ROC curve was 0.821 (P<0.001) with its 95% confidence interval of (0.734,0.907). Conclusion Compared with non?TRD patients,TRD patients have a longer disease course,a younger disease onset age, a lower education level, higher HAMD total scores, more severe retardation symptoms,and a lower FT3 level. The serum FT3 level has a high reference value in diagnosis of TRD.