| 赵明明,马家惠,李超,牛耕耘,王志飞,刘增训.艾司西酞普兰和帕罗西汀改善首发抑郁障碍患者认知功能及其与甲状腺激素水平的关系[J].四川精神卫生杂志,2023,36(3):222-227.Zhao Mingming,Ma Jiahui,Li Chao,Niu Gengyun,Wang Zhifei,Liu Zengxun,Improvement of cognitive function by escitalopram and paroxetine in patients with first-episode depressive disorder and its relationship with thyroid hormone levels[J].SICHUAN MENTAL HEALTH,2023,36(3):222-227 |
| 艾司西酞普兰和帕罗西汀改善首发抑郁障碍患者认知功能及其与甲状腺激素水平的关系 |
| Improvement of cognitive function by escitalopram and paroxetine in patients with first-episode depressive disorder and its relationship with thyroid hormone levels |
| 投稿时间：2022-10-08 |
| DOI：10.11886/scjsws20221008001 |
| 中文关键词: 抗抑郁药 抑郁障碍 认知功能 甲状腺激素 |
| 英文关键词:Antidepressant Depression Cognitive function Thyroid hormone |
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| 中文摘要: |
| 背景 抑郁障碍患者认知功能受损发生率较高，其受损原因及机制值得重点关注。抑郁障碍患者通常存在甲状腺激素水平改变，抑郁障碍患者认知功能改变是否与甲状腺激素有关，有待进一步研究。目的 探讨首发抑郁障碍患者在接受艾司西酞普兰和帕罗西汀治疗后认知功能的改善情况，并分析其与甲状腺激素水平的相关性，从而寻找抑郁障碍患者认知功能改变的潜在生物标志物。方法 选取2021年3月-2022年3月于山东省精神卫生中心住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）抑郁障碍诊断标准的120例患者为研究对象，采用随机数字表法分为两组，各60例，分别接受为期6周的艾司西酞普兰（起始剂量为5 mg/d）和帕罗西汀（起始剂量为20 mg/d）治疗。在治疗前及治疗6周后，分别检测患者的血清促甲状腺激素（TSH）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）水平。采用汉密尔顿抑郁量表17项版（HAMD-17）和蒙特利尔认知评估量表（MoCA）分别评定患者治疗前后抑郁程度和认知功能水平。采用Pearson或Spearman相关分析考查两组治疗前后MoCA评分差值与治疗后甲状腺激素水平的相关性。结果 治疗前和治疗6周后，两组HAMD-17总评分的时间效应有统计学意义（F=1 236.568，P<0.01），MoCA总评分的时间效应、组别效应以及时间与组别的交互效应均有统计学意义（F=79.186、6.026、20.417，P<0.05或0.01）。两组FT3水平和FT4水平的时间效应、组别效应以及时间与组别的交互效应均有统计学意义（F=75.973、20.287、0.961、84.194、0.142、8.299，P<0.05或0.01）。单独效应分析显示，治疗后，两组MoCA总评分均高于治疗前，FT3和FT4水平均低于治疗前（F=15.864、5.421、8.524、6.443、7.628、3.639，P均<0.01）。治疗6周后，艾司西酞普兰组和帕罗西汀组MoCA总评分、FT3和FT4水平差异均有统计学意义（t=5.841、-0.705、-2.349，P<0.05或0.01）。帕罗西汀组治疗前后MoCA评分差值与治疗后FT3和FT4水平均呈正相关（r=0.276、0.382，P<0.05或0.01）。结论 艾司西酞普兰和帕罗西汀均有助于改善首发抑郁障碍患者的认知功能，帕罗西汀对患者认知功能的改善可能与血清FT3和FT4水平变化有关。 |
| 英文摘要: |
| Background The incidence of cognitive impairment in patients with depressive disorder is high， and the causes and mechanisms of which deserve more attention. It is usual that the thyroid hormone levels in patients with depressive disorder alter. Further research is needed to explore whether the cognitive function changes in patients with depressive disorder are related to thyroid hormone levels.Objective To explore the improvement of cognitive function in patients with first-episode depressive disorder after escitalopram and paroxetine treatment， and to analyse its correlation with thyroid hormone levels， so as to look for potential biomarkers of cognitive function change in patients with depressive disorder.Methods From March 2021 to March 2022， 120 patients who met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） for depression and were hospitalized at Shandong Mental Health Center were selected as the research objects. They were randomly divided into two groups by random number table method with 60 patients in each group. The two groups were treated with escitalopram （starting dose 5 mg/d） and paroxetine （starting dose 20 mg/d） for 6 weeks. Before and 6 weeks after the treatment， levels of thyroid stimulating hormone （TSH）， free thyroxine （FT4） and free triiodothyronine （FT3） were tested respectively. Depression degree and cognitive function level were assessed using the Hamilton Depression Scale-17 item （HAMD-17） and Montreal Cognitive Assessment （MoCA）， respectively. Pearson or Spearman correlation analysis was used to examine the correlation between the MoCA score difference before and after the treatment and the post-treatment level of thyroid hormone.Results Before and 6 weeks after the treatment， the time effect of HAMD-17 total score in both groups was statistically significant （F=1 236.568， P<0.01）. Also， the time effect， group effect as well as interaction effect of time and group of MoCA total score in both groups were statistically significant （F=79.186， 6.026， 20.417， P<0.05 or 0.01）. The time effect， group effect as well as the interaction effect of time and group for FT3 level and FT4 level were statistically significant in both groups （F=75.973， 20.287， 0.961， 84.194， 0.142， 8.299， P<0.05 or 0.01）. According to the simple effect analysis. After the treatment， the MoCA total score in both groups was higher than that before treatment， while FT3 and FT4 levels were lower than those before treatment （F=15.864， 5.421， 8.524， 6.443， 7.628， 3.639， P<0.01）. After the 6-week treatment， the MoCA total score as well as FT3 and FT4 level differences in escitalopram and paroxetine groups were of statistical significance （t=5.841， -0.705， -2.349， P<0.05 or 0.01）. The MoCA score difference before and after treatment in paroxetine group was positively correlated with FT3 and FT4 levels after treatment （r=0.276， 0.382， P<0.05 or 0.01）.Conclusion Both escitalopram and paroxetine can improve cognitive function in patients with first-episode depressive disorder. The improvement may be related to the changes in serum FT3 and FT4 levels. |
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