甲状腺激素、性激素、皮质醇水平对评估首发女性抑郁障碍严重程度的临床意义

李鑫; 孙妍; 陈薇; 马文有; 于振剑; 张顺; 梁晓亮; 雷荣

doi:10.16766/j.cnki.issn.1674-4152.003513

甲状腺激素、性激素、皮质醇水平对评估首发女性抑郁障碍严重程度的临床意义

doi: 10.16766/j.cnki.issn.1674-4152.003513

李鑫¹,
孙妍^1, ,,
陈薇¹,
马文有¹,
于振剑¹,
张顺¹,
梁晓亮¹,
雷荣²

1.
开滦精神卫生中心精神科，河北唐山 063000
2.
惠州市第二人民医院精神科，广东惠州 516000

基金项目:

河北省2023年度医学科学研究课题计划 20231851

详细信息

通讯作者:
孙妍，E-mail：657301411@qq.com

中图分类号: R749.4 R446.112
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-18
- 网络出版日期: 2024-07-20

Clinical significance of thyroid hormones, sex hormones, and cortisol levels in assessing the severity of first-episode female depression disorder

1.
Department of Psychiatry, Kailuan Mental Health Center, Tangshan, Hebei 063000, China

摘要

摘要: 目的本研究探讨了甲状腺激素、性激素和皮质醇水平在不同严重程度的首发女性抑郁障碍患者中的分布差异，旨在深化对抑郁障碍激素调节机制的理解，并为临床诊断提供潜在的生物标志物。方法选取2022年6月—2023年6月于开滦精神卫生中心住院的首发女性抑郁障碍患者150例。收集患者的一般资料，并测量甲状腺素[T4、T3、促甲状腺激素(TSH)、FT3、FT4]和性激素[睾酮(T)、催乳素(PRL)、孕酮(P)、雌二醇(E2)]水平，以及促肾上腺皮质激素(ACTH)和皮质醇(COR)水平。采用Zung氏抑郁自评量表(SDS)评估患者抑郁程度。根据SDS评分和临床医生的诊断，将患者分为轻中度抑郁组(70例)和重度抑郁组(80例)。使用logistic回归及ROC曲线进行数据分析。结果轻中度抑郁组患者的FT3、FT4水平高于重度抑郁组患者，而TSH、睾酮(T)、雌二醇(E2)、ACTH、COR水平则显著低于重度抑郁组(P＜0.05)。低水平FT3和高水平T被认为是首发女性抑郁障碍患者重度发作的潜在危险因素。FT3和T水平用于诊断首发女性抑郁障碍患者为重度发作的曲线下面积分别为0.687(95% CI：0.602~0.773，P＜0.001)和0.654(95% CI：0.563~0.744，P=0.001)。FT3为3.165 pg/mL时，诊断为重度发作的灵敏度为82.5%，特异度为51.4%；T为0.221 ng/mL时，灵敏度为75.0%，特异度为62.9%。结论 FT3和T水平的变化与首发女性抑郁障碍的严重程度有显著相关性，为抑郁障碍的生物标志物研究提供了新的视角。
- 首发女性抑郁障碍 /
- 严重程度 /
- 甲状腺功能 /
- 性激素 /
- 皮质醇
Abstract: Objective This study aims to investigate the distribution differences of thyroid hormones, sex hormones, and cortisol levels in first-episode female patients with depression across varying severity levels. The goal was to deepen the understanding of the hormonal regulation mechanisms in depression and identify potential biomarkers for clinical diagnosis. Methods A total of 150 first-episode female patients with depression hospitalized at the Kailuan Mental Health Center from June 2022 to June 2023 were selected. General information of the patients was collected, and the levels of thyroid hormones (T4, T3, TSH, FT3, FT4), sex hormones (T, PRL, P, E2), adrenocorticotropic hormone (ACTH), and cortisol (COR) were measured. The severity of depression was assessed using the Zung self-rating depression scale (SDS). Based on the SDS scores and clinical diagnosis, patients were divided into a mild-to-moderate depression group (70 patients) and a severe depression group (80 patients). Logistic regression and ROC curve analysis were employed for data analysis. Results Patients in the mild-to-moderate depression group exhibited higher levels of FT3 and FT4, while lower levels of TSH, testosterone (T), estradiol (E2), ACTH, and COR compared to the severe depression group (P < 0.05). Low levels of FT3 and high levels of T were identified as potential risk factors for severe episodes in first-episode female patients with depression. The area under the curve (AUC) for diagnosing severe episodes in first-episode female patients with depression based on FT3 and T levels were 0.687 (95% CI: 0.602-0.773, P < 0.001) and 0.654 (95% CI: 0.563-0.744, P=0.001), respectively. At an FT3 level of 3.165 pg/mL, the sensitivity for diagnosing severe episodes was 82.5% with a specificity of 51.4%. Similarly, at a T level of 0.221 ng/mL, the sensitivity was 75.0% with a specificity of 62.9%. Conclusion Variations in FT3 and T levels are significantly correlated with the severity of first-episode depression in female patients, providing a new perspective on the study of biomarkers in depressive disorders.
- First episode female depressive disorder /
- The degree of severity /
- Thyroid function /
- Sex hormone /
- Cortisol

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图 1 FT3水平预测首发女性重度抑郁障碍的ROC曲线分析

Figure 1. ROC curve analysis of FT3 levels predicting major depressive disorder in women

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图 2 TSH、T、E2水平预测首发女性重度抑郁障碍的ROC曲线分析

Figure 2. ROC curve analysis of TSH, T, and E2 levels in predicting initial onset of major depressive disorder in women

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表 1 2组女性抑郁障碍患者基线资料比较

Table 1. Comparison of baseline data between two groups of female patients with depressive disorders

组别	例数	年龄[M(P₂₅, P₇₅)，岁]	受教育程度[例(%)]		吸烟史[例(%)]		饮酒史[例(%)]		婚姻状况[例(%)]		家族史[例(%)]
组别	例数	年龄[M(P₂₅, P₇₅)，岁]	高中以下	高中及以上	有	无	有	无	已婚	未婚/离异/丧偶	阴性	阳性
轻中度抑郁组	70	40(19, 57)	50(71.43)	20(28.57)	4(5.71)	66(94.29)	6(8.57)	64(91.43)	58(82.86)	12(17.14)	60(85.71)	10(14.29)
重度抑郁组	80	40(19, 55)	54(67.50)	26(32.50)	6(7.50)	74(92.50)	8(10.00)	72(90.00)	66(82.50)	14(17.50)	66(82.50)	14(17.50)
统计量		1.368^a	0.271^b		0.012^b		0.090^b		0.003^b		0.287^b
P值		0.171	0.603		0.913		0.764		0.954		0.592
注：^a为Z值，^b为χ²值。

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表 2 2组女性抑郁障碍患者激素水平的比较[M(P₂₅, P₇₅)]

Table 2. Comparison of hormone levels in two groups of female depression patients [M(P₂₅, P₇₅)]

组别	例数	T3(ng/mL)	FT3(pg/mL)	T4(ng/mL)	FT4(pg/mL)	TSH(μIU/mL)	T(ng/mL)
轻中度抑郁组	70	1.64(1.46, 1.78)	3.17(2.92, 3.29)	77.85(67.32, 85.82)	14.17(12.94, 14.99)	1.62(0.77, 2.01)	0.21(0.18, 0.33)
重度抑郁组	80	1.52(1.41, 1.82)	2.95(2.66, 3.15)	74.49(66.24, 89.77)	13.54(12.26, 14.59)	2.20(1.20, 3.34)	0.25(0.22, 0.38)
Z值		1.575	3.949	0.460	2.841	2.878	3.241
P值		0.115	＜0.001	0.646	0.005	0.004	0.001

组别	例数	PRL(μIU/mL)	P(ng/mL)	E2(pg/mL)		ACTH(pg/mL)	COR(ng/mL)
轻中度抑郁组	70	307.35(182.63, 690.86)	1.34(0.80, 5.55)	40.73(29.84.69.37)		22.81(13.23, 30.95)	197.12(144.45, 226.21)
重度抑郁组	80	304.01(238.44, 549.95)	0.93(0.73, 1.52)	55.65(34.42.131.36)		15.46(8.47, 23.98)	158.41(127.81.189.86)
Z值		0.075	1.809	2.923		3.037	3.263
P值		0.940	0.071	0.003		0.002	0.001

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表 3 首发女性抑郁障碍患者为重度发作的多因素logistic回归分析

Table 3. Multifactorial logistic regression analysis of severe episodes in patients with initial female depression disorder

变量	B	SE	Waldχ²	P值	OR(95% CI)
FT3(pg/mL)	-1.802	0.626	8.282	0.004	0.165(0.048~0.563)
FT4(pg/mL)	-0.215	0.134	2.584	0.108	0.807(0.621~1.048)
TSH(μIU/mL)	0.375	0.154	5.961	0.015	1.455(1.077~1.966)
T(ng/mL)	3.975	1.330	8.931	0.003	53.232(3.927~721.589)
E2(pg/mL)	0.010	0.005	4.944	0.026	1.010(1.001~1.020)
ACTH(pg/mL)	-0.034	0.023	2.131	0.144	0.967(0.924~1.012)
COR(ng/mL)	-0.005	0.005	1.005	0.316	0.995(0.987~1.004)

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