抑郁症患者血清性激素变化及其临床意义

Changes in Serum Sex Hormones in Patients with Depression and Their Clinical Significance

摘要: 目的：探讨抑郁症患者血清性激素水平、卵泡刺激素(follicle stimulating hormone, FSH)/黄体生成素(luteinizing hormone, LH)比值变化，及其与焦虑抑郁症状的相关性。方法：纳入2020年01月至2020年12月在昆明医科大学第一附属医院精神科住院的364例抑郁症患者作为抑郁组，选取同期健康体检人员994例作为对照组，按性别和年龄分为年轻男性抑郁组、老年男性抑郁组、年轻女性抑郁组、围绝经期女性抑郁组、老年女性抑郁组。测定纳入对象血清性激素水平，根据汉密尔顿抑郁量表、汉密尔顿焦虑量表评定病例组抑郁情绪和焦虑症状。采用Mann-Whitney U检验分析抑郁组与对照组血清性激素之间的差异，Pearson相关性分析评估抑郁组性激素与汉密尔顿抑郁量表(HAMD-17)及汉密尔顿焦虑量表(HAMA)评分的相关性。结果：1) 抑郁症患者泌乳素(prolactin, PRL)水平显著高于健康人群(P < 0.05)，男性患者中，45岁以上男性患者睾酮(testosterone, T)水平及T/雌二醇(estradiol, E2)高于健康人群(P < 0.05)，孕酮(progesterone, P)水平及FSH/LH低于健康人群(P < 0.05)；女性患者中，19~45岁女性患者T、FSH、FSH/LH、T/E2比值低于健康人群，E2水平高于健康人群(P < 0.05)。2) 19~45岁女性患者PRL水平与HAMA评分呈正相关(r = 0.195, P < 0.05)，FSH/LH与HAMD评分呈正相关(r = 0.264, P < 0.05)；45~55岁女性患者PRL水平与HAMA呈负相关(r = −0.251, P < 0.05)；55岁以上女性患者FSH/LH与HAMA呈负相关(r = −0.353, P < 0.05)，其他性激素指标与HAMD、HAMA评分无相关性(P > 0.05)。结论：不同性别和不同年龄段抑郁症患者血清性激素水平与HAMD、HAMA评分的相关性存在显著差异，性激素指标可作为抑郁症患者的早期诊治参考。

Abstract: Objective: To investigate the changes in serum sex hormone levels and follicle stimulating hormone (FSH)/luteinizing hormone (LH) ratio in patients with depression, and their correlation with anxiety and depressive symptoms. Methods: A total of 364 depressed patients hospitalized in the Department of Psychiatry of the First Affiliated Hospital of Kunming Medical University from January 2020 to December 2020 were included as the depression group, and 994 cases of health examiners during the same period were selected as the control group, and were divided into young male depression group, elderly male depression group, young female depression group, perimenopausal female depression group, and elderly female depression group according to gender and age. The serum sex hormone levels of the included subjects were measured, and the depressed mood and anxiety symptoms of the case group were assessed according to the Hamilton Depression Scale and the Hamilton Anxiety Scale. The Mann-Whitney U test was used to analyze the difference between serum sex hormones in the depressed group and the control group, and the Pearson correlation analysis was used to evaluate the correlation between sex hormones in the depressed group and Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) scores. Results: 1) Prolactin (PRL) levels in depressed patients were significantly higher than those in healthy people (P < 0.05), male patients over 45 years old had testosterone (T) levels and T/estradiol (E2) higher than healthy people (P < 0.05), progesterone (P) levels and FSH/LH were lower than healthy people (P < 0.05); Among female patients, the ratios of T, FSH, FSH/LH, and T/E2 in female patients aged 19~45 years were lower than those in healthy people, and the E2 level was higher than that in healthy people (P < 0.05). 2) The PRL level of female patients aged 19~45 years was positively correlated with the HAMA score (r = 0.195, P < 0.05), and FSH/LH was positively correlated with the HAHD score (r = 0.264, P < 0.05). The PRL level of female patients aged 45~55 years was negatively correlated with HAMA (r = −0.251, P < 0.05). FSH/LH was negatively correlated with HAMA in women over 55 years of age (r = −0.353, P < 0.05), and other sex hormone indexes were not correlated with HAMD and HAMA scores (P > 0.05). Conclusion: The correlation between serum sex hormone levels and HAMD and HAMA scores in depressed patients of different genders and different age groups is significantly different. Sex hormone indexes can be used as a reference for early diagnosis and treatment of depressed patients.