【作者】 吴大方；

【导师】 王家同； 姬秋和；

【作者基本信息】 第四军医大学 ， 应用心理学， 2007， 硕士

【摘要】 目的:T2DM患者抑郁症的发生率明显高于一般人群。一些学者认为糖尿病的病理生理改变可能是导致抑郁的重要原因。糖尿病引起的病理生理改变包括两个方面:一是血糖紊乱,二是神经内分泌的异常。胰岛素绝对或相对分泌不足是糖尿病患者糖代谢紊乱的根本原因。因此,给予外源性的胰岛素不仅纠正糖代谢紊乱,同时也可以纠正神经递质失调,促进神经细胞修复,阻断导致情绪紊乱的病理生理基础。而甲状腺功能是抑郁症发病及康复过程中重要的影响因素,甲状腺激素可能作为病因参与糖尿病的发病过程。本文通过对糖尿病患者胰岛素强化治疗前后抑郁的对比,胰岛素强化治疗者和口服降糖药治疗者抑郁情绪的对比及与血清甲状腺激素水平的相关性,探讨胰岛素强化治疗对糖尿病患者情绪的影响。方法:本研究应用抑郁自评量表,对入组的糖尿病患者入组时及胰岛素治疗三个月后进行抑郁情绪测定。并同时抽血送检甲状腺激素、FPG、2hPG、HbA1c。进行治疗前后的对比研究,并与口服降糖药治疗的对照组进行对比研究。治疗期间空腹血糖控制在4.4-6.1mmol/L,餐后2小时血糖控制在4.4-8.0mmol/L之间。采用t检验和秩和检验对数据进行统计。结果:胰岛素治疗前后抑郁程度差异显著(P < 0. 01),而口服降糖药组治疗前后无显著差异(P>0.05)。治疗前合并抑郁组T4、T3高于无抑郁组,TSH低于无抑郁组(P < 0. 01),治疗后两组T4、T3均下降,抑郁组较治疗前有显著差异,无抑郁组较治疗前无显著差异,抑郁组T4、T3仍高于无抑郁组,但两组间差异不显著,TSH略有下降,差异不显著。抑郁指数与T4、T3正相关,与TSH负相关;治疗后抑郁指数下降与T3、T4下降显著正相关(P < 0. 01)。结论:胰岛素强化治疗可以显著改善糖尿病患者的抑郁情绪,这种改变与甲状腺激素水平密切相关。更多还原

【Abstract】 Objective The prevalence of comorbid depression people with type 2 diabetes mellitus(T2DM) is reportedly higher than in the general population. Some scholars think the change that lead to diabetes’pathophysiologic may be the important reason of depression. The outgrowth changes by diabetes included two side: one is disorder of blood glucose; the other is abnormality of neuroendocrine. Absolute or relative absence of insulin is the prime cause of diabetic glucose metabolism.So that, use insulin treatment not only rectify the glucose metabolism’s disorder, but asle correct neurotransmitters’abnormality,promote neurons outgrowth and stop the base of pathophysiological of emotion disorder. The article compares depression before intensive insulin treatment with after in T2DM, meanwhile compare depression after intensive insulin treatment with after oral antihyperglycemic agents and the relation with thyroid hormone level. To study impact of intensive insulin treatment on emotion in diabetes patients. Methods Self-Rating Depression Scale was used to screen depression in patients with T2DM right away and after intensive insulin treatment. We tested all patient’s thyroid hormone,FPG,2hPG,HbA1c at the same time. To compare befor treatment with after and to compare with oral antihyperglycemic agents. Fasting plasma glucose between 4.6 mmol/L and 6.1mmol/L, 2 hours postprandial glucose between 4.4 mmol/L and 8.0mmol/L. Data was count by t-test and rand sum test. Results Depression degree showed significantly difference befor and after insulin treatment(P<0.01), but oral antihyperglycemic agents showed no significantly difference befor and after treatment(P>0.05). T3,T4 were highter and TSH was lower in comorbid depression patients than no comorbid depression befor treatment (P<0.01). T3,T4 in both groups were reduced, depression groups showed significantly difference befor and after treatment,no depression groups showed no significantly difference befor and after treatment.TSH was reduced lightly, but showed no significantly difference. Depression index was negatively correlated with T3,T4, was positive correlation with TSH. A drop in depression index was positive correlation with T3,T4 (P<0.01).Conclusion Intensive insulin treatment could markedly improved depression status in diabetic patients and that was closely related with thyroid hormone level.更多还原