【作者】 张娅男；

【导师】 张晓明；

【作者基本信息】 泰山医学院 ， 老年医学， 2007， 硕士

【摘要】 目的:探讨老年抑郁症脑电及单胺类神经递质和血脂水平变化及相关的心理-社会影响因素的影响,以提高对老年抑郁症的认识,为临床治疗和预防提供可靠的理论依据。方法:采用病例-对照研究设计方案。按CCMD-3心境障碍抑郁发作诊断标准,收集30例60岁以上首次发作的抑郁患者(抑郁组),34名健康老年人(对照组)。对入选者先进行研究告知,同意后即开始进行一般情况调查表、生活事件量表(LES)、简易应对方式问卷(SCSQ)、艾森克个性问卷(EPQ)、社会支持评定量表(SSRS)进行评定,用以分析老年抑郁症的个体心理社会因素。其次收集个体近一周血生化检查中的甘油三酯(TG)、血清胆固醇(CHO)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。再用脑电超慢涨落技术(ET)对脑电、熵值、脑功能状态、单胺类神经递质变化进行检测。把两组的结果进行对比,以分析老年抑郁症的脑功能状态、血脂水平和相关的促发因素。结果:1.脑功能方面:(1)抑郁组的脑功能优势涨落平均功率空间的前后功率梯度逆转数明显高于对照组,左右功率梯度逆转数对照组明显高于抑郁组(P<0.001)。(2)抑郁组8Hz优势几率明显高于对照组,10Hz优势几率低于对照组(P<0.05);抑郁组4个脑区的熵值均高于对照组(P<0.01)。(3)抑郁组单胺类神经递质去甲肾上腺素(NE)、5-羟色胺(5-HT)、多巴胺(DA)激活水平均低于对照组(P<0.001,P<0.001,P<0.01)。2.生化方面:(1)抑郁组的甘油三酯(TG)水平高于对照组(P<0.01),血清胆固醇(CHO)及低密度脂蛋白胆固醇(LDL-C)水平低于对照组(P<0.05, P<0.001),高密度脂蛋白胆固醇(HDL-C)水平两组无显著性差异(P>0.05)。(2)抑郁组单胺类神经递质与血脂水平之间的关系:CHO水平与NE值正相关(r=0.509, P<0.05),CHO水平与5-HT值正相关(r=0.454, P<0.05)。3.认知和应对方面:(1)抑郁组认知(MMSE)总分显著低于对照组(P<0.001),因子即刻回忆和延迟回忆分也显著低于对照组(P<0.01,P<0.001)。(2)在应对方式中,抑郁组积极应对维度小于对照组(P<0.001),消极应对维度多于对照组(P<0.01)。4.受社会因素影响方面:(1)抑郁组生活事件数量、强度总分及负性生活事件数量、强度值均显著高于对照组(P<0.001)。(2)SSRS评定显示抑郁组社会支持总分、对支持的利用度及主观支持分低于对照组(P<0.001,P<0.001,P<0.01)。5.个性因素影响方面:抑郁组神经质、精神质得分高于对照组(P<0.01,P<0.001)。结论:(1)老年抑郁症患者脑功率的逆转率高于对照组;α波慢化、认知参量10Hz明显减少、脑有序性降低;其脑功能状态是混沌的。(2)老年抑郁症患者血脂异常,其中低浓度血清胆固醇与老年抑郁症具有相关性。(3)老年抑郁症组存在着较高的认知功能异常:即刻回忆及延迟回忆能力低于对照组;负性生活事件和社会支持少在老年抑郁症的发生中起着重要作用;高精神质和高神经质的老年人更易患抑郁症。(4)老年抑郁症状是神经生物学因素和社会心理学因素共同作用的结果,即心理社会因素、生化代谢异常、大脑功能三方面相互联系,相互影响。更多还原

【Abstract】 Objective: This study attempted to explore brain electrobiological activity, monoamine neurotransmitters, serum lipids and relative psychosocial factors of elderly depressed patents so as to deepen the understanding of the elderly depression and provide reliably a theoretical basis for treatment and prevention.Methods: The method adopted in this paper was case-controlled design. 30 elderly depressive people (aged over 60) (depression group) with the first episode of depression diagnosed according to CCMD-3, and 34 elderly healthy people (aged over 60) (control group) were investigated. All subjects were informed and agreed and then they were interviewed in self-designed general information questionnaire, HAMD, HAMA, MMSE, LES, SCSQ, SSRS and EPQ to analyze the psychosocial factors of elderly depressed people. Secondly, all subjects were collected plasma triglyceride (TG), serum cholesterol (CHO), serum high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) for nearly a week. Thirdly, the electrobiological activity, entropy value, brain function state and the change of monoamine neurotransmitters of subjects were detected by encephalof luctuography technology (ET).Then comparison of two groups were carried out to analyze the brain function, serum lipids and relative factors of elderly depressed patents,Results: 1. Brain fuction:(1)The anterior-posterior reversal rates of dominant power in encephalofluctuograph were higher in depression group than those of control group and the left-right reversal rates were higher in control group than those of depression group(P<0.001).(2)The depression group showed significantly more 8Hz activity than that of control (P<0.05) . The depression group showed significantly less 10Hz activity than that of control group (P<0.05). The entropy value of the depression group showed higher than that of the control group(P<0.01).(3) The monoamine neurotransmitters value (NE, 5-HT and DA) in depression group were lower than those of control group(P<0.001,P<0.001,P<0.01).2. Biochemistry:(1)Triacylglycerol (TG) in depression group was higher than that in control group(P<0.01), cholesterol (CHO) and low density lipoprotein-cholesterol(LDL-C) in depression group were lower than those in control group(P<0.05, P<0.001),and serum high density lipoprotein-cholesterol (HDL-C)in two groups showed no statistical significant deviation(P>0.05). (2) The relationship between monoamine neurotransmitters and serum lipids: significantly positive correlations existed in elderly depressed group between CHO and NE(r=0.509, P<0.05),CHO and 5-HT levels respectively(r=0.454, P<0.05).3. Cognition and Coping:(1) The scores of MMSE were significantly lower in depression group than control group(P<0.001), the scores of immediate recall and long-delayed recall were significantly lower in depression group than those in control group(P<0.01,P<0.001). (2) The scores of positive coping were significantly lower in depression group than those in control group(P<0.001),The scores of passive coping were significantly higher in depression group than those in control group(P<0.01).4. Social factors: (1) The account of life events, the scores of life events, the account of negative life events and the scores of negative life events were significantly higher in depression group than those in control group(P<0.001). (2)There were lower scores of social support and its use ,subjective support in depression group than those in control group(P<0.001, P<0.001, P<0.01).5. Personality factors: The scores of neuroticism and psychoticism were significantly higher in depression group than those in control group.Conclusion: (1) The brain function of elderly depressed patients was chaos: cerebral power reversed, more slow alpha waves, the orderliness decreased. (2) The serum lipids of elderly depressed patients changed, there was significant relationship between low serum cholesterol and elderly depression. (3) Elderly depressed patients had more severe cognitive impairment, negative life events and poorer social support played an important role in the occurrence of elderly depression, elderly people with higher neuroticism and psychoticism were likelier to develop depression. (4) The elderly depression resulted from the reaction between neurobiological and psychosocial factors, and it was interactive among psychosocial factors, the change of Biochemical Metabolism and brain function.更多还原