【作者】 廖继武；

【导师】 潘集阳；

【作者基本信息】 暨南大学 ， 精神病与精神卫生学， 2010， 硕士

【摘要】 目的：探讨血浆神经肽Y(NPY)及P物质(SP)水平在单、双相抑郁障碍发病机制中的作用及单、双相抑郁障碍患者血浆NPY及SPP水平差异。方法：共有35名单相抑郁障碍患者、38名双相抑郁障碍患者及35名健康对照者参加研究,所有参研者均以M.I.N.I.简明国际神经精神障碍访谈检查进行结构化临床会晤,以MDQ及HCL-32筛查患者既往心境状况,以一般状况问卷、HAMD-17、HAMA及Young躁狂量表评定患者的一般状况及症状严重程度。采用ELISA法检查血浆NPY及SP水平。结果：1.单抑郁障碍较之双相抑郁障碍,起病年龄晚、单次抑郁发作病程长、焦虑症状及躯体化症状较明显、抑郁症状严重、忧郁特征明显,但发作次数较少。2.单相抑郁障碍组和双相障碍组血浆NPY水平低于对照组(5.838±1.793、5.951±2.148 v.s 8.071±3.224,P<0.05),SP水平高于对照组(6.239±2.617、5.784±1.498 V.S 4.081±1.540,P<0.05),差异有统计学意义,但单、双相抑郁障碍组之间NPY及SP水平差异没有统计学意义(P>0.05)。3.患者组间男、女性患者血浆NPY水平(6.030±1.853 V.s 5.789±2.083,P=0.624)及SP水平(5.766±1.741v.s 6.192±1.932,P=0.351)没有明显差异。4.无自杀风险组、低自杀风险组、中度自杀风险组及高自杀风险组患者的血浆NPY(5.418±2.624、6.099±1.744、6.172±1.721及5.716±2.703)及SP水平(5.101±1.871、6.669±1.744、5.708±1.789及6.054±0.859)差异无统计学意义(P>0.05)。5.重度抑郁发作组与中度抑郁发作组血浆NPY水平差异无统计学意义(5.889±1.910 v.s5.904±2.06,P>0.05)；重度抑郁发作组血浆SP水平明显高于中度抑郁发作组,差异有统计学意义(6.498±1.863 v.s5.519±1.725,P<0.05)。6.复发性抑郁发作组与首发性抑郁发作组血浆NPY水平无明显差异(6.271±1.88 v.s 5.307±2.000,P>0.05),但复发性抑郁发作组SP水平较首发性抑郁发作组明显增高,差异有统计学意义(6.341±1.890 v.s 5.466±1.676,P<0.05)7.患者按焦虑水平分为有明显焦虑症状组、中度焦虑水平组及轻度焦虑水平组,三组间血浆NPY(6.009±1.754、6.020±2.206 v.s 5.488±1.881,P>0.05)及SP水平(5.980±1.915、6.141±2.045 v.s5.763±1.367,P>0.05)差异没有统计学意义。8.患者血浆NPY与性别、年龄、发病年龄、总病程、单次发作病程、HAMA总分及HAMD总分为及各因子分之间没有明显相关性；血浆SP水平与睡眠障碍因子存在明显相关(R=0.328,P=0.007)结论：本研究首次对比分析UDD、BDD及健康对照者的血浆NPY及SP水平,结果提示：1.NPY及SP参与单、双相抑郁障碍的发病机制,单、双相抑郁障碍在NPY及SP方面的发病机制是相似的,血浆NPY及SP物质水平尚不能作为单、双相抑郁障碍鉴别诊断的生物学标志。2.抑郁发作不同亚型的NPY功能紊乱相似,但重性抑郁发作及复发性抑郁发作患者SP能神经功能紊乱更为严重。3.睡眠障碍是影响单、双相抑郁障碍患者血浆SP水平的主要因素。更多还原

【Abstract】 Objective:To explore the effects of plasma neuropeptide Y and substance P in the etiology of unipolar and bipolar depressive disorders, and to explore the difference in the plasma neuropeptide Y and substance P levels between patients with unipolar and bipolar depressive disorders.Methods:35 patients with unipolar depressive disorders(UDD),38 patients with bipolar depressive disorder(BDD) and 35 controls were recruited in the study, and interviewed by the MINI International Neuropsychiatric terview for DSM-Ⅳby a senior psychiatrist at the department of psychiatry in the First Affiliated Hospital of Jinan University. Hamilton Depression Scale, Hamilton Anxiety Scale and Young Mania Rating Scale were used to assess the severity of clinical symptoms. Mood Disorder Questionnaire (MDQ)and The 32-item Hypomania Symptom Check List (HCL-32) were used to explore the history of Manic/hypomanic episode. The plasma substance P and neuropeptide Y levels were determined with the enzyme linked immunosorbent assay.Results:1.Compared with BDD group, the UDD group presented the first depression onset at older ages,longer duration of single episodes of depression, more anxiety symptoms, somatization symptoms and melancholic features, more severe depressive symptoms, but less relapse times.2. The plasma neuropeptide Y levels were significantly lower in the patients with UDD and BDD than those in the controls (5.838±1.793.5.951±2.148V.S. 8.071±.224, P<0.05).The plasma substance P levels were significantly higher in the patients with UDD and BDD than those in the controls (6.239±2.617、5.784±1.498 V.S4.081±1.540, P<0.05), but there was no significant difference in plasma neuropeptide Y and substance P levels between UDD group and BDD group.(P> 0.05)3. There was no significant difference in plasma neuropeptide Y (6.030±1.853v.s5.789±2.083, P=0.624) and substance P levels (5.766±1.741 v.s6.192±1.932, P=0.351) between female patients and male ones. 4. Plasma neuropeptide Y levels(5.101±1.871,6.669±1.744,5.708±1.789 and 6.054±0.859) and substance P levels (5.418±2.624,6.099±1.744,6.172±1.721 and 5.716±2.703) showed no significant difference (P> 0.05) among no suicide risk group, low suicide risk group, moderate suicide risk group and high suicide risk group.5. There was no significant difference in plasma neuropeptide Y levels between severe depressive episode group and the moderate group (5.889±1.910v.s5.904±2.06, P> 0.05); the plasma substance P levels was higher in severe depressive episode group than those in moderate depressive episode group, the difference was statistically significant (6.498±1.863v.s5.519±1.725, P<0.05).6. The neuropeptide Y concentrations in the patients with recurrent depression were similar to those ones with first-episode depression (6.271±1.88v.s5.307±2.000, P>0.05).The plasma substance P levels were higher than that in first-episode depression patients (6.341±1.890v.s 5.466±1.676,P<0.05).7. The plasma levels of neuropeptide Y and substance P were similar among severe anxiety level group, moderate anxiety level group and mild anxiety group. The difference was no statistically significant8. The plasma neuropeptide Y levels had no correlation with sex, age, age of first depression onset, total duration, duration of single attack, HAMA total score and HAMD total score and factor scores. The plasma substance P levels were significantly correlated with sleep disturbance factors in HAMD,but had no correlation with other factors.Conclusion:The plasma neuropeptide Y and substance P levels in patients with UDD and BDD were first detected and compared, and the results demonstrated that:1.The change of substance P and neuropeptide Y may be involved in the pathogenesis or pathophysiology of UDD and BDD, the abnormalities wre remarkably similar in BDD and UDD. There is no evidence shows that the substance P and neuropeptide Y could been useful biomarkers for differential diagnosis of BDD and UDD.2. Different subtypes of depressive episode were similar in the NPY dysfunction side,but SP dysfunction was more serious in the major depressive episode group and recurrent depressive episode group than moderate depressive episode and firstdepressive episode group.3. Sleep disturbance was the main factor that affected the plasma substance P levels in patients with UDD and BDD.更多还原