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[摘要] 目的 探討难治性抑郁症（TRD）病人血浆非酶类抗氧化物和甲状腺激素水平的特点和意义。
方法 选择2017年6月—2019年12月在青岛市精神卫生中心住院的70例非难治性抑郁症（NTRD）病人（NTRD组）、50例TRD病人（TRD组）以及青岛市市立医院查体中心的66例健康体检者（对照组）作为研究对象。检测并比较各组血浆非酶类抗氧化物（尿酸、清蛋白和总胆红素）以及甲状腺激素（游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH））的水平。并用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）进行临床评估，用公认认知成套测验进行认知功能评估。
结果 TRD组血尿酸水平显著高于NTRD组（F=2.685，P<0.05）;TRD组和NTRD组血浆清蛋白水平显著低于对照组（F=9.761，P<0.01），总胆红素水平也显著低于对照组（F=3.891，P<0.05）。TRD组血FT3水平显著低于NTRD组和对照组（F=5.562，P<0.05）;TRD组和NTRD组血FT4水平显著高于对照组（F=141.632，P<0.01）。TRD组病人血FT4水平与HAMD总分呈显著正相关（r=0.330，P<0.05），TSH水平与信息处理速度得分呈正相关（r=0.295，P<0.05），FT3水平与词语学习、工作记忆呈正相关（r=0.336、0.360，P<0.05）。
结论 TRD病人血浆非酶类抗氧化物和甲状腺激素水平存在异常;血浆尿酸、FT3水平可能是识别TRD的生物学指标。
[关键词] 抑郁症，难治性;抗氧化剂;甲状腺激素类;认知
[中图分类号] R749.41
[文献标志码] A
[文章编号] 2096-5532（2021）05-0746-04
doi：10.11712/jms.2096-5532.2021.57.100
[开放科学（资源服务）标识码（OSID）]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20210510.1131.006.html;2021-05-10 17：51：32
PLASMA LEVELS OF NON-ENZYME ANTIOXIDANTS AND THYROID HORMONES IN PATIENTS WITH TREATMENT-
RESISTANT DEPRESSION
NIU Jing， PAN Weihua， WANG Ke， ZENG Botao
（Department of Clinical Psychology of Qingdao Mental Health Center， Qingdao University， Qingdao 266034， China）
[ABSTRACT] Objective To investigate the features and significance of plasma levels of non-enzyme antioxidants and thyroid hormones in patients with treatment-resistant depression （TRD）.
Methods A total of 70 patients with non-TRD and 50 patients with TRD who were hospitalized in Qingdao Mental Health Center from June 2017 to December 2019 were enrolled as NTRD group and TRD group， respectively， and 66 healthy individuals who underwent physical examination in Physical Examination Center of Qingdao Municipal Hospital during the same period of time were enrolled as control group. The three groups were compared in terms of the plasma levels of non-enzyme antioxidants （uric acid， albumin， and total bilirubin） and thyroid hormones （free triiodothyronine （FT3）， free thyroxine （FT4）， and thyroid stimulating hormone （TSH））. Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used for clinical evaluation， and well-proven cognitive tests were used to evaluate cognitive function.
Results The TRD group had a significantly higher level of serum uric acid than the NTRD group （F=2.685，P<0.05）; compared with the control group， the TRD group and the NTRD group had significantly lower plasma levels of albumin （F=9.761，P<0.01） and total bilirubin （F=3.891，P<0.05）. The TRD group had a significantly lower plasma level of FT3 than the NTRD group and the control group （F=5.562，P<0.05）， and the TRD group and the NTRD group had a significantly higher plasma level of FT4 than the control group （F=141.632，P<0.01）. In the TRD group， the plasma level of FT4 was positively correlated with the total score of HAMD （r=0.330，P<0.05）， the level of TSH was positively correlated with the score of information processing speed （r=0.295，P<0.05）， and the level of FT3 was positively related with verbal learning and working memory （r=0.336，0.360;P<0.05）.
方法 选择2017年6月—2019年12月在青岛市精神卫生中心住院的70例非难治性抑郁症（NTRD）病人（NTRD组）、50例TRD病人（TRD组）以及青岛市市立医院查体中心的66例健康体检者（对照组）作为研究对象。检测并比较各组血浆非酶类抗氧化物（尿酸、清蛋白和总胆红素）以及甲状腺激素（游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH））的水平。并用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）进行临床评估，用公认认知成套测验进行认知功能评估。
结果 TRD组血尿酸水平显著高于NTRD组（F=2.685，P<0.05）;TRD组和NTRD组血浆清蛋白水平显著低于对照组（F=9.761，P<0.01），总胆红素水平也显著低于对照组（F=3.891，P<0.05）。TRD组血FT3水平显著低于NTRD组和对照组（F=5.562，P<0.05）;TRD组和NTRD组血FT4水平显著高于对照组（F=141.632，P<0.01）。TRD组病人血FT4水平与HAMD总分呈显著正相关（r=0.330，P<0.05），TSH水平与信息处理速度得分呈正相关（r=0.295，P<0.05），FT3水平与词语学习、工作记忆呈正相关（r=0.336、0.360，P<0.05）。
结论 TRD病人血浆非酶类抗氧化物和甲状腺激素水平存在异常;血浆尿酸、FT3水平可能是识别TRD的生物学指标。
[关键词] 抑郁症，难治性;抗氧化剂;甲状腺激素类;认知
[中图分类号] R749.41
[文献标志码] A
[文章编号] 2096-5532（2021）05-0746-04
doi：10.11712/jms.2096-5532.2021.57.100
[开放科学（资源服务）标识码（OSID）]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20210510.1131.006.html;2021-05-10 17：51：32
PLASMA LEVELS OF NON-ENZYME ANTIOXIDANTS AND THYROID HORMONES IN PATIENTS WITH TREATMENT-
RESISTANT DEPRESSION
NIU Jing， PAN Weihua， WANG Ke， ZENG Botao
（Department of Clinical Psychology of Qingdao Mental Health Center， Qingdao University， Qingdao 266034， China）
[ABSTRACT] Objective To investigate the features and significance of plasma levels of non-enzyme antioxidants and thyroid hormones in patients with treatment-resistant depression （TRD）.
Methods A total of 70 patients with non-TRD and 50 patients with TRD who were hospitalized in Qingdao Mental Health Center from June 2017 to December 2019 were enrolled as NTRD group and TRD group， respectively， and 66 healthy individuals who underwent physical examination in Physical Examination Center of Qingdao Municipal Hospital during the same period of time were enrolled as control group. The three groups were compared in terms of the plasma levels of non-enzyme antioxidants （uric acid， albumin， and total bilirubin） and thyroid hormones （free triiodothyronine （FT3）， free thyroxine （FT4）， and thyroid stimulating hormone （TSH））. Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used for clinical evaluation， and well-proven cognitive tests were used to evaluate cognitive function.
Results The TRD group had a significantly higher level of serum uric acid than the NTRD group （F=2.685，P<0.05）; compared with the control group， the TRD group and the NTRD group had significantly lower plasma levels of albumin （F=9.761，P<0.01） and total bilirubin （F=3.891，P<0.05）. The TRD group had a significantly lower plasma level of FT3 than the NTRD group and the control group （F=5.562，P<0.05）， and the TRD group and the NTRD group had a significantly higher plasma level of FT4 than the control group （F=141.632，P<0.01）. In the TRD group， the plasma level of FT4 was positively correlated with the total score of HAMD （r=0.330，P<0.05）， the level of TSH was positively correlated with the score of information processing speed （r=0.295，P<0.05）， and the level of FT3 was positively related with verbal learning and working memory （r=0.336，0.360;P<0.05）.