Study On The Depression To Combine With Somatic Patients And The Disparity Of Neuroendocrine Of Depression

Purpose:1. Correlation analysis of clinical features and neuroendocrine diversity of depression patients.2. To investigate the neuroendocrine difference between TRD and non-TRD;3. To acquire the influence factors of co morbidity of physical disease and depression, and implement correlation analysis.Method:The study of neuroendocrine and clinic features of depression patients and the neuroendocrine character of the patients with TRD: This study was a prospective hierarchies random control study, executed in several centers. 416 patients entered the study. All the patients were divided into 2 groups-depression patients that had never been treated and TRD. HPA axle and HPT axle biochemistry detection were implemented, so as clinic index evaluation. Data management was performed by the department of medical statistics of Public Health school, Sichuan University.The study of comobidity of depression and physical disease was a cross section retrospective study. The medical histories of all the patients (241) with depression in Psychological Health Center of Huaxi Hospital since 1st March, 2005 to 31th August, 2006 entered the study. 114 patients were complicated by physical disease. Neuroendocrine detections were implemented in 117 patients.Results:All the depression patients were divided into 4 groups through neuroendocrine indexes - normal group, HPA axle abnormal group, HPT axle abnormal group.The results of comparison of neuroendocrine indexes diversity and clinic features: There was no difference in sex, but the age of normal group is lower than HPT axle abnormal group and abnormal group. And weight of the normal group is higher than HPT axle abnormal group and lower than abnormal group. Total Hamilton anxiety scale score, DFA score, agitate symptom score, muscular system symptom score, respiratory system symptom score, ANS symptom score of normal group is significantly lower than HPT axle abnormal group. Pleasant sensation absence of normal group is higher than HPA axle abnormal group. GUS score of normal group is higher than the other groups.In HPT axle abnormal group, mobidity of female was higher than male,influence to weight is lower than the other groups. Age, total HAMA anxiety scale score was higher than normal groups. HAMD sleep factor score was higher than abnormal group. DFA score is higher than normal group and abnormal group. Sleep depth factor score was higher than abnormal group, agitate, tense score was lower than HPA axle abnormal group. Respiration system score was higher than normal group and HPA axle abnormal group.HPA axle abnormal group: influence to weight, sleep was lower than HPT axle abnormal group; Agitate score was higher than normal group and HPT axle abnormal group; Musculation score was higher than normal group; Respiratory system score was lower than HPT axle abnormal group; Depression mental state score was lower than normal group; ANS score was higher than the other groups.Abnormal group: Influence to weight was higher than normal group and HPA axle abnormal group; influence to sleep was lower than HPT axle abnormal group; Delay score was higher than the other groups; Genital system score was lower than normal group; ANS score was lower than HPA axle abnormal group.Curative effect of medicines to the patients: Among the 4 groups, the effect of the medicines had no difference, and the score decreasing rate had no difference between before and after treatment; The HAMD weight decreasing factor decreasing rate of HPA axle abnormal group is higher than abnormal group.3 medicines was used randomly in each group: In normal group, HPT axle abnormal group and abnormal group, the score decreasing rate had no significant difference.In HPA axle abnormal group, score decreasing rate of HAMD and HAMA anxiety had significant difference among the 3 medicines. Comparing between each medicine, total score decreasing rate of HAMD and HAMA anxiety factor in tricyclic group was higher than in the other two groups.After used different medicines, the score decreasing rate in the 4 groups were compared:After used tricyclic medicine, the score decreasing rate had no difference among the 4 groups. Compared each group: The score decreasing rate of total HAMD, HAMA physical anxiety factor, HAMD mind anxiety factor of the HPA axle abnormal group was higher than that of HPT axle abnormal group. The score decreasing rate of HAMD physical anxiety factor of the HPA axle abnormal group was higher than that of HPT axle abnormal group. The score decreasing rate of sleep factor of the abnormal group was higher than that of HPT axle abnormal group. The score decreasing rate of total HAMD, HAMA physical anxiety factor, HAMD mind anxiety factor of the HPA axle abnormal group was higher than that of HPT axle abnormal group.After used SSRIs medicine, the score decreasing rate had no difference among the 4 groups. Comparing each medicine group, score decreasing rate of HAMA physical anxiety factor in HPT axle abnormal group was higher than in the other two groups. Score decreasing rate of HAMD weight factor of normal group was lower than that of the HPA axle abnormal group.After used SNRIs medicine, the score decreasing rate of HAMD delay factor had significant difference among the 4 groups. Comparing each medicine group.There was significant difference between TRD and non-TRD in sex, education time, age of outset, total course of disease, frequency of break out and family history.The result of scale evaluation at the beginning of the study: TRD group is higher than non- TRD group in block factor score and morbid personality factor score through Hamilton depression scales. And the non-TRD group is higher than TRD group in weight factor score, MMPI depression factor score and MMPI hysteria factor score. Score decreasing rate: non-TRD group was higher than TRD group in Hamilton depression and Hamilton anxiety.Comparison the neuroendocrine index between the patients and normal persons: ACH, lib-T3(before treatment), lib-T4(before treatment), total T3(before treatment), lib-T4(after treatment), total T3(after treatment),ACTH(in TRD group before treatment), TSH( in TRD group before treatment) was significantly different between patients and normal people. ACH, ACTH, total T4 of patients group was higher than normal before treatment, and became normal level after treatment. TSH, lib-T3, lib-T4, total T3 of patients group was lower than normal before treatment, and became normal after treatment.Comparison of entire between before and after treatment in the two groups: Hydrocortisone, ACTH significantly decreased after treatment. The diversity of TSH, lib-T3, lib-T4, total T3, and total T4 was not obvious. In the non-TRD group, the level of hydrocortisone, ACTH decreased significantly. And in the TRD group, the level of ACTH decreased significantly. The level of TSH in both groups decreased significantly.The rate of comobidity of depression and physical disease is 47.10%. And the physical disease that could suffer from depression easily includes irritablebowel syndrome(7%), hypertension(6.6%), CAD(5.8%), diabetes(5.0%), stroke (4.5%)and menopause syndrome(3.3%). The liability factor of the comobidity includes sex, age, marriage, course of disease, frequency and age of outset of depression, neuroendocrine alteration.Conclusion:1. Correlation of clinical features and neuroendocrine diversity of depression patients. Agitate symptom often existed in HPA axle abnormal group.Elder women suffered HPT axle abnormal depression frequently, but weight diversity was not obvious; Sleep disorder and anxiety often exist in HPT axle abnormal group. Self-reproach and delay symptom often existed in abnormal group. Patients of normal depression group were often combined with hebetude, interest absence, early awaking, frequent micturition, urgency,menopause, frigidity, astyphia, impotence, and anhedonia. There was no difference among 4 groups on Hamilton depression scale score. Tricyclic was better than SNRIs on treating HPA axle abnormal depression. SSRIs was more effective on HPA axle abnormal group than on HPT axle abnormal group. SNRIs showed less effective on HPA axle abnormal group than on the other 3 groups.2. There was significant difference between TRD group and non-TRD group on sex, education time, age of break out, total course, frequency, and family history. As to delay factor score, weight factor score, TRD group was higher than non-TRD. After treatment, ACH, ACTH, total T4 showed decline trend,as TSH, lib-T3, lib-T4, total T3 increased. Cmparing TRD and non-TRD group, all the neuroendocrine indexes had no difference, except TSH.3.47.10% of the depression patients suffered from physical disease, which included irritable bowel syndrome, hypertension, CAD, diabetes, cerebral apoplexy, menopause syndrome. The liability factors of comobidity of depression and physical disease included sex, age, marriage status, course of disease, frequency of depression and age of break out.