| [Objective] 1. To investigate the characteristics and differences of thyroid hormones, sex hormones, cortisol, ACTH and growth hormone in the first episode of major depressive disorder, anxiety disorder, comorbid depression and anxiety,somatoform disorder, and the relationship between hormones and age, disease severity,somatic symptoms and social function, so as to explore the neuroendocrine mechanism of first-episode of major depressive disorder, anxiety disorder, comorbid depression and anxiety, and somatoform disorder. 2. To compare the changes of hormone secretion before and after treatment for 2 weeks, and to explore the mechanism of neuroendocrine change after early treatment. 3. The change of hormone levels among basement, the end of 2 weeks and 12 weeks after treatment were detected, in order to analyze the overall trend of changes in hormones and interaction between hormones.4.Through the comparison of the above aspects, the mechanism of neuroendocrine change after the adequate treatment of depression disorder, anxiety disorder and somatoform disorder was discussed. Finally, this study wanted to provide biomarkers of neuroendocrine for evaluation of therapeutic effect.[Methods]1. Before treatment, a total of 199 patients with major depressive disorder, anxiety disorder, comorbid depression and anxiety, somatoform disorder were measured of thyroid hormone, sex hormone, cortisol, ACTH, growth hormone.According to the normal range of hormone secretion, the distribution of hormone secretion in each disease group was observed, and the difference among each disease groups was compared. The differences of hormone secretion between male and female were compared. Each patient was asked to complete the evaluation of HAMD score, HAMA total score, SCL-90 somatization factor, Social function deficit scale, then analyze the correlation between the axis of hormones, hormones and the scores of each scale before treatment. 2. After 2 weeks of treatment, the data of 127 patients were collected. The levels of thyroid hormone, sex hormone, cortisol,ACTH and growth hormone were measured and compared with the hormone before treatment. 3.After 12 weeks of treatment, 15 patients were collected. The levels of thyroid hormone, sex hormone, cortisol, ACTH and growth hormone were measured.The differences among baseline, end of 2th week and 12th week were detected and their changing trend were analyzed.[Results]1. Patients with first episode of major depressive disorder,anxiety disorder,depression and anxiety comorbidity and somatoform disorder existed abnormal state of decrease in secretion of thyroid hormone, growth hormone and sex hormone,however, increased in cortisol and ACTH secretion. The level of FT4 in patients with depression and anxiety comorbidity was higher than that of patients with depression and anxiety only, and the difference was statistically significant(LSD-t = -3.335, P =0.001 <0.05; LSD-t=-1.996, P = 0.047 <0.05), but there was no any significant difference among the other hormones. The level of TSH in male patients with depressive disorder was significantly lower than that in female (t = -2.619, P = 0.011<0.05).The level of TSH in male patients with anxiety disorder was lower significantly than that in female (t=-2.091, P = 0.042 <0.05). The level of GH in male patients was significantly lower than that in female (t = -2.721, P = 0.009 <0.05).There was a negative correlation between Cor level and FT3 level in depressive disorder group ( r= -0.231, P = 0.047 <0.05). The level of ACTH in the somatoform disorder group was positively correlated with the level of TSH (r = 0.568, P = 0.027<0.05). In depressive disorder group, the level of FT3, GH level and E2 level were negatively correlated with age (r= -0.239, P = 0.040; r = -0.323, P = 0.005; r = -0.604,P = 0.000); Cor level was positively correlated with social function defects(r = 0.262,P = 0.024 <0.05). The ACTH level was positively correlated with HAMD score and social function defect (r = 0.335, P = 0.004; r = 0.240, P = 0.039 <0.05). There was a negative correlation between E2 level and age in anxiety group (r=-0.707,P=0.000<0.05) ; T3 level was negatively correlated with HAMD score, HAMA score and social function defect (r=-0.371, P=0.012; r=-0.343, P=0.021; r=-0.426,P=0.004) ; FT3 level was negatively correlated with HAMD score, social function defect and SCL-90 somatization factor (r=-0.354, P=0.017; r=-0.443,P=0.002;r=-0.373, P=0.012) .There was a negative correlation between E2 level and age in patients with comorbid depression and anxiety (r=-0.744, P=0.000) ; FT3 level was negatively correlated with SCL-90 somatization factor(r=-0.261, P=0.036);FT4 level was positively correlated with social function defect (r=0.297, P=0.016<0.05) .In somatoform disorder group,the levels of T3, FT3, T4 and FT4 were negatively correlated with SCL-90 somatic factors, (r=-0.758, P=0.001; r=-0.641, P=0.010;r=-0.629, P=0.012; r=-0.657, P=0.008) ,and the level of male T was negatively correlated with HAMA score (r=-0.616, P=0.044). 2.After treatment for 2 weeks, the levels of thyroid hormones in each group were lower statistically than those of before treatment (P<0.05) . The level of GH in patients with depressive disorder was higher than that before treatment, the difference was statistically significant(P=0.041 <0.05),and Cor level was lower statistically significantly in patients with depression and anxiety than before treatment (P=0.012<0.05) . 3. A total of 15 patients (5 patients with depression, 3 patients with anxiety disorder, 2 patients with depression and anxiety, 2 patients with somatoform disorder) were re-evaluted at 12 weeks after treatment. After 2 weeks of treatment, the levels of FT4 were lower than those before treatment, the difference was statistically significant (P=0.000<0.05) .After 12 weeks of treatment the level of FT4 was lower than baseline, and the difference was statistically significant (P=0.033<0.05). There was no significant change in FT4 level after 12 weeks of treatment than 2 weeks .At 2 weeks ACTH levels were higher than those before treatment, and the difference was statistically significant (P=0.045<0.05).After 12 weeks of treatment, the level of ACTH decreased, lower than 2 weeks treatment, the difference was statistically significant (P=0.002<0.05) ,but the change of ACTH level was not significant after 12 weeks of treatment than baseline. After treatment for 2 weeks, the level of testosterone T was higher significantly than that of before treatment (P=0.009<0.05), but the change of testosterone T was not significant at 12 weeks after treatment than baseline and 2 weeks. There was no significant difference of chang in other hormone levels. FT4 level of patients with depression and anxiety comorbidity was higher than that of depressive disorder and anxiety disorder patients significantly ( LSD-t=-3.288, P=0.007<0.05; LSD-t=-3.116, P=0.010<0.05).There was no significance difference of FT4 level between depression and anxiety patients.[Conclusion]1. Depressive disorder, anxiety disorder,depression and anxiety comorbidity, somatoform disorder patients were be associated with decreased thyroid hormone, GH, sex hormone secretion and Cor,ACTH secretion increased. The hormone secretion process was similar in each hormone. 2.The level of FT4 in patients with depression and anxiety before treatment was higher than that in depressive disorder and anxiety disorder, and the higher level of FT4,the worse the social function,which may be heterogeneity of depression and anxiety. 3.Pre-treatment depression, anxiety disorders with thyroid hormone secretion significantly reduction in women than men. 4. FT3 levels of patients with depression may be reduced accompanied by age. ACTH, Cor levels can be used as a biological indicator of disease improvement. The decrease in thyroid hormone levels in anxiety disorders may be used as an indicator to assess the severity of anxiety disorders.5.After 2 weeks of treatment, the levels of thyroid hormones in each group were still lower than those before treatment. The Cor level of patients with depression and anxiety was lower than that before treatment. GH in patients with depression was higher than that before treatment. After 2 weeks of treatment, patients with HPA axis hyperthyroidism were improved, hormone secretion activity tends to return to normal,but the condition is not stable, and hormone secretion is still fluctuation, being in an abnormal state.6. After 12 weeks of treatment, the serum concentration of FT4,male testosterone T showed a relatively increased trend, and the relatively high secretion of Cor. ACTH showed a decreased trend.7. The secretion of HPA axis during the development of the disease has an inhibitory effect on the secretion of HPT axis, HPG axis and HPGH axis. The endocrine activity is regulated mutually,simultaneously affecting the development of the entire disease process. |
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