目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.

目的 探讨中医妇科门诊患者的焦虑及抑郁的发生情况,优化诊治工作,更好地服务患者。方法 采用焦虑自评量表(SAS)和 抑郁自评量表(SDS)评定190名中医妇科门诊患者的心理状态。结果 中医妇科患者焦虑均分高于正常常模组(P＜0.05),抑郁评分与全国常模相比则无统计学差异(P＞0.05),有焦虑及抑郁症状的患者分别为6.3%及10%。结论 中医妇科门诊患者的焦虑症状较正常人群高,医生在临床诊治过程应重视对患者心理状态的评价,并进行相应的心理干预及人文关怀, 以提高患者对治疗的依从性和满意度,为其身体及心理健康打下良好基础。

Objective To explore the occurrences of anxiety and depression in female TCM gynecology outpatients, and thus to make improvements in diagnosis, treatment, and service for the patients. Methods We adopted Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) to evaluate the mental status of 190 TCM gynecology outpatients. Results Anxiety scores in TCM gynecology group were higher than those in the normal group (P＜0.05), while there was no statistical difference in depression scores between these two groups (P＞0.05). Among the outpatients, 6.3% had symptoms of anxiety, and 10% had symptoms of depression. Conclusion TCM gynecology outpatients show more anxiety symptoms than normal people. We should pay attention to the assessment of those patients' mental status in the process of diagnosis and treatment, and offer psychological intervention and humane care to those patients accordingly. In this way, we could enhance patients' compliance and satisfaction, and help them build a solid foundation in physical health as well as in mental health.

目的 研究米氮平和文拉法辛二药连用治疗抑郁症的临床疗效和安全性,以及对患者认知功能及生活质量的影响。方法 选取125例抑郁症患者随机分为三组,A组42例给予文拉法辛,B组41例给予米氮平,C组42例给予米氮平及文拉法辛,疗程均为8周。采用HAMD-17、GQOLI-74集WMS-RC量表作为评价指标。结果 用药8周后总有效率比较,C组>B组>A组,同时,C组与其他两组比较有差异(P<0.05)。治疗前,三组患者WMS-RC各项评分比较无差异(P>0.05),治疗8周后,三组患者各项认知功能均有改善;其中,联合用药的改善效果最为显著。相较于治疗前,三组患者GQOLI-74评分均有不同程度上升,但C组患者上升幅度更大(P<0.05)。结论 联合应用来治疗难治性抑郁症疗效显著,且能帮助恢复患者的认知能力,研究过程中未发现较明显不良反应,故提倡临床推广。

Objective To study on the clinical efficacy and safety of mirtazapine and venlafaxine in the treatment of refractory depression, as well as to improve cognitive function and quality of life in patients. Methods 125 patients were randomly assigned to three groups, including group A: 42 cases with venlafaxine, group B: 41 cases with mirtazapine, group C 42 cases with mirtazapine and venlafaxine, 8 weeks for a course. Results After the treatment, total effective rate: group C>group B>group A. There's no difference between WMS-RC among three groups. After treatment for 8 weeks, cognitive function of three groups was enhanced, and group C was the most significant. GQOLI-74 scores of the three groups were increased, but group C of patients increased even more sharply (P<0.05). Conclusion Mirtazapine and venlafaxine may effectively improve the quality of life and cognitive function of patients with depression. It's high safety and worthy of clinical promotion and application.

目的 了解先兆早产孕妇的抑郁和唾液皮质醇浓度,探讨两者间的相关性。方法 共纳入138例先兆早产孕妇作为研究对象。采用爱丁堡产后抑郁量表(Edinburgh Postpartum Depression Scale,EPDS)测量其抑郁状况,同时收集8am、16pm、23pm的唾液进行皮质醇浓度检测。以EPDS≥9.5分为界值,将研究对象分为抑郁组和非抑郁组。采用独立样本t检验比较两组唾液皮质醇浓度,采用Pearson相关分析抑郁和唾液皮质醇浓度的相关性。结果 先兆早产孕妇的抑郁平均得分为(8.8±4.97)分。抑郁(EPDS≥9.5分)检出率为46.4%。8am、16pm、23pm的唾液皮质醇浓度分别为(14.07±7.36)ng/mL、(9.27±5.03)ng/mL、(5.71±3.92)ng/mL。总研究对象的EPDS与8amSC(r=0.257,P=0.002)、16pmSC(r=0.303,P＜0.001)存在相关;非抑郁组孕妇的EPDS与8amSC(r=0.306,P=0.008)、16pmSC(r=0.203,P=0.048)存在相关。结论 先兆早产孕妇抑郁者比例较高。抑郁与唾液皮质醇存在中低度相关性。产科医护人员应关注先兆早产孕妇的心理健康状况,即使是抑郁相对较轻者,也要帮助其改善抑郁状况以获得良好的妊娠结局。

Objectives To discover the depression status and salivary cortisol(SC)level among women with threatened preterm labor, and find their associations. Methods 138 pregnant women with threatened preterm labor were recruited in this study. Edinburgh Postpartum Depression Scale (EPDS) was applied to assess women's depression, and their saliva were collected at 8am, 16pm,23pm to test the cortisol level. EPDS≥9.5 was set as the cut-off value to assign the participants to depressive group(EPDS≥9.5) and non-depressive group (EPDS＜9.5). Independent samples t-test was used to compare the difference of salivary cortisol of the two groups, and Pearson correlation analysis was also applied to calculated the associations between depression and salivary cortisol. Results The average scores of EPDS in total women were (8.8±4.97). The incidence of depression (EPDS≥9.5) was as high as 46.4%.The average level of salivary cortisol at 8am,16pm and 23pm were(14.07±7.36) ng/mL, (9.27±5.03)ng/mL and (5.71±3.92)ng/mL respectively. EPDS in total women was associated with 8amSC(r=0.257, P=0.002) and 16pmSC(r=0.303, P＜0.001). EPDS in non-depressive group were also associated with 8amSC (r=0.306,P=0.008) and 16pmSC(r=0.203, P=0.048). Conclusion Women with threatened preterm labor have a high incidence of depression. There was a low-moderate level of association between maternal depression and salivary cortisol. Obstetrical doctors and nurses should focus on maternal psychological health level in women with threatened preterm labor. Even those individuals comparatively with a less severe depression, we need help them to minimize the severity of depression to achieve satisfying pregnant outcomes.

目的 分析研究不同类型脑梗死患者睡眠结构及其与抑郁的相关性,为脑梗死患者睡眠障碍及抑郁的治疗提供新的思路及理论支持。方法 抽取我院2012年4月—2015年5月接收的124例脑梗死患者进行分组研究,根据脑梗死不同发生部位将患者分为四组,分别为小脑梗死组30例、皮层梗死组33例、脑干梗死组29例及皮层下梗死组32例,对比观察四组患者睡眠结构及睡眠参数和睡眠障碍、HAMD评分的相关性。结果 四组患者睡眠结构相比存在明显差异,脑干梗死组和皮层下梗死组觉醒时间远多于小脑梗死组和皮层梗死组,小脑梗死组NREM 1+2期、NREM期明显短于皮层梗死组、脑干梗死组及皮层下梗死组,小脑梗死组REM期、NREM 3+4期明显大于皮层梗死组、脑干梗死组及皮层下梗死组,各项数据对比差异均有统计学意义(P＜0.05);HAMD评分、PSQI评分和NREM1+2期、觉醒指数呈正相关关系(P＜0.05,r＞0);与REM期和NREM 3+4期呈负相关关系(P＜0.05,r＜0)。结论 皮层下梗死睡眠结构紊乱发生率更高,并且睡眠结构的变化和脑梗死后抑郁评分、睡眠障碍评分具有一定关系。

Objective To study the correlation between sleep structure and depression in patients with different types of cerebral infarction,to provide new ideas and theoretical support for the treatment of sleep disorders and depression in patients with cerebral infarction. Methods 124 patients with cerebral infarction in our hospital from April 2012 to May 2015 were selected. They were divided into four groups according to the different parts of the cerebral infarction, respectively, 30 cases of cerebellar infarction group, 33 cases of cortical infarction group, 29 cases of brainstem infarction group and 32 cases of subcortical infarction group. The correlation of sleep structure and sleep parameters, sleep disorder and HAMD score of the four groups were observed and compared. Results There was a significant difference in sleep structure between the four groups. Brainstem infarction group and subcortical infarction group awakening time was far more than that of cerebellar infarction group and cortex infarction group.Cerebellar infarction group NREM 1+2, NREM period was significantly shorter in cortical infarction, brain stem infarction group and subcortical infarction group. Cerebellar infarction group of REM and NREM stage 3+4 were significantly greater than that of cortical infarction death group, brain stem infarction group and cerebral cortex infarction group. The differences were statistically significant(P<0.05);HAMD score, PSQI score and NREM1+2 period, arousal index was positively correlated (P<0.05, r> 0); And REM phase and 3+4 NREM phase was negatively correlated (P<0.05, r< 0). Conclusion Subcortical infarction sleep structure disorder incidence is higher, and the sleep structure changes and infarction depression score, sleep disorder score has a certain relationship.

目的 探讨逍遥散治疗首发抑郁症的疗效与5-HT2A受体基因多态性的关联。方法 采用病例对照研究方法,以120例首发抑郁症患者(研究组)和120例正常人(对照组)为研究对象,研究组予逍遥散治疗,疗程8周。于治疗前后采用汉密顿抑郁量表评定。采用高温连接酶检测反应法(LDR)检测5-HT2A受体基因,分析其与抗抑郁药物疗效的关系。结果 5-HT2A受体基因(T102C)T／C基因型、C／C基因型频率及等位基因频率与对照组相比差异无统计学意义(P﹥0.05)。不同基因型的疗效无差异(P﹥0.05)。结论 5-HT2A受体基因(T102C)多态性与逍遥散治疗抑郁症的疗效无关联。

目的 了解广州综合医院内分泌科门诊就诊者中抑郁焦虑障碍的患病率。方法 对广州市第一人民医院的内分泌科门诊就诊的患者进行横断面调查。采用医院焦虑抑郁量表(HADS)对105名入选的患者进行筛查,精神科医生对HADS≥8 分的患者进行国际神经精神科简式访谈问卷( MINI ) 的诊断性评估。结果 MINI诊断的抑郁障碍、焦虑障碍、抑郁和焦虑共病的患病率分别为3.80%、0.95%和2.86%。结论 抑郁和焦虑障碍是综合医院内分泌科门诊就诊者中的常见问题,但识别率和治疗率均不高。

Objective To investigate the prevalence rates of depressive and anxiety disorders of the endocrinology outpatients in a general hospital of Guangzhou. Methods A cross-sectional survey was conducted in the endocrinology outpatient department of Guangzhou First People's Hospital. A total of 105 outpatients were screened with hospital anxiety and depression scale(HADS). The patients with the HADS score of 8 and over were investigated and diagnosed by psychiatrists with the mini-international neuropsychiatric interview(MINI). Results The prevalence rates of MINI-diagnosed depressive disorder, anxiety disorder, and depressive-anxiety co-morbid disorders were 3.80%, 0.95% and 2.86%, respectively. Conclusion Depression and anxiety disorders are common problems in the endocrinology outpatient department of general hospitals,but few outpatients were well-diagnosed and treated.

目的 探讨Foxp3-924(rs2232365)基因位点多态性与产后抑郁的相关性。方法 选取211例在越秀区光塔街社区卫生服务中心分娩的产妇进行回访研究,所有产妇均经PCR-SSP技术对Foxp3-924(rs2232365)基因位点分型。结果 对比产后抑郁组与对照组产妇Foxp3-924各种基因型频率,结果显示均无差异(P>0.05)。结论 产后抑郁和Foxp3-924(rs2232365)位点基因多态性无较大关联。

Objective To investigate the distribution of-924(rs2232365) genotypes and to explore the correlation between gene loci polymorphism and postpartum depression. Methods In puerpera in Yuexiu district Guangta street community health center, there were 211 cases of childbirth study visits, who were confirmed by PCR-SSP technique Foxp3-924 (rs2232365) gene locus genotyping. Results Compared postpartum depression group and control groupFoxp3-924 various genotypes, it showed no great difference (P> 0.05). Conclusion It has no greater relevance between postpartum depression and Foxp3-924 (rs2232365) polymorphism loci.

目的 检测抑郁障碍患者血清中IL-2和TNF-α水平,探讨IL-2和TNF-α水平与认知功能情况相关性。方法 采用酶联免疫吸附法(ELISA)检测100例抑郁障碍患者(观察组)和100例健康人(对照组)的血清IL-2、TNF-α的水平,并结合汉密尔顿抑郁量表(HAMD)观察患者抑郁障碍的严重程度,应用Loewenstein 认知评定量表评定患者的认知状态情况进行相关分析。结果 与对照组相比,观察组的IL-2、TNF-α的水平明显更高(P<0.05)。IL-2、TNF-α的水平与HAMD,LOTCA总分呈正相关(P<0.05)。结论 抑郁障碍患者血清中IL-2、TNF-α的水平与抑郁障碍患者的严重程度和认知状态情况呈正相关。

Objective To study the levels of serum IL-2 and TNF-α in depressed patients and theircorrelations with the cognitive function. Methods 100 depressed patients (observation group) and 100 healthy people (control group) were enrolled to this study and we compared their levels of serum IL-2 and TNF-α detected by enzyme-linked immunosorbent (ELISA) from two groups. The correlation analyses of the serum IL-2 and TNF-α levels with the severity of depression of depressed patients observed with Hamilton depression scale (HAMD), and the serum IL-2 and TNF-α levels with the cognitive function evaluated with Loewenstein were conducted. Results The levels of serum IL-2 and TNF-α in the observation group were significantly higher than control group (P<0.05).There were positive correlations between the levels of IL-2 and TNF-α and HAMD scores and between the levels of IL-2 and TNF-α and LOTCA scores (P<0.05). Conclusion The levels of serum IL-2 and TNF-α in the depressed patients were positively correlative with the severity of depression and their cognitive function.

       目的   本研究以脑卒中患者为研究对象，通过二代Illumina高通量测序平台对患者的粪便标本进行微生物群落多样性测序。选择物种丰度≥30%的24个门类（Phylum）作为肠道菌群的研究指标，进而研究肠道菌群与脑卒后抑郁（PSD）之间的相关关系。方法   以40位脑卒中患者的24个门类作为特征变量，抑郁组和对照组为二分类目标变量，建立以Logistic回归、随机森林、支持向量机和AdaBoost为基模型的Stacking分类模型。主成分分析方法作为该模型的特征选择方法选择恰当的主成分进行模型训练，通过二分类评价报告（precision、recall、f1-score）、ROC曲线和混淆矩阵等评价指标对其性能进行评价。结果   （1）通过差异性检验分析了两组（抑郁组和对照组）的基线一致（P＜0.05）；（2）从Stacking模型融合的角度定量分析了影响脑卒中后抑郁情绪的具体肠道菌群。研究结果可知，放线菌门、拟杆菌门、变形菌门和酸杆菌门在PSD患者中均增加（P＜0.001）；厚壁菌门，疣微菌门，绿弯菌门和软壁菌门在PSD患者中降低（P＜0.001）。结论   以上菌群是影响脑卒中后抑郁患者情绪的主要影响因素，因此，在临床上通过恰当干预肠道菌群的变化来调节脑卒中后抑郁患者的抑郁水平，这为脑卒中后抑郁情绪的诊断和治疗方案提供科学依据。

        Objective  In this study，patients with stroke were selected as the research object，and the microbial community diversity of patients’ stool samples was sequenced by the second-generation Illumina high-throughput sequencing platform．Twenty four phylum species with 30% species abundance were selected as indicators for the study of gut microbiota，and then the correlation between gut microbiota and post-stroke depression（PSD） was studied．Methods  Taking 24 categories of 40 stroke patients as characteristic variables，depression group and control group as dichotomous target variables，a stacking classification model based on Logistic regression，random forest，support vector machine and AdaBoost was established．As the feature selection method of the model，principal component analysis selects the appropriate principal components for model training，and evaluates its performance through dichotomous evaluation reports（precision，recall，f1 score），ROC curve and confusion matrix．Results  The baseline of the two groups（depression group and control group）was consistent（P＜0.05）through the difference test．From the perspective of stacking model fusion，the specific intestinal flora affecting post-stroke depression was quantitatively analyzed．The results showed that Actinobacteria，Bacteroidetes，Proteobacteria and Acidobacteria were significantly increased in PSD patients（P＜0.001），while Firmicutes，Verrucomicrobia，Chloroflexi and Tenericutes were significantly decreased in PSD patients（P＜0.001）．Conclusions  The above microbiota are the main factors affecting the mood of patients with post-stroke depression．Therefore，in clinical practice，we can adjust the depression level of patients with post-stroke depression by properly intervening the changes of intestinal microbiota，which provides a scientific basis for the diagnosis and treatment of PSD．