广泛性焦虑症与抑郁症患者皮肤交感反应对照研究

广泛性焦虑症与抑郁症患者皮肤交感反应对照研究

蒋红;王灵;王新玲;冯锐;章迎春;屠玲玲;陈炜

【摘要】目的:探讨广泛性焦虑症(GAD)与抑郁症(MDD)患者皮肤交感反应(SSR)的差异.方法:对30例GAD患者、30例MDD患者,分别在治疗前及治疗8周后检测SSR的潜伏期与波幅,并与30例正常对照组(HC)比较.结果:GAD组治疗前SSR 潜伏期低于HC组,波幅明显高于HC组,差异均有显著性意义(P ＜0.05);MDD组治疗前潜伏期比HC组明显延长,波幅明显低平,差异均有显著性意义(P＜0.05),而且有2例未引出波形.经治疗后,GAD组潜伏期水平较治疗前延长,接近于对照组水平;波幅较治疗前降低,但高于对照组(P ＞0.05);MDD组潜伏期较治疗前降低(P＜0.05),差异均有显著性意义.MDD组的SSR潜伏期明显延长,GAD组潜伏期缩短,两组比较差异有统计学意义(P＜0.05);MDD组波幅明显低平,而GAD组波幅明显增高,两组比较差异有统计学意义(P ＜0.001).相关分析显示,SSR各参数与HAMA和HAMD呈正相关,相关系数分别为0.57和0.73.结论:GAD与MDD在SSR的电生理检测方面有显著性差异.%Objective: To compare skin sympathetic response( SSR) between patients with generalized anxiety disorder(GAD) and patients with major depression disorder( MDD). Methods: The latency and amplitude of SSR wave were measured in 30 GAD patients and 30 MDD patients, before and after 8-week treatment of anti-anxiety or anti-depression drugs. Thirty age and sex-matched healthy subjects served as healthy controls ( HC ). Results: Before the treatment, the latency of SSR in CAD patients was significantly shorter than that in HC group, while the amplitude was significantly higher than that in the HC(P <0.05). In MDD group,the latency before the treatment was significantly longer than that

in thernHC, while the amplitude was significantly lower than that in the HC (P < 0. 05). After treatment, the latency of SSR in GAD group was extended compared to the baseline level, and close to the level of the HC. The amplitude of SSR in GAD group became lower after treatment, but still higher than that of control group. The latency of SSR in MDD patients was significantly shorter after treatment compared to baseline level(P <0.05). In addition,the latency of SSR in MDD group was still longer than that in GAD group (P <0.05) ; meanwhile, the amplitude of SSR in MDD group was significantly lower that in GAD group (P < 0.001). SSR parameters were positively correlated with HAM A and HAMD scores with a correlation coefficient of 0. 57 and 0. 73, respectively. Conclusion: There are significant differences in SSR parameters between patients with GAD and patients with MDD, indicating that SSR can be used as an objective index to distinguish anxiety from depression.

【期刊名称】《浙江大学学报（医学版）》

【年(卷),期】2013(042)002

【总页数】5页(P192-196)

【关键词】广泛性焦虑;抑郁症;表现焦虑量表;精神病状态评定量表;皮肤交感反应;汉密尔顿抑郁量表;汉密尔顿焦虑量表

【作者】蒋红;王灵;王新玲;冯锐;章迎春;屠玲玲;陈炜

【作者单位】浙江大学医学院附属邵逸夫医院精神卫生科,浙江杭州310016

【正文语种】中文

【中图分类】R749.72

广泛性焦虑症(GeneralizedAnxiety Disorder，GAD)和抑郁症 (Major Depression，MDD)的临床诊断依靠症状表现，但有部分患者因为抑郁和焦虑症状合并存在，导致对二者诊断鉴别的困难，虽然共病(comorbidity)概念的提出解决了这样的困境，但无论是概念提出的出发点，还是临床发展的结局，共病均为过渡性诊断，因此，寻找两者生物学差异成为热点。有研究认为，GAD、MDD与神经电生理的关系密切［1-2］可能成为鉴别两者的一个可靠指标。为此，作者对两组患者进行皮肤交感反应(Sympathetic skin response，SSR)检查，并与健康对照组进行比较，报道如下。

1 对象和方法

1.1 对象

1.1.1 广泛性焦虑症组(GAD组)和抑郁症组(MDD组)患者入组标准 (1)符合中国精神疾病分类方案与诊断标准第3版有关GAD和MDD的诊断标准;(2)无严重躯体疾病及合并其他精神疾病;(3)入组前未进行药物治疗;(4)GAD组:汉密顿焦虑量表(Hamilton Anxiety Scale，HAMA)≥15分，汉密尔顿抑郁量表(Hamilton depression scale，HAMD)≤12分;MDD组:HAMD≥18分，HAMA≤10分。两组各入组30例，均为2007年2月至2008年6月浙江大学医学院附属邵逸夫医院精神卫生科门诊患者。HAMA、HAMD检查由对诊断不知情的心理测量室人员评定。本研究经浙江大学医学院附属邵逸夫医院伦理委员会批准，全部对象均对本研究知情及签署知情同意书。

1.1.2 GAD组共30例，男14例，女16例;年龄18～57岁，平均(39±13)岁;病