目的 探讨育龄期女性双相障碍躁狂发作时的甲状腺激素水平.方法 选取2018年12月至2020年8月郑州市第八人民医院收治的126例育龄期女性双相障碍躁狂发作患者为研究组,并分为服药组(64例)和无药组(62例),抽取同期进行体检的125名健康育龄期女性志愿者作为对照组,以催乳素(PRL)为协变量对甲状腺激素水平进行分析,采用杨氏躁狂量表(YMRS)评定躁狂症状,分析甲状腺激素水平与躁狂症状的相关程度.结果 研究组的总甲状腺素(TT4)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平均较对照组升高(F=39.381、21.211、71.386,P＜0.01),总三碘甲腺原氨酸(TT3)水平下降(F=10.000,P＜0.01),无药组的TT4、FT4水平较服药组升高(F=4.214、9.537,P＜0.05).FT3水平与思维内容呈正相关(r=0.178,P＜0.05),FT4水平与YMRS总分、心境障碍、睡眠、语言速度和数量、思维内容、语言思维形式障碍均呈正相关(r=0.277、0.185、0.190、0.247、0.286、0.373,P＜0.05);促甲状腺激素(TSH)水平与YMRS总分、语言思维形式障碍、语言速度和数量、睡眠、性兴趣、活动精力增加、心境障碍均呈负相关(r=-0.184、-0.268、-0.192、-0.256、-0.216、-0.296、-0.283,P＜0.05).结论 育龄期女性双相障碍躁狂发作患者血清甲状腺激素水平存在异常,且躁狂症状严重程度与血清FT4、FT3和TSH水平相关,可能会对生育功能产生影响.

Objective To explore the gender differences in the influence of escitalopram on serum prolactin levels in patients with first-episode depression.Methods A total of 121 hospitalized patients with first depressive episode were retrospectively analyzed,divided into male research（n=57） and female group（n=64） according to genders,prolactin levels at baseline and at the end of 4 weeks of treatment collected,and so did the total scores on the Hamilton Depression Scale（HAMD-17） and side reactions at baseline,at the end of 4 weeks of treatment and on discharge;fifty-seven healthy males and 64 females matched with research groups were assigned to control group.Results On baseline,there were significant differences in prolactin levels among the four groups（P＜0.001）,differences between male research and control group as well as female research and control group had no statistical significance（P＞ 0.05）;at the end of 4weeks of treatment prolactin levels elevated in male and female research groups compared with baseline,but difference only in female research group had statistical significance（P＜0.05）.At the end of 4 weeks of treatment prolactin levels in male research group and female research group were higher than those in baseline period,but there was statistical significance in female research group（P＜0.05）.At the end of 4weeks,the incidence of hyperprolactinemia was respectively 7.02% in male and 20.31 % in female research group,the difference was statistically significant（P＜0.005）.Conclusion Serum prolactin levels elevate in patients with first-episode depression and the elevation is more obvious in female than male ones.

轻度认知功能障碍(MCI)是介于正常衰老和痴呆的一种认知功能轻度损伤的过渡状态,中医学认为MCI属于心、脾、肾三脏虚损,痰浊、瘀血、邪毒阻滞清窍的本虚标实之证.而现代中医对于MCI的治疗也多以益气健脾化痰、补肾、活血为主要的治疗原则.提出"情志失常-肝失疏泄致衰说",为"肝藏象理论"以及"中医衰老学说"增添新的科学内涵.

目的:探讨加味柴胡汤辅助帕罗西汀治疗对抑郁症患者血清神经细胞因子和单胺类递质水平的影响.方法:抑郁症患者96例,按就诊顺序奇偶数分组法分为对照组48例和观察组48例.两组均予以帕罗西汀治疗,观察组联合应用加味柴胡汤,治疗24周.比较两组治疗前后血清神经细胞因子及单胺类递质水平,汉密尔顿抑郁量表(HAMD)评分和不良反应.结果:治疗后观察组血清BDNF 16.77±2.40μg/L、NGF 15.21±1.59μg/L、5-HT 133.42±9.61μg/L、NE 3.62±0.71μg/L,分别高于对照组的12.08±2.31μg/L、9.67±1.31μg/L、120.68±7.64μg/L、2.69±0.51μg/L,观察组5-HIAA 0.16±0.04μg/L,低于对照组0.37±0.08μg/L,差异均具有统计学意义(P<0.05).治疗后观察组HAMD量表各项得分低于对照组,差异均具有统计学意义(P<0.05).观察组不良反应发生率10.41％,低于对照组的27.08％,差异具有统计学意义(P<0.05).结论:加味柴胡汤辅助帕罗西汀可能通过改善抑郁症患者的神经系统代谢,减轻抑郁症症状,且安全性良好.

目的 研究耳穴压豆疗法联合盐酸舍曲林对青少年抑郁症的疗效.方法 选取2018年10月—2019年12月在郑州市第八人民医院门诊治疗的轻中度青少年抑郁症患者60例,用随机数字表法分2组,每组患者30例.治疗组采用耳穴压豆贴敷联合口服盐酸舍曲林治疗,对照组采用口服盐酸舍曲林治疗.应用汉密尔顿抑郁量表(Hamilton's Depression Scale,HAMD)和抑郁自评量表(Self-rating depression scale,SDS)观察并分析2组临床治疗效果和不良反应.结果 2组临床疗效比较差异无统计学意义(P>0.05);2组治疗后的HAMD评分、SDS评分差异均有统计学意义(P<0.05),但2组间比较,差异无统计学意义(P>0.05);治疗组在口干和睡眠障碍的不良反应上,明显低于对照组,差异有统计学意义(P<0.05).结论 耳穴压豆疗法联合盐酸舍曲林治疗青少年轻中度抑郁症患者,疗效与单用盐酸舍曲林相当,但不良反应少,有助于提高患者依从性.

目的 观察长期情志不畅的肝气郁结型轻度认知功能障碍(MCI)患者应激相关激素水平的变化.方法 采用问卷调查法在河南中医学院第一附属医院、第三附属医院体检中心及郑州市多个社区筛选40～65岁的正常中老年人和长期情志不畅的肝气郁结型MCI患者,并按照同性别、同年龄段(±2.5岁)、相同文化程度进行1:1匹配,采用酶联免疫吸附试验(ELISA)检测两组被试血清促肾上腺皮质激素(ACTH)、糖皮质激素(GC)、去甲肾上腺素(NE)水平.结果 与正常中老年人相比,肝气郁结型MCI患者的血清ACTH水平显著降低(P<0.05),GC、NE水平显著升高(P<0.05).结论 长期情志不畅的肝气郁结型MCI患者存在下丘脑-垂体-肾上腺皮质(HPA)轴过度激活、交感-肾上腺髓质(SAM)系统兴奋,这可能是肝郁日久加速脑老化进程的机制之一.

目的:研究轻、中度抑郁症的事件相关电位(ERPs)改变,探索轻、中度抑郁症患者相关脑区电生理变化的敏感指标.方法:对14例抑郁症患者进行ERPs测定,观察其与对照组P300成分的差异.结果:①患者行为数据与对照组比较无统计学差异;②P300潜伏期在组间与电极位点问存在交互效应(P＜0.05),简单效应分析显示在PZ和OZ电极位点,抑郁症患者P300潜伏期长于对照组;③P300波幅组间与电极位点间无交互效应,但组间主效应差异显著,对照组P300波幅大于抑郁症患者组(P＜0.05).结论:轻、中度抑郁症患者存在P300潜伏期延长,波幅降低的客观表现,可作为早期区分患者与正常人的预警检测指标.

Objective To explore the characteristics of magnetic resonance spectroscopy (MRS) of mild cognitive impairment (MCI) patients with liver-qi stagnation syndrome and the possible mechanism of treatment with Xiaoyao Pill (逍遥丸). Methods Ten MCI patients with liver-qi stagnation syndrome formed treatment group, and another 10 healthy subjects with corresponding genders, ages, educational degree formed control group. The treatment group was given Xiaoyao Pill by oral administration, 8 pills once, 3 times a day in continuous 12 weeks, and no intervention in control group. Montreal cognitive assessment scale (Mo CA) was used to evaluate before and after the intervention of the treatment group and since inclusion starting for the control group. GE 3. 0 T super imaging system was used to detect the area under the curve of N-acetyla spartate (NAA), choline (Ch), myinositol (m I) of hippocampus, cingulate gyrus of left and right sides, and calculate the ratio to creatine (Cr). Results Compared with the control group, the numerical value of nomenclature, abstraction, orientation in Mo CA of treatment group before intervention had no statistical significance (P＞ 0. 05), and the scores of other items were significantly lower (P ＜ 0. 05).NAA/Cr in the left hippocampus was lower than the control group (P ＜ 0. 05). The numerical value of nomenclature, orientation in Mo CA of treatment group after intervention had no statistical significance when compare with before treatment (P＞ 0. 05), and the scores of other items were significantly increased (P ＜ 0. 05). Ch/Cr in the right cingulate gyrus of MRS was lower than the control group (P ＜ 0. 05). Conclusion The decrease of NAA/Cr in the left hippocampus can be used as a marker of nerve injury in MCI patients with liver qi stagnation syndrome, and the decrease of the level of choline compound in the posterior cingulate gyrus of hippocampal loop may be one of the neurological mechanisms of Xiaoyao Pill to correct cognitive decline.

目的 探讨疏肝解郁法治疗肝气郁结型轻度认知功能障碍(MCI)患者的疗效及机制.方法 肝气郁结型MCI患者30例,应用疏肝解郁方药逍遥丸干预12 w.采用蒙特利尔认知评估(MoCA)量表评估认知功能;酶联免疫吸附(ELISA)法检测患者用药前后外周血端粒酶活性.结果 与用药前相比,定向得分差异无统计学意义(P>0.05),患者用药后MoCA量表其他项目得分均显著改善(P<0.05);且用药后端粒酶活性明显提升(P<0.05).结论 疏肝解郁方药可以提升端粒酶活性,改善患者认知功能.

目的:应用对检测认知功能具有极高敏感性且无创的事件相关电位(event-related potentials,ERPs)技术研究轻、中度抑郁症患者ERPs认知相关成分的改变,探索轻、中度抑郁症患者相关脑区电生理变化的敏感指标.方法:研究流程经伦理委员会批准.根据《国际疾病与相关健康问题统计分类》(ICD-10)抑郁症诊断标准筛选轻、中度抑郁症患者及根据年龄性别进行匹配的正常对照,采用oddball范式采集行为学及脑电数据,分析两组被试间行为学及事件相关电位P300成分的差异.两组被试行为学结果的比较采用配对t检验.P300潜伏期及波幅采用重复测量方差分析进行统计,组间因素为组别,组内因素为电极位点.检验水准α=0.05.结果:①患者行为数据与正常对照相比无统计学差异(P>0.05);②轻、中度抑郁症患者组与正常对照组被试均成功诱发出P300成分,PZ点诱发出的P300成分最明显.③P300潜伏期组间没有统计学差异(F组间(1,26)=3.990,P=0.056,η2=0.133),电极位点间也没有统计学差异(F电极位点(3,78)=1.930,P=0.150,η2=0.069),但两组被试的组别与电极位点存在交互作用(F组别*电极位点(3,78)=3.675,P=0.028,η2=0.124),简单效应分析显示抑郁症患者组在PZ和OZ位点潜伏期长于正常对照组;④P300波幅组间效应有统计学差异(F组间(1,26)=13.064,P=0.001,η2=0.334),电极位点间有统计学差异(F电极位点(3,78)=25.364,P=0.000,η2=0.494),正常对照组P300波幅大于抑郁症患者组;组间与电极位点间无交互作用(F组别*电极位点(3,78)=2.102,P=0.136,η2=0.075).结论:本研究希望通过观察Oddball范式诱发出的P300波,发现轻、中度抑郁症患者认知功能的细微变化,结果显示患者虽然没有表现出明显的行为学差异,但ERPs检测结果显示出P300潜伏期延长,P300波幅降低,提示轻、中度抑郁症患者尽管外在行为学表现改变不明显,其对刺激的辨别分类加工进程已经受到影响,认知加工能力已开始下降,而这种下降可以通过ERPs检测早期发现,故可将ERPs结果作为检测轻、中度抑郁症患者认知功能的早期辅助预警指标,以更早发现轻中度抑郁症患者并进行适当干预.

Objective To study the effect of Peripateticism pill on the mood, liver depression degree and neuroendocrine function in MCI patients with liver qi stagnation.Methods International diagnostic criteria for MCI and symptoms of liver qi stagnation screening standard were used to screen 40 ~ 65 years old MCI patients with liver qi stagnation.Beck Depression Inventory, Beck Anxiety Inventory and the degree of liver qi stagnation scores table were used to evaluate emotional state and the degree of liver qi stagnation.Enzyme-linked immunosorbent assay (ELISA) was used to analyze adrenocorticotropic hormone (ACTH), glucocorticoid (GC) and norepinephrine (NE) in patients before and after treatment.Results Compared with before treatment, scores of BDI, BAI and symptoms of liver qi stagnation screening were all reduced (P<0.05), ACTH was decreased (P<0.05), NE was increased (P<0.05), GC had no significant changes(P>0.05) after treatment.Conclusions Peripateticism pill could reduce depression, anxiety and symptoms of liver qi stagnation in MCI patients with liver qi stagnation.The possible reason is ACTH concentration decrease and NE concentration increase.

Objective:To study the effect of Shugan method to liver depression degree,cognitive function,8-OHdG,SOD and LPO in MCI patients with liver qi stagnation.Methods:Use the International diagnostic criteria for MCI and symptoms of liver qi stagnation screening standard to screening 40 to 65 years old MCI patients with liver qi stagnation.Use degree of liver qi stagnation scores table to evaluate patients degree of liver qi stagnation.Use MoCA and WAIS-RC to evaluating patients cognitive function.Use ELISA to detect 8-OHdG,SOD and LPO in patients before and after treatment.Results:Compared with before treatment,after treatment in the patients,score of liver qi stagnation symptom reduced,score of visuospatial execution,attention,language,abstract,delayed recall,orientation and total score of MoCA Scale all increased.Score of name of MoCA Scale did not change significantly.Score of similarity,digit span,mapping,block diagram and total score of WAIS-RC all increased.The content of 8-OHdG decreased.The activity of SOD and the content of LPO had no significant change.Conclusion:Shugan method can reduce symptoms of liver qi stagnation in MCI patients with liver qi stagnation,improve patients cognitive function,reduce oxidative damage to DNA is the possible causes of the improve of patients cognitive function.

Objective To investigate the correlation between the event related potentials (ERPs) and evaluation of Montreal Cognitive Assessment (MoCA). Methods The cognitive function of aged people was evaluated by MoCA. Then ERPs data revelant to audio oddball paradigm in participants were recorded and analyzed. The regression analysis was applied to investigate the relationships of the MoCA score with latency and amplitudes of ERPs components. Results The MMN and P3a components of ERPs were recorded in all the participants. No correlation was found between MMN and the score of MoCA (P > 0.05). There was a negative correlation between P3a latency and MoCA (P =0.000). A negative correlation between P3a amplitude and MoCA was found ( P=0.009). Conclusions The P3a component of ERPs can be used as an objective index to examine the cognitive function of aged people.

目的:探讨大学生肝气郁结型抑郁症的患病情况、男女性别比例以及抑郁自评量表(SDS)在筛选抑郁症时的准确率.方法:应用临床流行病学横断面调查法对河南中医学院2 300名大学生进行问卷调查,采用《疾病和有关健康问题的国际统计分类》第十次修订版(ICD-10)抑郁症的诊断标准和肝气郁证判断参考,同时由临床心理科两位副主任医师协诊筛选出肝气郁型抑郁症(轻、中度)大学生患者,对大学生患者的学院分布,男女比例分布,以及SDS的被选频率进行描述性分析.结果:SDS量表总粗分≥41分共筛查出326人.肝气郁结型轻、中度抑郁症患者38人.故本次2 260名大学生抑郁症的患病率为1.68％.抑郁症大学生男性明显小于女性,SDS中条目1明显高于其他条目;条目19明显低于其他条目.结论:大学生抑郁症患者女性明显高于男性,SDS量表是比较好的筛查工具,且抑郁症与肝主疏泄有密切关系,中医临床治疗抑郁症应从主疏泄调畅情志论治为宜.

目的：建立并评价负性情绪应激大鼠模型。方法采用改进的不可预知性心理应激诱导方法建立负性情绪应激模型，观察负性情绪应激对大鼠旷场行为活动、糖水消耗量、24 h摄食量的影响，采用ELISA法检测血浆单胺类神经递质水平。结果应激组较空白对照组大鼠的旷场实验水平得分、垂直得分及总得分下降，中央格停留时间增加；糖水消耗量减少，24 h摄食量减少（P＜0．05），血浆促肾上腺皮质激素（ACTH）、皮质酮（CORT）、去甲肾上腺素（NE）水平升高、5－羟色胺（HT）水平下降（P＜0．05）。结论负性情绪应激大鼠模型较好地模拟了人群遭遇多种应激事件产生的负性情绪状态，造模方法成熟可靠。

Depression disorder is a kind of common mental disease which mainly reflects in down mood. Chinese medicine pathology manifests in the failure of the liveru0027s facilitating the coursing of qi and stagnation of liver qi,involving liver,spleen and kidney. The paper analyzed the stagnation of liver qi syndrome in depression disorder from the ancient Chinese medicine doctors,traditional Chinese medicine diagnostic criteria and treatment situation,providing reference for further research.

五脏衰老学说是中医衰老学说的主流,但脏腑致衰说往往从先后天之本脾肾立论,忽视了肝主疏泄,调畅气机以及肺主气、心主血脉的生理功能.根据中医整体观念,机体的衰老不只是某一脏或两脏虚衰而导致,是五脏生理功能共同衰退变化的结果,所以在临床上应当和五脏之气血阴阳,以延缓衰老.

Objective:To compare students′ critical thinking ability of traditional Chinese medicine colleges education and inheritance education mode,in order to provide objective basis for further TCM training model reform and improvement.Methods:Students of TCM majors of Zhongjing′s academic inheritance class and college education mode were investigated applying Chinese version of critical thinking disposition inventory(CTDI-CV).Results:CTDI-CV overall score of Zhongjing academic inheritance class students was(281.72 ± 18.97) points,and they were positive critical thinking attitude tendency.scores of each factor in CTDI-CV more than 40 points were analysis ability,seeking the truth,cognitive maturity,open-minded and intellectual curiosity.Scores of CTDI-CV,seeking the truth,analysis ability,intellectual curiosity,and cognitive maturity of students in Zhongjing academic inheritance class were significantly higher than that of Chinese medicine profession students of the college education pattern(P<0.05),but the systematic capacity and self-confidence score were low.Conclusion:The new TCM heritage personnel training mode is more conducive to the cultivation of students′ critical thinking ability.