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目的探讨雌二醇及单胺递质——5羟色胺、多巴胺水平与产后抑郁症的关系。方法对342例产后42 d 内的产妇,应用爱丁堡产后抑郁量表(EPDS)、Beck 抑郁量表(BDI)、一般健康问卷(GHQ)进行评定。以 EPDS 总分≥13分为产后抑郁症诊断标准,并分为抑郁症组与正常组,应用放射免疫法测定两组妇女血浆雌二醇和5羟色胺、多巴胺水平。结果 (1)发生率:产后抑郁症发生率为16.7%(57/342)。发生率最高的年龄段为35岁以上(22.2%);23岁以下发生率最低(12.5%),两者比较,差异有统计学意义(P<0.01)。本科及以上学历的发生率较高,为21.3%,文化程度为大专及中专者发生率仅7.9%,两者比较,差异有统计学意义(P<0.01)。(2)生物学指标测定:抑郁症组妇女雌二醇水平为(64.39±0.22)pmol/L,明显低于正常组的(126.18±0.47)pmol/L,两组比较,差异有统计学意义(P<0.01);抑郁症组妇女5羟色胺水平为(1.09±0.21)μmol/L,明显低于正常组的(2.67±0.36)μmol/L,两组比较,差异有统计学意义(P<0.01);抑郁症组妇女多巴胺水平为(5.21±0.54)μmol/L,明显高于正常组的(3.16±0.98)μmol/L,两组比较,差异有统计学意义(P<0.01)。(3)雌二醇水平与 EPDS、BDI、GHQ 量表分值呈负相关(相关系数分别为-0.53,-0.76,-0.35;P<0.05),即雌二醇水平越低,产后 EPDS、BDI、GHQ 量表分值越高;5羟色胺水平与EPDS、BDI、GHQ 量表分值呈负相关(相关系数分别为-0.18,-0.28,-0.11;P<0.05),即5羟色胺水平越低,产后 EPDS、BDI、GHQ 量表分值越高;多巴胺水平与 EPDS、BDI 量表分值呈正相关,与 GHQ量表分值呈无相关性(相关系数分别为0.12,0.07,0.00;P>0.05)。结论 EPDS、BDI、GHQ 量表评定可作为筛选产后抑郁症的依据,雌二醇及5羟色胺、多巴胺水平的测定可为产后抑郁症的诊断提供客观的生物学指标。
Objective To investigate the relationship between estradiol and monoamine neurotransmitters, serotonin, dopamine and postpartum depression. Methods 342 postpartum women within 42 d were assessed with Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Scale (BDI) and General Health Questionnaire (GHQ). The EPDS total score≥13 was divided into the diagnostic criteria of postpartum depression, and divided into depression group and normal group. The levels of plasma estradiol, serotonin and dopamine in the two groups were measured by radioimmunoassay. Results (1) Incidence: The incidence of postpartum depression was 16.7% (57/342). The highest incidence was 35 years old (22.2%); the lowest incidence was 23 years old (12.5%), the difference between the two groups was statistically significant (P <0.01). Bachelor degree or above, a higher incidence rate of 21.3%, college education and secondary education only 7.9%, the difference between the two was statistically significant (P <0.01). (2) Determination of biological indicators: The level of estradiol in depression group was (64.39 ± 0.22) pmol / L, which was significantly lower than that in normal group (126.18 ± 0.47) pmol / L, the difference was statistically significant (P <0.01). The serotonin levels in depression group were (1.09 ± 0.21) μmol / L, which were significantly lower than those in normal group (2.67 ± 0.36) μmol / L, the differences were statistically significant (P < 0.01). The level of dopamine in depression group was (5.21 ± 0.54) μmol / L, which was significantly higher than that in normal group (3.16 ± 0.98) μmol / L, the difference was statistically significant (P <0.01). (3) The level of estradiol was negatively correlated with the score of EPDS, BDI and GHQ (correlation coefficient -0.53, -0.76, -0.35 respectively; P <0.05) BDI, GHQ scale scores higher; 5-HT levels and EPDS, BDI, GHQ scale scores were negatively correlated (correlation coefficients were -0.18, -0.28, -0.11; P <0.05) Low, postpartum EPDS, BDI, GHQ scale scores higher; dopamine levels and EPDS, BDI scale scores were positively correlated with GHQ scale scores were no correlation (correlation coefficients were 0.12,0.07,0.00; P > 0.05). Conclusion The assessment of EPDS, BDI and GHQ scales can be used as a basis for screening for postpartum depression. The determination of estradiol, serotonin and dopamine levels can provide objective biological indicators for the diagnosis of postpartum depression.