摘要/Abstract

摘要： 目的 ·探讨双相障碍患者及其不同疾病状态下的氧化应激水平，了解碳酸锂治疗对双相障碍患者氧化应激水平的影响。方法 ·选取上海交通大学医学院附属精神卫生中心门诊 /住院的双相障碍患者 61例（轻躁狂 /躁狂发作 8例，抑郁发作 53例），同时选取 49例健康人作为正常对照。双相障碍患者单用碳酸锂治疗，观察 6周，在治疗前和 6周末采用汉密尔顿抑郁量表 17项（Hamilton Depression Scale-17，HAMD17）、Young躁狂评定量表（ Young Mania Rating Scale，YMRS）及临床疗效总评量表严重度分量表（ Clinical Global Impression-Severity of Illness，CGI-SI）评估患者的临床疗效，同时抽取外周静脉血，检测血浆过氧化氢酶（catalase，CAT）、超氧化物歧化酶（ superoxide dismutase，SOD）、谷胱甘肽过氧化物酶（ glutathione peroxidase，GSH-Px）及丙二醛（malondialdehyde，MDA）含量。比较双相障碍患者和正常对照组间氧化应激水平的差异，碳酸锂治疗前后氧化应激水平的变化。结果 ·双相障碍患者 SOD水平均低于正常人群（ t5.403，P0.000），GSH-Px和 MDA水平均高于正常人群（ t8.371，P0.000； t6.063，P0.000），CAT水平在这 2组中差异无统计学意义，且 4项氧化应激指标在躁狂状态或抑郁状态患者之间无明显差异。 GSH-Px、MDA含量在碳酸锂治疗后较治疗前下降，差异有统计学意义（ t4.352，P0.000；t2.720，P0.009），其他氧化应激指标 SOD、CAT水平治疗前后无明显变化。碳酸锂治疗后，双相躁狂状态和抑郁状态 MDA含量均有明显下降（ t3.072，P0.018； t3.532，P0.001），且躁狂状态下降更明显，而双相抑郁状态的 GSH-Px水平有明显下降（ t2.880，P0.006）。结论 ·双相障碍患者存在氧化应激损伤；碳酸锂可以调整双相障碍患者氧化应激系统的不平衡，其作用在不同疾病状态下略有差别。
关键词: 双相障碍, 氧化应激, 心境稳定剂, 锂盐, 作用机制
Abstract:
Objective · To explore the effect on oxidative stress status of lithium treatment in bipolar disorder patients. Methods · This was a case-control study of 61 patients with bipolar disorder (8 manic patients and 53 depressed patients) matched with 49 healthy volunteers Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine. Patients with bipolar disorder were treated with lithium carbonate for 6 weeks. The 17 Hamilton Depression Rating Scale (HAMD-17), Young Mania Rating Scale (YMRS), Clinical Global Impression-Severity of Illness (CGI-SI) were used to assess the clinical outcomes at baseline and endpoint. The serum levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) were measured at baseline and endpoint. The oxidative stress status of the patients and controls was compared, as well as its change after lithium treatment. Results · In the patients with bipolar mania or bipolar depression, the level of SOD was lower (t5.403, P0.000) and the levels of GSH-Px and MDA were higher (t8.371, P0.000; t6.063, P0.000) than those of the normal population, and the level of CAT had no difference in these two groups. There was no difference in the four oxidative stress indicators between the manic state and the depressive state. There were significant differences in plasma GSH-Px and MDA contents after lithium treatment (t4.352, P0.000; t2.720, P0.009), while there was no significant difference in plasma SOD and CAT levels after lithium treatment. After treatment with lithium, MDA content in bipolar mania and bipolar depression decreased significantly (t3.072, P0.018; t3.532, P0.001), and that in the manic state decreased more. There was a significant decrease in GSH-Px level in bipolar depression (t2.880, P0.006). Conclusion · Oxidative stress injury exists in the patients with bipolar disorder. Lithium carbonate may adjust the imbalance of oxidative stress in these patients, and its effect in different disease states is slightly different.
Key words: bipolar disorder, oxidative stress, mood stabilizer, lithium, mechanism


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