【摘要】 目的 探讨不同亚型抑郁障碍患者认知功能损伤的差异，以及各亚型患者认知功能与脑源性神经营养因子（BDNF）及其前体（pro-BDNF）的相关性。方法 选取2020年7月至2021年12月就诊于山西医科大学第一医院的151例首发重性抑郁障碍（MDD）患者，以及在社区同期招募的40名健康志愿者（对照组）作为研究对象。根据亚型分类标准将首发MDD患者分为焦虑/躯体型抑郁障碍（ASD）组78例、忧郁/动力不足型抑郁障碍（MPD）组53例、非典型抑郁障碍（ATD）组20例。比较4组受试者的17项汉密尔顿抑郁量表（HAMD-17）评分、重复性神经心理状态测验（RBANS）评分、BDNF和pro-BDNF水平。采用Spearman秩相关分析3个亚型RBANS评分与BDNF、pro-BDNF的相关性。结果 ASD组、MPD组的受教育年限低于对照组[（12.49±4.05）年、（13.19±3.21）年比（14.85±2.65）年]，差异有统计学意义（P<0.05）。ASD组、MPD、ATD组的HAMD-17总分高于对照组[（21.88±3.79）分、（19.87±3.22）分、（18.60±2.35）分比（2.03±2.36）分]，差异有统计学意义（P<0.05）。MPD组、ATD组的HAMD-17总分低于ASD组，差异有统计学意义（P<0.05）。ASD组、MPD组及ATD组的BDNF水平高于对照组[0.5(0.3,8.5)pg/ml、0.6(0.3,39.9)pg/ml、18.8(0.5,61.1)pg/ml比0.3(0.2,0.5)pg/ml]，差异有统计学意义（P<0.05）。4组受试者的RBANS量表分和即刻记忆、言语功能、注意力、延时记忆因子评分比较，差异有统计学意义（P<0.05）。ASD组的BDNF与即刻记忆因子评分呈负相关（r=-0.238,P<0.05）,MPD组的pro-BDNF与视觉广度因子评分呈正相关（r=0.314,P<0.05）。结论 不同亚型抑郁障碍患者与健康人群在认知功能和BDNF水平方面存在一定程度的差异，且不同亚型抑郁障碍患者的认知功能损伤与BDNF和pro-BDNF存在相关性。更多还原

【Abstract】 Objective To explore the difference of cognitive impairment in patients with different subtypes of depressive disorder, and analyze the correlation between the cognitive function and brain-derived neurotrophic factor(BDNF) and pro-BDNF in patients with different subtypes of depression. Methods A total of 151 patients with first-episode major depressive disorder(MDD) admitted to the First Hospital of Shanxi Medical University from July 2020 to December 2021 and 40 healthy volunteers [health control(HC) group] from the same period were selected as the research objects. According to subtype classification criteria, the first episode MDD patients were divided into anxiety/somatization depression(ASD) group(n=78), melancholy/under powered depression(MPD) group(n=53) and Atypia depression(ATD) group(n=20). The scores of 17-item Hamilton Depression Scale(HAMD-17), Repeatable Battery for the Assessment of Neuropsychological Status(RBANS), BDNF and pro-BDNF were compared among the 4 groups. Spearman rank correlation was used to analyze the correlation between RBANS scores and BDNF and pro-BDNF in ASD, MPD and ATD groups, respectively. Results The length of schooling in ASD and MPD groups was lower than that in HC group [(12.49± 4.05)years、（13.19±3.21）years vs(14.85±2.65)years], and the differences was statistically significant(P < 0.05). The total scores of HAMD-17 in ASD, MPD and ATD groups were higher than that in HC group [(21.88±3.79)、（19.87±3.22）、（18.60±2.35） vs(2.03±2.36)], and the differences was statistically significant(P<0.05). The total scores of HAMD-17 in MPD and ATD groups were lower than that in ASD group, and the differences was statistically significant(P<0.05). The concentration of BDNF in ASD, MPD and ATD groups was higher than that in control group [0.5(0.3,8.5)pg/ml、0.6(0.3,39.9)pg/ml、18.8(0.5,61.1)pg/ml vs 0.3(0.2,0.5)pg/ml], and the differences was statistically significant(P < 0.05). The RBANS scale scores and immediate memory, verbal function, attention, and delayed memory factor scores of the four study groups were significantly different(P<0.05). There was a negative correlation between BDNF and immediate memory factor in ASD group(r=-0.238, P<0.05). There was a positive correlation between pro-BDNF and visual span factor in MPD group(r=0.314, P < 0.05). Conclusions The cognitive function and BDNF level of patients with different subtypes of depressive disorder are different from that of healthy controls, and the cognitive function impairment of patients with different subtypes of depressive disorder is correlated with BDNF and pro-BDNF to some extent.更多还原