Objective:To investigate the effects of lithium combined with quetiapine or modified electroconvulsive therapy(MECT) on serum brain-derived neurotrophic factor(BDNF) in patients with depressive episode of bipolar disorder(BD) and its relationship with therapeutic effect.Method:Based on BD criteria of diagnostic and statistical manual of mental disorders 4th edition(DSM-IV),80 patients with depressive episode of BD(case group) and 42 healthy controls(control group) were enrolled.Patients were randomly assigned into quetiapine group who were treated with lithium and quetiapine and MECT group who received lithium and MECT.The serum BDNF level and Hamilton rating scale for depression(HAMD) were assayed before and after 4-week treatment.Results:After 4-week treatment,36 patients in quetiapine group and 31 ones in MECT group completed the study;There was a significant difference in the BDNF level before treatment between case and control groups(P<0.01);The levels of BDNF in both drug and MECT groups increased after 4-week treatment(t=-6.04,-5.80;all P<0.01).The HAMD score after treatment significantly decreased than that before treatment(t=16.18,17.51;all P<0.01);Pearson correlation analysis showed that the change of BDNF level was negatively correlated with the change of HAMD score before and after treatment in case group(r=-0.30,P=0.013).Conclusion:Patients with depressive episode of BD have significantly decreased serum level of BDNF than healthy controls.Lithium combined with quetiapine or MECT could improve symptoms and increase BDNF level.BDNF may be the potential biomarker for the treatment of BD with depressive episode.%目的:比较锂盐合并喹硫平或改良电休克治疗(MECT)对双相障碍抑郁发作患者血清脑源性神经营养因子(BDNF)水平的影响及其与疗效的关系. 方法:80例符合美国《精神障碍诊断与统计手册》第4版双相障碍抑郁发作诊断标准的患者(病例组)采用随机数字表法分为喹硫平组40例(碳酸锂联合喹硫平治疗组)及MECT组40例(碳酸锂合并MECT组),分别在治疗前及治疗4周末测定血清BDNF水平并评定汉密尔顿抑郁量表(HAMD),同时对42名健康对照者(正常对照组)测定血清BDNF水平进行比较. 结果:经过4周治疗,喹硫平组共完成36例,MECT组完成31例.病例组治疗前血清BDNF水平显著低于正常对照组(t=-8.91,P<0.01);治疗后,喹硫平组与MECT组血清BDNF水平较治疗前显著升高(t=-6.04,-5.80;P均<0.01),HAMD评分较治疗前显著降低(t=16.18,17.51;P均<0.01).Pearson相关分析显示病例组在治疗前后血清BDNF变化水平与HAMD评分变化值呈显著负相关(r=-0.30,P=0.013). 结论:双相障碍抑郁发作患者血清BDNF水平显著降低,锂盐合并喹硫平或MECT治疗均能有效改善患者症状并提高血清BDNF水平,且疗效相当;BDNF可能是双相障碍抑郁发作疗效的潜在生物标记物.
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