选择性5-羟色胺再摄取抑制剂的临床应用进展

5-羟色胺（5-hydroxy tryptamine,5-HT）是中枢及外周神经系统中一种重要的神经递质。5-羟色胺转运体（5-HT transporter,5-HTT）可将5．HT再摄取,降低细胞外5-HT浓度,从而调节神经信号传导。5-HTT异常在某些精神疾病的发病中起重要作用。近年来选择性5．羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors,SSRIs）在临床上的应用日趋广泛,如治疗抑郁症、焦虑症、抑郁和焦虑共病等常见的精神疾病。氟西汀、帕罗西汀、舍曲林、氟伏沙明和西酞普兰是目前临床上最常用的五种SSRIs,被誉为抗抑郁药的“五朵金花”。本文详细介绍近年来在临床上药物治疗抑郁症取得的成果以及这类药物的药效学、药动学、不良反应和相互作用等,并简要介绍SSRIs在其它疾病领域取得的应用进展。     

氟西汀联合六味地黄丸对更年期综合征患者血清孕激素、叶酸及5-羟色胺水平的影响

目的:探讨氟西汀联合六味地黄丸对更年期综合征患者抑郁症状及血清孕激素、叶酸及5-羟色胺水平的影响。方法:收集在我院就诊或住院治疗的80例更年期综合征患者,随机分为实验组和对照组,每组40例。对照组患者给予盐酸氟西汀治疗,实验组患者在对照组基础上给予六味地黄丸治疗。观察并比较两组患者治疗前后血清孕激素、叶酸及5-羟色胺水平的变化以及汉密尔顿抑郁量表(HAMD)评分。结果:与治疗前相比,两组患者治疗后的孕激素、叶酸以及5-羟色胺水平均显著升高(P0.05),HAMD评分水平明显下降(P0.05);与对照组相比,实验组患者的孕激素、叶酸以及5-羟色胺水平较高(P0.05),HAMD评分水平较低(P0.05)。结论:氟西汀联合六味地黄丸能够显著升高更年期综合征患者血清孕激素、叶酸及5-羟色胺水平,改善更年期综合征症状。     

儿童强迫症、抑郁症患者血小板5-羟色胺浓度的比较研究

目的:通过检测儿童强迫症、抑郁症患者血小板5-羟色胺(5-HT)的浓度,探讨血小板5-HT在儿童强迫症、抑郁症发病中的作用.方法:采用高效液相色谱法检测22例强迫症患儿(包括强迫思维15例,强迫动作7例)和20例抑郁症惠儿血小板5-HT的浓度,并与20名正常儿童进行比较.结果:强迫症患儿(173.43±90.67)ng/109和抑郁症患儿(251.62±152.72)ng/109血小板5-HT的浓度低于正常儿童(351.91±170.97)ng/109(P<0.05),强迫症患儿的血小板5-HT的浓度和抑郁症惠儿的差异没有显著性(P>0.05).强迫症患儿中,强迫思维惠儿的血小板5-HT的浓度(147.09±44.92)ng/109低于强迫动作患儿(229.88±1:136.44)ng/109(P<0.05).结论:儿童强迫症、抑郁症患者血小板5-HT浓度明显下降,并且强迫思维患儿的血小板5-HT浓度与强迫动作患儿的差异有显著性.     

5-羟色胺转运体敲除小鼠的分子和细胞改变

5-羟色胺转运体(5-HTT)在神经精神心理正常功能的维持及疾病的发生和发展中起重要作用。5-HTT的表达能力减低或消失的小鼠(称为:5-HTT敲除小鼠)表现出许多行为的改变,例如:焦虑类似行为增多、对应激更加敏感和攻击性行为减少。这些行为的改变有的与携带5-HTTLPR短等位基因的人很相似。因此5-HTT敲除小鼠被作为研究5-HTTLPR多态性导致情感性精神障碍发病机制的动物模型。本文主要就5-HTT敲除小鼠的5-HT浓度和代谢、下丘脑-垂体-肾上腺皮质轴以及对其他神经递质转运体影响的分子和细胞改变进行综述。     

5-羟色胺与Toll样受体及肠道菌群之间关系的研究

5-羟色胺(5-HT)是参与调节胃肠道运动、内脏敏感性、分泌等功能的重要神经递质和信号分子。肠道菌群对5-HT的产生有重要影响,已发现一些产芽孢细菌(spore-forming bacteria,SP)类肠道微生物能刺激肠嗜铬细胞(enterochromaffin cell,EC)产生5-HT。微生物通过Toll样受体(Toll-like receptors,TLR)激活神经分泌机制来调节胃肠运动,某些TLR通过作用于5-HT受体调节小鼠回肠的自主收缩和5-HT诱导的收缩反应。通过调节肠道菌群可以对5-HT综合征及其相关生理和病理状况产生重要影响。因此,对5-HT与TLR及肠道菌群相互之间的关系进行进一步的研究有重要意义。     

不同脊椎动物消化道内5-羟色胺免疫染色细胞的分布

用过氧化物酶——抗过氧化物酶（PAP）法,对乌鳢（Ophiccephalus argus）、中华大蟾蜍（Bufo bufo garaaarizans）、黄喉水龟（Clemmys mutica）、虎皮鹦鹉（Melopsittacus undulatus）和小白鼠（Mus musculus albula）五种脊椎动物消化道内的5-羟色胺（5-hydroxytryptamine,简称5-HT）免疫染色细胞的分布进行了研究。发现各种动物胃肠道（虎皮鹦鹉胃、乌鳢肠及胃贲门除外）均含有5-HT免疫染色细胞,并首次发现黄喉水龟和中华大蟾蜍食道内含有5-HT免疫染色细胞。一般地,各种动物胃内5-HT免疫染色细胞密度最高,十二指肠和大肠次之,小肠最低。5-HT免疫染色细胞位于粘膜上皮或腺上皮细胞间,常有一个或一个以上的细胞突起伸入固有层或肠腔面（或腺腔面）,有些细胞的一端突起伸入固有层,另一端突起伸入肠腔面,表明5-HT免疫染色细胞兼具内分泌或分泌功能。     

大鼠脾气虚结合胃溃疡模型中结肠 5-羟色胺及其受体的变化

目的探讨脾气虚胃溃疡证病结合模型结肠中5-羟色胺及其受体的变化,及加味四君子汤治疗脾虚证的机理。方法免疫组织化学染色和图像分析技术。结果脾气虚合并胃溃疡模型中结肠5-羟色胺及其受体阳性反应产物的含量均增加,经过加味四君子汤治疗后,上述指标的变化降低,接近对照组。结论大鼠脾气虚胃溃疡模型中结肠组织及其受体含量的增高可导致消化系统功能紊乱,可能是脾气虚胃溃疡的一种重要病因或病机之一,加味四君子汤能通过纠正这些变化而发挥治疗作用。     

5-羟色胺受体基因多态性位点与海洛因依赖的关联性研究

目的：5-HT（5-hydroxytryptamine,5-HT）参与了多种中枢神经活动的生理过程,其功能异常可以影响很多行为障碍,已有研究显示,5-HT水平与多种精神疾病密切相关。5-HT受体及其转运体基因在海洛因依赖发生发展中起到了重要的作用,是海洛因依赖的主要候选基因。探讨5羟色胺2A受体（Serotonin 2A receptor,HTR2A）基因启动子区-1438A/G（rs6311）、外显子区102T/C（rs6313）与5羟色胺1B受体（Serotonin 1B receptor,HTR1B）基因外显子区861G/C（rs6296）3个单核苷酸多态性和海洛因依赖的关联性分析。方法：严格按照诊断标准,选取无亲缘关系的海洛因依赖个体616例及健康个体600例提取基因组DNA,采用PCR-RFLP方法检测rs6311、rs6313和rs6296 3个SNPs位点的基因型频率,采用SPSS16.0软件分析各位点等位基因、基因型频率在病例-对照组间差异。结果：HTR2A基因rs6311和HTR1B基因rs6296位点的等位基因及基因型频率分布在2组间存在统计学差异（P〈0.05）,病例组rs6311位点的等位基因A频率显著高于对照组（X2=5.436,P=0.020,OR=1.208,CI=1.031~1.417）,rs6296位点的等位基因C频率显著高于对照组（X2=12.116,P=0.000,OR=1.329,CI=1.132~1.560）。连锁不平衡检验结果显示,HTR2A基因rs6311、rs6313位点处于不连锁状态,D＇〈0.5。结论：HTR2A基因rs6311和HTR1B基因rs6296多态性可能与海洛因成瘾有关,携带有rs6311 A等位基因与rs6296 C等位基因的人可能更容易对海洛因产生依赖。我们的研究为海洛因依赖易感人群筛选及药物靶向治疗提供了理论依据。     

赤链蛇消化道5-羟色胺细胞的免疫组织化学定位

应用卵白素-生物素-过氧化物酶复合物（avidin—biotin—peroxidase complex,ABC）免疫组织化学方法对赤链蛇消化道5-羟色胺（5-hydroxytryptamine,5-HT）细胞的分布密度和形态学特点进行了观察。5-HT在其整个消化道中均有分布,以十二指肠密度最高,胃幽门部其次,食道和胃体最低。在整个消化道中,均可见到呈圆形或椭圆形的闭合型5-HT细胞,且主要分布于食道、胃部和直肠;开放型5-HT细胞呈长梭形、三角形或不规则形,集中分布于小肠各段,在其余消化道各段偶见。本文总结了蛇类消化道5-HT细胞分布型的一般规律,并结合赤链蛇的生活环境和合件．对苴消化谱5-HT细朐的分布密席讲行了讨论。     

爬行类消化道5-羟色胺细胞免疫组化研究进展

5-羟色胺是一种单胺类,约95%以上分布于胃肠道中,关于其形态学特征和分布密度的研究是比较组织学和比较内分泌学的热点领域之一。文章总结了爬行动物消化道5-羟色胺细胞的形态学特征和分布密度规律,概述了分类地位、食性和栖息地环境与细胞分布型的关系,探讨了特殊分布型产生的原因。     

抑郁症患者儿童期受虐对单胺类神经递质及相关因素的影响

目的：探索抑郁症患者儿童期受虐对血清5．羟色胺（5-hydroxytryptamine5-HT）、多巴胺（Dopamine DA）和去甲肾上腺素（Norepinephrine NE）水平及相关因素的影响。方法：对101例抑郁症患者采用儿童受虐问卷（CTQ）、24项汉密尔顿抑郁量表（HAMD24）、自杀意念量表（SIOSS）及Beck绝望量表（BHS）评定儿童期受虐程度,抑郁严重程度,自杀意念强度和绝望严重程度。采用酶联免疫吸附法（ELLSA）测定血清5-HT、DA和NE水平。根据CTQ评分将总分≥50分,分量表≥10分定为被虐待。结果：（1）情感忽视组血清5-HT和DA水平明显低于无忽视组（35．63±62．43,62．58±79．50;P〈0．05;4．08±6．30ng／1,7．61±11．47ng／1,P〈0．05）,受虐组血清NE水平虽高于无受虐组但无统计学意义;（2）情感受虐组和躯体受虐组的HAMD24评分明显高于无受虐组（30．60±9．84,26．77±6．54P〈0．05;31．00±9．59,27．79±8．23;P〈0．05）．遭受性虐待组SIOSS评分明显高于无虐待组（17．07±3．29,14．26±3．63,P〈0．01）。情感受虐组BHS评分明显高于无受虐组（12．13±3．32,10．35±4．30,P〈0．05）（3）儿童期情感被忽视和躯体被虐待评分与BHS评分呈明显正相关（r=0．22,r=0．23,P〈0．05）,被性虐待程度与SIOSS评分有明显相关（r=0．35,P〈0．01）。结论：儿童期情感被忽视的抑郁症患者血清5-HT和DA水平偏低,儿童期受虐的抑郁症患者可能存在下丘脑-垂体-肾上腺轴的不稳定。儿童期受虐是抑郁发作的危险因素并有更严重的抑郁症状。     

Effects of Methiothepin and Lysergic Acid Diethylamide on Serotonin Release In Vitro and Serotonin Synthesis In Vivo: Possible Relation to Serotonin Autoreceptor Function

Abstract: An in vitro system characterizing the presyn- aptic serotonin (5-HT) autoreceptor which controls the release of 5-HT from rat brain slices is described. Using this system, methiothepin (1–10 μ M) demonstrated 5-HT autoreceptor antagonist activity -by enhancing 5-HT release, while several recognized postsynaptic 5-HT receptor antagonists were inactive: mianserin, cinanserin, cyproheptadine, methysergide. The activity of methiothepin was highest in hypothalamic slices and lowest in striatal slices and was inhibited by the autoreceptor agonists lysergic acid diethylamide (LSD) and 5-methoxy- tryptamine (5-MT). The reversal of the methiothepin-enhanced 5-HT release from hypothalamic slices by LSD was not influenced by 0.3 μ M tetrodotoxin. The peripheral administration of LSD to rats has been shown to reduce 5-HT synthesis and release by a mechanism thought to involve, in part, an autoreceptor-mediated reduction in impulse flow of 5-HT neurons. In the present experiments, intraperitoneal injection of methiothepin antagonized the LSD-induced reduction in hypothalamic 5-HT synthesis (5-hydroxytryptophan accumulation) while exerting no influence by itself. Conversely, compounds which were not active as 5-HT autoreceptor antagonists in vitro (i.e., cyproheptadine, methysergide, cinanserin) did not influence the effect of LSD on 5-HT synthesis. Further, the reduction in 5-hydroxytryptophan (5-HTP) accumulation by LSD showed regional differences in inhibition by methiothepin (hypothalamus > cortex > striatum) which paralleled the autoreceptor antagonist activity of methiothepin in vitro. These data suggest that similar autoreceptor mechanisms control 5-HT release and synthesis in terminal 5-HT projection areas and that the reduction in 5-HT accumulation by LSD and the antagonism by methiothepin may represent a useful biochemical measure of 5-HT autoreceptor activity in vivo.     

猫下丘中央核5-HT、P物质和星形胶质细胞年龄相关变化

目的比较研究青年猫与老年猫下丘中央核(CIC)5-羟色氨(5-HT)、P物质(SP)能神经元及星形胶质细胞年龄性变化,探索老年个体听力下降的神经机制。方法 Nissl染色显示下丘神经元,免疫组织化学ABC法显示5-HT、SP和胶质纤维酸性蛋白(GFAP)免疫反应(immunoreactive,IR)细胞。光镜下观察、拍照,对神经元和5-HT、SP及GFAP免疫反应细胞分别计数并换算成密度,测量其IR细胞直径取平均值,以及它们的阳性反应平均灰度值。结果 5-HT-IR、SP-IR和GFAP-IR细胞、阳性纤维及其终末在青年猫及老年猫下丘中央核均有分布。与青年猫相比,老年猫下丘中央核5-HT密度均显著下降(P<0.01),胞体直径明显减小(P<0.01),阳性反应明显减弱(阳性反应强度与灰度值呈负相关),SP-IR神经元和星形胶质细胞密度却显著增大,阳性反应显著增强。结论在衰老过程中猫下丘神经元尤其是5-HT能神经元有显著丢失现象,提示5-HT能神经元显著减少导致下丘听觉信息传递功能减弱,可能引起老年个体听觉功能衰退的重要原因;SP能神经元和星形胶质细胞密度显著增大,可能起到延缓衰老的作用。     

奥氮平联合氟西汀治疗对抑郁症患者血清NE水平以及抑郁情绪影响的临床研究

摘要 目的：研究奥氮平联合氟西汀治疗抑郁症患者的临床疗效,并探讨联合治疗对抑郁症患者血清去甲肾上腺素（Norepinephrine,NE）和抑郁情绪的影响。方法：纳入2018年6月到2020年5月在我院接受治疗的抑郁症患者56例,随机数表法将其分为对照组和研究组两组。对照组患者接受氟西汀治疗,而研究组患者接受奥氮平联合氟西汀治疗,两组患者均治疗8周。比较两组患者年龄、性别、身高、BMI以及病程等一般资料,并比较两组患者临床治疗疗效、治疗期间不良反应发生率、治疗前后血清NE水平。用汉密顿抑郁量表(Hamilton Rating Scale for Depression,HAMD)和抑郁自评量表（Self-Rating Depression Scale,SDS）评估两组患者抑郁情绪。结果：两组患者性别、年龄、身高、BMI、病程以及合并症等一般情况均显示无显著差异（P>0.05）。研究组治疗总有效率（92.86%）显著高于对照组（64.29%）总治疗有效率（P<0.05）,但研究组患者治疗期间不良发生率（32.14%）与对照组（28.57%）比较无显著差异（P>0.05）。治疗后,两组患者血清NE水平均较治疗前显著升高（P<0.05）,并且研究组患者治疗后血清NE水平均显著高于对照组患者（P<0.05）;两组患者血清HAMD和SDS评分均较治疗前显著降低（P<0.05）,并且研究组患者治疗后HAMD和SDS评分均显著低于对照组患者（P<0.05）。结论：奥氮平联合氟西汀治疗抑郁症患者安全有效,不良反应发生率较低,可有效升高抑郁症患者血清NE水平,而改善患者抑郁情绪。     

Adrenocorticotropic hormone activation of adenylate cyclase in raphe neurons: Multiple regulatory pathways control serotonergic neuronal differentiation

The RN46A cell line was derived from embryonic day 13 rat medullary raphe cells by infection with a retrovirus encoding the temperature-sensitive mutant of SV 40 large T antigen (tsT-ag). The RN46A cell line is neuronally restricted and constitutively differentiates following a shift to nonpermissive temperature. Differentiated RN46A cells express low levels of tryptophan hydroxylase (TPH) but no detectable levels of serotonin (5-HT). Treatment of cultures with the adrenocorticotrophic hormone peptide ACTH_4–10 up-regulates the expression of TPH immunoreactivity in differentiated RN46A cells, but 5-HT synthesis requires initial treatment with ACTH_4–10, followed by partial membrane depolarizing conditions. Up-regulation of TPH by ACTH_4–10 is apparently due to activation of adenylate cyclase, whereas the increased 5-HT synthesis with membrane depolarization can be blocked with the voltage-sensitive Ca²⁺ -channel blockers nifedipine and ω-conotoxin. ACTH_4–10 treatment also markedly up-regulates the expression of the 5-HT reuptake transporter, as do dibutyryl cyclic AMP and forskolin; chronic membrane depolarization has no effect on 5-HT reuptake. The expression of the high-affinity 5-HT_1A receptor is increased threefold by ACTH_4–10 treatment during differentiation and fivefold by differentiation under partial membrane depolarizing conditions. Combining ACTH_4–10 treatment and membrane depolarization does not increase expression of the 5-HT_1A receptor further. 5-HT release is constitutive in ACTH-treated RN46A cells and linked to spontaneous synaptic vesicle fusion in RN46A cells. Considered with previous results, these data indicate that multiple effectors, ACTH, brain-derived neurotrophic factor, and membrane depolarization, have both distinct and overlapping effects that regulate specific elements of the serotonergic neuronal phenotype during differentiation and maturation. © 1995 John Wiley & Sons, Inc.     

Serotonin- and two putative serotonin receptors-like immunohistochemical reactivities in the ground crickets Dianemobius nigrofasciatus and Allonemobius allardi

Serotonin (5-hydroxytryptamine; 5-HT)- and two putative serotonin receptors, 5-HT1A- and 5-HT1B-like, immunohistochemical reactivities were investigated in the cephalic ganglia of two ground crickets, Dianemobius nigrofasciatus and Allonemobius allardi. 5-HT-ir was strongly expressed in the central body, accessory medulla region of the optic lobe, frontal ganglion, posterior cortex of the protocerebrum, dorsolateral region of the protocerebrum, and the suboesphageal ganglion (SOG) in both crickets. However, 5-HT1A-ir and 5-HT1B-ir showed quite mutually distinct patterns that were also distinct from 5-HT-ir. 5-HT1A-ir was located in the pars intercerebralis, dorsolateral region of the protocerebrum, optic tract, optic lobe, and the midline of the SOG in both crickets. 5-HT1B-ir was located in the pars intercerebralis and dorsolateral region of the protocerebrum, and detected weakly in the optic lobe, tritocerebrum, and the midline of the SOG in both crickets. Interspecific differences were observed with 5-HT1A-ir. 5-HT1A-ir was expressed weakly in two neurons in the mandibular neuromere of the SOG in D. nigrofasciatus, while it was expressed strongly in the tritocerebrum, mandibular neuromere, and maxillary neuromere of the SOG in A. allardi and co-localized with CLOCK-ir (CLK-ir). 5HT-1B-ir was co-localized with CLK-ir in the tritocerebrum, mandibular neuromere, and maxillary neuromere of the SOG when double-labeling was conducted in both crickets. These results indicated that 5-HT and both types of 5-HT receptors may regulate circadian photo-entrainment or photoperiodism in A. allardi, while only 5-HT1B may be involved in circadian photo-entrainment or photoperiodism in D. nigrofasciatus.     

Lack of CB1 receptor activity impairs serotonergic negative feedback

Serotonergic and endocannabinoid systems are important substrates for the control of emotional behaviour and growing evidence show an involvement in the pathophysiology of mood disorders. In the present study, the absence of the activity of the CB₁ cannabinoid receptor impaired serotonergic negative feedback in mice. Thus, in vivo microdialysis experiments revealed increased basal 5-HT extracellular levels and attenuated fluoxetine-induced increase of 5-HT extracellular levels in the prefrontal cortex of CB₁ knockout compared with wild-type mice. These observations could be related to the significant reduction in the 5-HT transporter binding site density detected in frontal cortex and hippocampus of CB₁ knockout mice. The lack of CB₁ receptor also altered some 5-HT receptors related to the 5-HT feedback. Extracellular recordings in the dorsal raphe nucleus (DRN) revealed that the genetic and pharmacological blockade of CB₁ receptor induced a 5-HT_1A autoreceptor functional desensitization. In situ hybridization studies showed a reduction in the expression of the 5-HT_2C receptor within several brain areas related to the control of the emotional responses, such as the DRN, the nucleus accumbens and the paraventricular nucleus of the hypothalamus, whereas an over-expression was observed in the CA3 area of the ventral hippocampus. These results reveal that the lack of CB₁ receptor induces a facilitation of the activity of serotonergic neurons in the DRN by altering different components of the 5-HT feedback as well as an increase in 5-HT extracellular levels in the prefrontal cortex in mice.