中文摘要：

目的 了解首次发病类型不同双相障碍患者的临床特征和甲状腺素水平的差异.方法 本研究为横断面研究和回顾性研究.回顾分析2012年11月至2013年1月全国26家精神专科医院或综合医院精神科住院或门诊就诊、符合ICD-10中双相障碍诊断标准的1 479例以抑郁为首次发病的双相障碍患者（抑郁首发组）和2 085例以躁狂/轻躁狂为首次发病的双相障碍患者（躁狂/轻躁狂首发组）的临床特征,比较1 277例6个月内未服用碳酸锂的调查对象的甲状腺激素水平,其中195例患者处于缓解期,1 082例患者处于躁狂/轻躁狂发作期或混合发作期.结果 抑郁首发组女性患者比例、产后抑郁比例、既往抑郁发作次数、抑郁发作最短持续时间、过去12个月抑郁发作天数高于躁狂/轻躁狂首发组,既往轻躁狂/躁狂发作次数少于躁狂/轻躁狂首发组,抑郁首发年龄小于躁狂/轻躁狂首发组,躁狂首发年龄大于躁狂/轻躁狂首发组（t/χ2=12.544,5.741,-9.269,-6.039,-5.379,6.281, 3.966,-6.160,P＜0.05或P＜0.01）.缓解期躁狂/轻躁狂首发组甲状腺素水平高于抑郁首发组[（75.65± 2.10）nmol/L与（67.82±2.01）nmol/L,t=5.536;P＜0.05],发作期躁狂/轻躁狂首发组三碘甲状腺原氨酸、游离三碘甲状腺原氨酸、游离甲状腺素水平高于抑郁首发组[（4.84±1.36）pmol/L与（4.57±1.08）pmol/L, t=4.823;（1.86±0.03）nmol/L与（1.70±0.03）nmol/L,t=9.900;（13.13±0.24）pmol/L与（12.44±0.22）pmol/L, t=13.674;P＜0.05或P＜0.01].结论 以抑郁和以躁狂为首发症状的双相障碍患者表现出不同的临床特征且具有不同的甲状腺素水平,可能需根据不同的生物学指标采用不同的治疗方式.

英文摘要：

Objective To explore the differences in clinical features and thyroxine levels between bipolar disorder（BD） with first onset depression and first onset mania/hypomania. Methods The clinical data of 1 479 BD with first onset depression（FOD） and 2 085 BD with first onset mania/hypomania（FOM）, from 26 psychiatric hospitals or general hospital inpatient and outpatient in China, were compared in current study. Among them, thyroid levels were compared between 1 277 lithium free （recent 6 months） patients. There were 195 patients in remission state, and 1 082 patients in mania/hypomania or mixed episodes state. Results The positive family history in first-degree relatives between FOD and FOM groups had no significant difference （P〉0.05）, but the proportion of postpartum depression, previous episodes of depression, depressive episode the shortest duration,depressive episode days in the past 12 months in FOD were significantly higher than those in FOM （t/χ2=12.544,5.741,-9.269,-6.039,-5.379,6.281,3.966,-6.160, P〈0.05 or P〈0.01）. Previous episodes of mania/hypomania in FOD was significantly lower than that in FOM. The age at first onset in both groups had no significant difference, but the age at first onset depression in FOD was significantly younger than that in FOM（P〈0.01）, and the age at first onset mania/hypomania in FOD was significantly older than that in FOM（P〈0.01） . In remission patients, thyroxine （T4） in FOM group was significantly higher than those in FOD （（75.65±2.10） nmol/L vs. （67.82±2.01） nmol/L, t=5.536, P〈0.05 or P〈0.01）. In episodes patients, triiodothyronine（T3）, free triiodothyronine（FT3）, free thyroxine （FT4） were significantly higher in FOM than those in FOD （（4.84 ± 1.36） pmol/L vs.（4.57 ± 1.08） pmol/L,t=4.823;（1.86 ± 0.03） nmol/L vs. （1.70 ± 0.03） nmol/L,t=9.900;（13.13 ± 0.24） pmol/L vs. （12.44 ± 0.22） pmol/L,t=13.674;P〈0.05）. Conclusion Bipolar disorders with first onset depression and