焦虑性抑郁症患者皮质醇节律紊乱及影响因素  

Cortisol rhythm disorder and influencing factors of patients with anxious depression

作　　者：冯婷婷 张洪艳[2] 张会杰 庞剑月[1] 何瑾 姚静 李恒芬[1] Feng Tingting;Zhang Hongyan;Zhang Huijie;Pang Jianyue;He Jin;Yao Jing;Li Hengfen(Department of Psychiatry, First Affiliated Hospital, Zhengzhou 450052, China;Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China)

机构地区：[1]郑州大学第一附属医院精神医学科,450052 [2]河北北方学院第一附属医院神经内科,张家口075000

出　　处：《中华行为医学与脑科学杂志》2019年第6期499-504,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金项目(81371494).

摘　　要：目的探讨焦虑性抑郁症与皮质醇节律紊乱及其免疫代谢相关因素之间的关系,寻找可用于临床判断焦虑性抑郁症诊断和治疗的生物学标记。方法收集43例焦虑性抑郁症患者(A-MDD组),选择性别、年龄、受教育年限匹配的44例非焦虑性抑郁症患者(NA-MDD组)。采用电化学发光法(electrochemiluminescence)检测患者血浆促肾上腺皮质激素(ACTH)、皮质醇(COR)、C反应蛋白(CRP)、白细胞介素6(IL-6)水平;采用自动生化分析检测血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL)水平。采用Logistic回归分析焦虑性抑郁症的影响因素。结果A-MDD组首发年龄、BMI及收缩压[(35.15±11.56)岁、(24.11±3.03)kg/m2、(130.09±13.33)mmHg]高于NA-MDD组[(31.34±14.08)岁,(22.70±3.19) kg/m2,(121.89±12.49)mmHg](t=2.631,2.009,2.964,均P<0.05);A-MDD组HAMD总分、认知障碍、日夜变化、迟缓、睡眠障碍、绝望感等因子分[(31.81±5.39)分、(8.03±3.00)分、(1.17±0.70)分、(6.88±1.93)分、(4.44±1.44)分、(4.67±2.37)分]显著高于NA-MDD组[(25.25±5.017)分、(3.87±3.12)分、(0.79±0.78)分、(4.64±2.22)分、(3.34±1.54)分、(3.61±2.02)分](t=2.297,6.524,2.505,5.210,3.452,2.421,均P<0.05);A-MDD组血浆TG、CRP及IL-6水平[(1.63±1.11)mmol/L、(1.20±0.77)mg/L、(3.54±1.90)pg/L]均显著高于NA-MDD组[(1.19±0.66)mmol/L、(0.933±0.89)mg/L、(2.65±1.34)pg/L](t=2.254,2.250,2.352,均P<0.05);A-MDD组皮质醇紊乱的发生率为72%,NA-MDD组为48%,两组间差异有统计学意义(χ2=5.369,P=0.020);多因素Logistic回归发现睡眠障碍(β=0.729,OR=2.072,95%CI=1.018~3.119)、IL-6(β=0.583,OR=1.792,95%CI=1.168~2.748)、认知障碍(β=0.099,OR=1.104,95%CI=1.022~1.193)、皮质醇紊乱(β=0.075,OR=1.078,95%CI=1.014~1.146)是焦虑性抑郁症的高危因素。结论焦虑性抑郁症患者皮质醇昼夜节律紊乱发生率高,COR及IL-6可能是皮质醇节律紊乱中介因素。IL-6、皮质醇节律紊乱、睡眠障碍及负�Objective To explore the relationship between anxious depression and cortisol rhythm disorder and influencing factors of immune metabolism.And to look for biological markers that can be used for clinical diagnosis and treatment of anxious depression. Methods Totally 43 patients with anxious depression(A-MDD group) and 44 patients with non-anxious depression matched by sex, age and years of education(NA-MDD group)were recruited.Electrochemiluminescence was used to detect the plasma levels of adrenocorticotropic hormone(ACTH), cortisol(COR), c-reactive protein(CRP) and IL-6.Automatic biochemical analysis was used to detect plasma total TC, TG, HDL and LDL.Using logistic regression analysis to discuss the influencing factors of anxiety depression. Results The comparison between the two group showed that the age of first onset, BMI and SBP in the A-MDD group((35.15±11.56),(24.11±3.03)kg/m2,(130.09±13.33)mmHg) were significantly higher than those in the NA-MDD group((31.34±14.08),( 22.70±3.19)kg/m2,( 121.89±12.49)mmHg)(t=2.631, 2.009, 2.964, all P<0.05). The HAMD score and the factor scores of cognitive impairment, change of day and night, delay, sleep disorder and feeling of despair in the A-MDD group((31.81±5.39),(8.03±3.00),(1.17±0.70),(6.88±1.93),(4.44±1.44),(4.67±2.37)) were significantly higher than those in the NA-MDD group((25.25±5.017),(3.87±3.12),(0.79±0.78),(4.64±2.22),(3.34±1.54),(3.61±2.02))(t=2.297, 6.524, 2.505, 5.210, 3.452, 2.421, all P<0.05). The plasma TG, CRP and IL-6 levels in the A-MDD group((1.63±1.11)mmol/L,(1.20±0.77)mg/L,(3.54±1.90)pg/L) were significantly higher than those in the NA-MDD group ((1.19±0.66)mmol/L,(0.933±0.89)mg/L,(2.65±1.34)pg/L)(t=2.254, 2.250, 2.352, all P<0.05). The incidence of cortisol disturbance was 72% in the A-MDD group, and 48% in the NA-MDD group, and the difference was statistically significant (χ2=5.369 P=0.020). Multivariate Logistic regression found that sleep disorder (β=0.729, OR=2.072, 95%CI=1.018-3.119), IL-6(β=0.583, OR=1.792, 95%

关 键 词：焦虑性抑郁症 皮质醇节律 白细胞介素6 睡眠障碍 

分 类 号：R749.4[医药卫生—神经病学与精神病学]