抑郁症患者维生素D水平与睡眠效率及临床症状的关联研究  

Correlation Study Between Vitamin D Levels and Sleep Efficiency and Clinical Symptoms in Patients with Depression

作　　者：张玉 解钧[1] 余家快 郑明明 张佳佳 马双双 朱道民[2] 朱鹏 Zhang Yu;Xie Jun;Yu Jiakuai(Department of Maternal,Child and Adolescent Health,School of Public Health,Anhui Medical University,Hefei,Anhui 230032;Affiliated Psychological Hospital of Anhui Medical University,Anhui Mental Health Center,Hefei Fourth People's Hospital,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学公共卫生学院儿少卫生与妇幼保健学系,安徽合肥230032 [2]安徽医科大学附属心理医院·安徽省精神卫生中心·合肥市第四人民医院睡眠障碍科,安徽合肥230022

出　　处：《四川医学》2023年第12期1249-1255,共7页Sichuan Medical Journal

基　　金：合肥市卫生健康委应用医学重点研究项目(编号:Hwk2021zd012)。

摘　　要：目的探讨抑郁症患者维生素D水平与睡眠效率及临床症状的关系进一步分析季节性差异。方法选择2018年11月至2022年5月在我院住院治疗的369例抑郁症患者,使用汉密尔顿抑郁量表及汉密尔顿焦虑量表评价抑郁及焦虑评分,匹兹堡睡眠质量指数问卷评价睡眠质效率,静脉血测定血清25(OH)D水平。结果抑郁症患者的25(OH)D和焦虑评分呈显著的季节性波动,25(OH)D在冬春季呈较低水平,焦虑评分在冬春季呈较高水平。控制混杂因素后,多因素线性回归模型显示,相比于维生素D非缺乏组,维生素D缺乏组患者的睡眠效率更低(β=-0.046,95%CI-0.089~-0.003),精神焦虑评分更高(β=1.240,95%CI 0.501~1.980),未发现维生素D水平与躯体焦虑(R=0.006,P=0.902)及抑郁总得分(R=-0.025,P=0.632)差异有统计学意义。按季节分层后发现,维生素D状态与睡眠效率(P=0.001)、精神焦虑评分(P=0.018)仅在冬春季差异有统计学意义。有更高睡眠效率的抑郁症患者,其精神焦虑评分更低,差异有统计学意义(β=-1.877,95%CI-3.634~-0.119)。按季节分层后的中介效应模型显示,在冬春季调查人群中,维生素D可能通过改变睡眠效率来影响精神焦虑症状(直接效应为0.999,P=0.081;中介效应为0.401,P=0.013)。结论抑郁症患者维生素D缺乏状态可能通过降低睡眠效率,加重精神焦虑症状,并且这种关联可能存在季节性差异。Objective To investigate the relationship between vitamin D levels and sleep efficiency and clinical symptoms in patients with depression,and to further analyze the seasonal differences.Methods A total of 369 patients with depression who were hospitalized in the Psychological Hospital from November 2018 to May 2022 were selected.The 25(OH)D level was detected by questionnaire,and the anxiety,depression scores and sleep efficiency were evaluated.Results The 25(OH)D and anxiety scores of depressed patients showed significant seasonal fluctuations,25(OH)D was lower in winter and spring,and anxiety scores were higher in winter and spring.After controlling for confounding factors,the multivariate linear regression model showed that patients in the vitamin D deficiency group had lower sleep efficiency(β=-0.046,95%CI-0.089~-0.003)and higher scores for mental anxiety(β=1.240,95%CI 0.501~1.980)compared with those in the vitamin D non-deficiency group.No statistical association was found between vitamin D status and omatic sanxiety(R=0.006,P=0.902)or depression scores(R=-0.025,P=0.632).Statistically significant associations between vitamin D status and sleep efficiency(P=0.001)and mental anxiety scores(P=0.018)were observed only in winter and spring after stratification by season.Depression patients with higher sleep efficiency had a significantly lower anxiety score(β=-1.877,95%CI-3.634~-0.119).The seasonally stratified mediating effect model showed that vitamin D might affect the symptoms of mental anxiety by changing the sleep efficiency in the winter and spring survey population(direct effect was 0.999,P=0.081;The mediating effect was 0.401,P=0.013).Conclusion Vitamin D deficiency in patients with depression may aggravate symptoms of mental anxiety by reducing sleep efficiency,and there may be seasonal differences in this association.

关 键 词：抑郁症 维生素D 睡眠效率 临床症状 

分 类 号：R749.4[医药卫生—神经病学与精神病学]