细胞因子及糖皮质激素受体在童年创伤与青少年抑郁症间的中介作用  

The mediating role of cytokines and glucocorticoid receptors in the relationship between childhood trauma and adolescent depression

作　　者：王小曼 李娜[1] 李天舒 姚书婧 张亚兴 尤红 田园 金圭星[1] 赵媛媛[1] Wang Xiaoman;Li Na;Li Tianshu;Yao Shujing;Zhang Yaxing;You Hong;Tian Yuan;Jin Guixing;Zhao Yuanyuan(The Mental Health Center,the First Hospital of Hebei Medical University,the Mental Health Institute of Hebei Province,Shijiazhuang 050031,China;Judicial Appraisal Center,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院精神卫生中心,河北省精神卫生研究所,石家庄050031 [2]司法鉴定中心,石家庄050031

出　　处：《中华精神科杂志》2024年第8期485-494,共10页Chinese Journal of Psychiatry

基　　金：河北省重点研发计划项目民生科技专项(C20190356);河北省重点研发计划项目(21377794D);河北省重点研发计划健康医疗与生物医药专项(182777185);河北省卫生健康委科研项目(20201168)。

摘　　要：目的探讨细胞因子、糖皮质激素受体(glucocorticoid receptors,GR)在青少年抑郁症与童年创伤间的作用。方法按照方便抽样的方法,纳入2021年8月至2022年12月在河北医科大学第一医院精神卫生中心住院的青少年抑郁症患者80例(患者组),同期通过社会招募健康青少年受试者70名(对照组)。采用青少年生活事件量表、童年创伤问卷(Childhood Trauma Questionnaire,CTQ)、汉密尔顿抑郁量表(Hamilton Depression Scale-17,HAMD17)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)对受试者进行生活学习压力、童年创伤、焦虑及抑郁症状评估,并检测血清GR及血浆12项细胞因子水平,组间差异比较采用秩和检验或卡方检验。采用Spearman法分析童年创伤、GR、细胞因子、抑郁症间的相关性,极大似然估计法检验中介作用,Bootstrap方法检验间接路径后得出平均路径系数,其95%的可信区间(CI)不包含0则中介效应具有统计学意义。结果患者组与对照组GR水平差异有统计学意义(Z=-10.50,P<0.001),并且IL-1β、IL-2、IL-5、IL-10、IL-12、IL-17、IFN-α组间差异均具有统计学意义(Z=-10.31~-3.14,P<0.001或0.05)。Spearman相关分析显示,HAMD17及HAMA评分均与情感虐待、情感忽视、躯体虐待、CTQ总分以及细胞因子水平IL-5、IFN-α呈正相关,躯体忽视、IL-1β仅与HAMD17评分呈正相关;GR与情感虐待(r=-0.523,P<0.001)、情感忽视(r=-0.245,P=0.002)、性虐待(r=-0.172,P=0.035)、躯体虐待评分(r=-0.180,P=0.027)、CTQ总分(r=-0.562,P<0.001)、HAMD17评分(r=-0.783~-0.271,P<0.001)、HAMA评分(r=-0.741~-0.602,P<0.001)、细胞因子IL-1β(r=-0.217,P=0.008)、IL-5(r=-0.334,P<0.001)、IFN-α(r=-0.276,P=0.001)水平呈负相关;IL-5水平和IFN-α水平与情感虐待评分(r=0.211、0.207)、CTQ总分(r=0.201、0.166)均呈正相关均P<0.05。中介效应分析显示,GR在童年创伤与抑郁症间发挥部分中介作用(间接效应:效应值0.294,标准误0.043,95%CI=0.236~0.398)ObjectiveTo explore the role of cytokines and glucocorticoid receptors(GR)in adolescent depression and childhood trauma.MethodsUsing convenient sampling,80 adolescents with depression were recruited from the in-patient department of the Mental Health Center,First Hospital of Hebei Medical University from August 2021 to December 2022.Meanwhile,70 healthy adolescents were recruited to participate in the study.Life and learning stress,childhood trauma,anxiety and depression symptoms were evaluated using adolescent Life Events Scale,Childhood Trauma Questionnaire,Hamilton Depression Scale-17(HAMD 17)and Hamilton Anxiety Scale(HAMA).Serum glucocorticoid receptor and plasma 12 cytokines were also detected.SPSS 25.0 and AMOS 26.0 was used for statistical analysis.The rank sum test or Chi-square test was used to compare the demographic data and blood indicators between adolescents with and without depression.Spearman method was used to examine the correlation between childhood trauma,GR,cytokines and depression.Maximum likelihood estimation method was performed to test the mediating effect,and the average path coefficient was obtained after testing the indirect path by Bootstrap method.If the 95%confidence interval(CI)does not contain 0,the intermediary effect is significant.ResultsThere was significant difference in GR concentration between adolescents with and without depression(Z=-10.50,P<0.001).IL-1β,IL-2,IL-5,IL-10,IL-12,IL-17 and IFN-αwere also significantly different between the two groups.Spearman correlation analysis showed that HAMD 17 and HAMA scores were associated with emotional abuse,emotional neglect,physical abuse,CTQ total score and cytokine level IL-5,IFN-αwere positively correlated.Physical neglect and IL-1βwere only positively correlated with HAMD 17 score.GR was negatively associated with emotional abuse(r=-0.523,P<0.001),emotional neglect(r=-0.245,P=0.002),sexual abuse(r=-0.172,P=0.035),physical abuse score(r=-0.180,P=0.027),CTQ total score(r=-0.562,P<0.001),HAMD 17 score(r=-0.783--0.271,P<0.001

关 键 词：青少年 抑郁症 细胞因子 糖皮质激素 受体 

分 类 号：R749.4[医药卫生—神经病学与精神病学]