青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D_(3)和血脂水平的相关性研究  

Correlation of Non-suicidal Self-injury with 25-Hydroxyvitamin D_(3)and Blood Lipid Levels in Adolescents with Major Depressive Disorder

作　　者：凡豪杰 刘乐伟 夏磊[2,3] 田英汉 杨铖 郝明茹 赵鑫 申晴晴 莫大明 耿峰 刘寰忠 FAN Haojie;LIU Lewei;XIA Lei;TIAN Yinghan;YANG Cheng;HAO Mingru;ZHAO Xin;SHEN Qingqing;MO Daming;GENG Feng;LIU Huanzhong(Department of Psychiatry,School of Mental Health and Psychological Sciences,Anhui Medical University,Hefei 238000,China;Department of Psychiatry,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;Anhui Psychiatric Center,Hefei 238000,China;The Fourth People's Hospital of Hefei,Hefei 238000,China;Department of Psychology and Sleep Medicine,the Second Hospital of Anhui Medical University,Hefei 238000,China;Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization,Hefei 238000,China)

机构地区：[1]安徽医科大学精神卫生与心理科学学院,安徽省合肥市238000 [2]安徽医科大学附属巢湖医院精神科,安徽省合肥市238000 [3]安徽省精神医学中心,安徽省合肥市238000 [4]安徽省合肥市第四人民医院,238000 [5]安徽医科大学第二附属医院心理与睡眠医学科,安徽省合肥市238000 [6]脑库构建及资源利用安徽省重点实验室,安徽省合肥市238000

出　　处：《中国全科医学》2025年第5期612-618,共7页Chinese General Practice

基　　金：2022年安徽省转化医学研究院科研基金(2022zhyx-B01);安徽省高等学校科学研究项目(2022AH050671);2019年度国家临床重点专科能力建设项目(皖卫医秘[2019]267号)。

摘　　要：背景抑郁障碍(MDD)在青少年人群中的发病率逐年增高,非自杀性自伤(NSSI)行为也是其常见的临床表现。有研究结果显示维生素D和血脂水平与MDD有关,但是其是否与NSSI有关尚不明确。目的比较伴或不伴有NSSI行为青少年MDD患者的25羟维生素D_(3)[25(OH)D_(3)]和血脂水平,并探索其对NSSI的诊断价值。方法选取2020年10月-2022年3月在安徽医科大学附属巢湖医院精神科和合肥市第四人民医院就诊的青少年MDD患者129例,参考《精神障碍诊断与统计手册》第5版(DSM-5)中NSSI的诊断标准将其分为NSSI组(77例)和非NSSI组(52例)。采用青少年自杀意念量表(PANSI)、失眠严重指数(ISI)、流调用抑郁量表(CES-D)评估患者的临床症状。采集空腹静脉血,检测样本中25(OH)D_(3)和血脂水平,并进行两两比较。进一步采用多因素Logistic回归分析探究青少年MDD患者发生NSSI行为的影响因素,并绘制受试者工作特征(ROC)曲线评估25(OH)D_(3)和血脂水平对NSSI行为的诊断价值。结果NSSI组的年龄低于非NSSI组,而PANSI总分、ISI总分、CES-D总分高于非NSSI组(P<0.05)。NSSI组25(OH)D_(3)水平低于非NSSI组,而总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平高于非NSSI组(P<0.05)。多因素Logistic回归分析显示,LDL-C(OR=5.695,95%CI=2.422~13.388,P<0.001)和25(OH)D_(3)(OR=0.871,95%CI=0.768~0.987,P<0.05)是青少年MDD患者伴有NSSI行为的影响因素。LDL-C和25(OH)D_(3)评估青少年MDD患者NSSI行为发生风险的ROC曲线下面积(AUC)分别为0.73(95%CI=0.65~0.82,P<0.001)、0.62(95%CI=0.52~0.72,P=0.023),最佳截断值分别为1.89 mmol/L、19.15μg/L;LDL-C联合25(OH)D_(3)水平[ln(p/1-p)=1.364X1-0.143X2-0.161,其中X1、X2分别为LDL-C、25(OH)D_(3)]预测青少年MDD患者NSSI行为的AUC为0.77(95%CI=0.69~0.85,P<0.001),灵敏度为77.92%、特异度为67.31%。结论伴有NSSI行为的青少年MDD患者存在一定水平的25(OH)D_(3)和血脂水平Background The incidence of major depressive disorder(MDD)in adolescents is annually elevated.Non-suicidal self-injury(NSSI)is a common clinical manifestation of MDD.Evidence suggested that vitamin D and lipid levels are associated with MDD,but whether they are related to NSSI is unclear.Objective To compare the levels of 25(OH)D_(3)and blood lipids in MDD adolescents with or without NSSI behavior,and to explore their diagnostic value for NSSI.Methods A total of 129 MDD adolescents who received treatment in the Department of Psychiatry,Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei from October 2020 to March 2022 were recruited.They were assigned into NSSI group(n=77)and non-NSSI group(n=52)based on the diagnostic criteria of NSSI in the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5).The Positive and Negative Suicide Ideation(PANSI),Insomnia Severity Index(ISI),and Center for Epidemiological Survey,Depression Scale(CES-D)were used to evaluate the clinical symptoms.Fasting venous blood samples were collected to measure the levels of 25(OH)D_(3)and blood lipids,and compared between groups.In addition,multivariate Logistic regression analysis was performed to identify influencing factors for NSSI behavior in MDD adolescents.The diagnostic value of 25(OH)D_(3)and lipid levels in NSSI behaviors was assessed by plotting the receiver operating characteristic(ROC)curves.Results The age of the NSSI group was significantly lower than that of the non-NSSI group,whereas the total scores of PANSI,ISI,and CES-D were significantly higher than those of the non-NSSI group(P<0.05).The level of 25(OH)D_(3)in the NSSI group was significantly lower than that in the non-NSSI group,whereas the levels of total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)were significantly higher than those in the non-NSSI group(P<0.05).Multivariate Logistic regression analysis showed that both LDL-C(OR=5.695,95%CI=2.422-13.388

关 键 词：抑郁 抑郁障碍 青少年 非自杀性自伤 25羟维生素D_(3) 血脂异常 

分 类 号：R749.42[医药卫生—神经病学与精神病学]