抑郁症病人维生素D和C反应蛋白与糖脂代谢的相关性

Correlation between vitamin D and C-reactive protein and glucose and lipid metabolism in patients with depression

目的探讨抑郁症病人维生素D和C反应蛋白与血糖、血脂水平的关系。方法收集2018年11月至2019年5月在安徽医科大学附属心理医院住院治疗的296例抑郁症病人进行问卷调查,包括人口学特征和生活行为方式等。并采空腹静脉血,检测病人25-羟维生素D[25-hydroxyvitamin D,25(OH)D]、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)以及超敏C反应蛋白(hs-CRP)的水平。采用方差分析和线性回归分析抑郁症病人维生素D水平与上述代谢指标及C反应蛋白的关系、C反应蛋白与代谢指标的关系。结果抑郁症病人25(OH)D、空腹血糖、总胆固醇、三酰甘油、HDL-C和hs-CRP的均值分别为(41.11±11.75)nmol/L、(5.15±0.92)mmol/L、(4.46±1.17)mmol/L、(1.48±1.08)mmol/L、(1.28±0.26)mmol/L和(1.24±1.51)mmol/L。维生素D严重缺乏者49例(16.6%),维生素D轻度缺乏194例(65.5%),维生素D非缺乏为53例(17.9%)。方差分析结果显示,抑郁病人不同维生素D状态时的空腹血糖、总胆固醇、三酰甘油、HDL-C以及hs-CRP间均差异有统计学意义(P<0.05),不同C反应蛋白组的空腹血糖、总胆固醇、三酰甘油以及HDL-C间均差异有统计学意义(P<0.05)。调整混杂因素后,线性回归分析的结果显示,随着维生素D水平的升高,空腹血糖(β=-0.018,P<0.001)、总胆固醇(β=-0.027,P<0.001)、三酰甘油(β=-0.007,P=0.009)以及hs-CRP(β=-0.031,P<0.001)水平逐渐降低,HDL-C(β=0.005,P=0.001)水平逐渐升高;随着C反应蛋白水平的升高,空腹血糖(β=0.199,P<0.001)、总胆固醇(β=0.204,P=0.001)、三酰甘油(β=0.133,P<0.001)水平逐渐升高,HDL-C(β=-0.072,P<0.001)水平逐渐降低。维生素D缺乏且伴有高hs-CRP病人的空腹血糖、总胆固醇、三酰甘油水平最高、HDL-C水平最低。结论抑郁症病人维生素D和高hs-CRP与糖脂代谢存在交互作用。维生素D缺乏且伴有高hs-CRP病人存在最为严重的糖脂代谢异常,但因果关系不明确。

Objective To investigate the relationship between vitamin D and C-reactive protein and blood glucose and lipid levels in patients with depression.Methods Questionnaires were collected from 296 patients with depression who were hospitalized in Psychological Hospital of Anhui Medical University from November 2018 to May 2019,including demographic characteristics and lifestyle.Fasting venous blood was taken to detect the levels of 25-hydroxyvitamin D[25(OH)D],fasting blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol(HDL-C)and hypersensitive C-reactive protein(hs-CRP).Analysis of variance and linear regression were used to analyze the relationship between vitamin D levels,the above metabolic indicators and C-reactive protein in patients with depression,and the relationship between C-reactive protein and metabolic markers.Results The mean values of[25(OH)D],fasting blood glucose,total cholesterol,triglyceride,HDL-C and hs-CRP in patients with depression were(41.11±11.75)nmol/L,(5.15±0.92)mmol/L,(4.46±1.17)mmol/L,(1.48±1.08)mmol/L,(1.28±0.26)mmol/L and(1.24±1.51)mmol/L,respectively.There were 49 patients(16.6%)with severe vitamin D deficiency,194 patients with mild vitamin D deficiency(65.5%),and 53 patients with non-deficiency of vitamin D(17.9%).The results of analysis of variance showed that the differences of fasting blood glucose,total cholesterol,triglyceride,HDL-C and hs-CRP in depressed patients with different vitamin D states were statistically significant(P<0.05),and the differences of fasting blood glucose,total cholesterol,triglyceride and HDL-C in different c-reactive protein groups were statistically significant(P<0.05).After adjusting for confounding factors,the results of linear regression analysis showed that with the increase of vitamin D level,fasting blood glucose(β=-0.018,P<0.001),total cholesterol(β=-0.027,P<0.001),triglyceride(β=-0.007,P=0.009)and hs-CRP(β=-0.031,P<0.001)levels gradually decreased,while HDL-C(β=0.005,P=0.001)levels gradually increased;with the increase of C-reactive protein levels,fasting blood glucose(β=0.199,P<0.001),total cholesterol(β=0.204,P=0.001),triglyceride(β=0.133,P<0.001)levels gradually increased,while HDL-C(β=-0.072,P<0.001)levels gradually decreased.Patients with vitamin D deficiency and high hs-CRP had the highest levels of fasting blood glucose,total cholesterol and triglyceride and the lowest levels of HDL-C.Conclusions Vitamin D and high hs-CRP interact with glucose and lipid metabolism in patients with depression.Patients with vitamin D deficiency and high hs-CRP have the most serious abnormalities in glycolipid metabolism,but the causal relationship is not clear.