抑郁症患者外周血Th17/Treg平衡变化及其与疾病严重程度的关系

Changes of peripheral blood Th17/Treg balance and its relationship with disease severity in depression patients

目的探究抑郁症患者外周血辅助性T细胞17/调节性T细胞(Th17/Treg)平衡变化及其与疾病严重程度的关系。方法以2021年1-12月淮安市第三人民医院84例抑郁症患者为抑郁组,根据汉密尔顿抑郁量表(HAMD)评分将患者分为轻度组(8~17分)(n=30)、中度组(18~24分)(n=35)、重度组(≥25分)(n=19),以同期健康体检者58人为对照组。比较不同程度抑郁症患者及对照组的外周血Th17/Treg相关指标,分析其对抑郁症严重程度的评估价值及与病情程度的相关性;所有抑郁症患者给予针对性治疗,根据临床疗效将患者分为有效组及无效组,分析外周血Th17/Treg相关指标对抗抑郁治疗疗效的评估价值。结果对照组、轻度、中度和重度抑郁症患者Th17细胞比例[(1.38±0.17)%vs.(1.52±0.19)%vs.(1.71±0.15)%vs.(1.89±0.18)%]及Th17/Treg比值[(0.23±0.05)vs.(0.26±0.05)vs.(0.31±0.06)vs.(0.37±0.06)]随病情严重程度的加重呈升高趋势,Treg比例[(6.08±0.31)%vs.(5.79±0.39)%vs.(5.43±0.47)%vs.(5.17±0.41)%]呈降低趋势,差异均有统计学意义(F=54.436、38.720、36.743,P均<0.05)。Th17/Treg相关指标联合检测评估抑郁症严重程度的AUC为0.854,大于Treg比例单独检测的0.681,差异有统计学意义(P<0.05)。Th17细胞比例及Th17/Treg比值与抑郁严重程度成正相关(r=0.396、0.415,P均<0.001),Treg比例与抑郁严重程度成负相关(r=-0.262,P<0.05)。无效组Th17细胞比例及Th17/Treg比值[Th17:(1.89±0.29)%vs.(1.59±0.31)%,Th17/Treg:(0.37±0.07)vs.(0.28±0.05)]高于有效组,Treg细胞比例[(5.08±0.52)%vs.(5.69±0.49)%]低于有效组,差异均有统计学意义(t=4.181、6.708、5.176,P均<0.05);Th17/Treg相关指标联合检测评估抗抑郁治疗疗效的ROC曲线下面积(AUC)为0.898,大于Th17、Treg的0.738、0.725(P<0.05)。结论抑郁症患者存在外周血Th17/Treg比例失衡现象,且联合检测对抑郁严重程度及抗抑郁治疗疗效具有评估价值,并与病情严重程度具相关性。

Objective To explore the changes of peripheral blood helper T17/regulatory T cells(Th17/Treg)balance and its relationship with disease severity in depression patients.Methods A total of 84 patients with depression were enrolled as depression group between January and December 2021.According to scores of Hamilton depression scale(HAMD),they were divided into mild group(8-17 points),moderate group(18-24 points)and severe group(≥25 points).A total of 58 healthy controls during the same period were enrolled as control group.The peripheral blood Th17/Treg related indexes among patients with different degrees of depression,and between depression group and control group were compared.Their evaluation value for depression severity and correlation with disease severity were analyzed.All patients with depression were given targeted treatments.According to clinical curative effect,patients were divided into effective group and ineffective group.The evaluation value of peripheral blood Th17/Treg related indexes for anti-depression effect was analyzed.Results The proportion of Th17 cells[(1.38±0.17)%vs.(1.52±0.19)%vs.(1.71±0.15)%vs.(1.89±0.18)%]and Th17/Treg ratio[(0.23±0.05)vs.(0.26±0.05)vs.(0.31±0.06)vs.(0.37±0.06)]tended to increase with the severity of the disease,Treg ratio[(6.08±0.31)%vs.(5.79±0.39)%vs.(5.43±0.47)%vs.(5.17±0.41)%]showed a decreasing trend,the differences were statistically significant(F=54.436,38.720,36.743,all P<0.05).The area under the curve(AUC)of combined detection with all Th17/Treg related indexes for evaluating the severity of depression was 0.854,greater than that of Treg alone(0.681)(P<0.05).The proportion of Th17 and ratio of Th17/Treg were positively correlated with depression severity(r=0.396,0.415,all P<0.05),while proportion of Treg was negatively correlated with depression severity(r=-0.262,P<0.05).The proportion of Th17 and ratio of Th17/Treg in ineffective group were higher than those in effective group[Th17:(1.89±0.29)%vs.(1.59±0.31)%,Th17/Treg:(0.37±0.07)vs.(0.28±0.05)],while proportion of Treg was lower than that in effective group[(5.08±0.52)%vs.(5.69±0.49)%](t=4.181,6.708,5.176,all P<0.05).AUC of combined detection with all Th17/Treg related indexes for evaluating anti-depression effect was 0.898,greater than that of Th17 and Treg(0.738,0.725)(P<0.05).Conclusions There was an imbalance of peripheral blood Th17/Treg ratio in patients with depression.The combined detection has evaluation value for depression severity and anti-depression treatment effect,which were correlated with disease severity.