抑郁症患者治疗前后血清脑源性神经营养因子水平变化及相关因素分析

Serum BDNF changes before and after treatment and the relative factors in depressive patients

目的探讨抑郁症患者血清脑源性神经营养因子（BDNF）水平及其变化与负性生活事件、抑郁症发病及治疗效应的关系。方法采用横断面的病例-对照及前瞻性自身对照设计。对所有抑郁症患者给予抗抑郁治疗（包括抗抑郁药和改良电抽搐治疗），并随访治疗8周；采用酶联免疫吸附法测定63例抑郁症患者（抑郁症组）治疗前和治疗第2，4，8周末及80名正常对照（以下简称对照组）血清BDNF水平，并评定汉密尔顿抑郁量表（HAMD）和生活事件量表。结果抑郁症组治疗前血清BDNF水平[（24±14）μg/L]显著低于对照组[（36±15）μg／L]（t=-4．863，P=0．000），并与病前1年负性生活事件刺激值、治疗前HAMD总分均显著负相关（r=-0．331，P=0．008；r=-0．343，P=0．006），而后两者有相互正相关（r=0．292，P=0．020）；治疗第2周末血清BDNF水平仍显著低于对照组（t=-5．990，P=0．000），并与其抑郁症状严重度平行负相关（r=-0．269，P=0．033），且其血清BDNF增加率与HAMD减分率平行正相关（r=0．252，P=0．047）；治疗第4，8周末血清BDNF水平均显著高于治疗前（经LSD检验，P=0．000；P=0．005），与对照组的差异均无统计学意义（P均〉0．05）。治疗第2，4，8周末HAMD总分渐减并均低于治疗前（P均=0．001），且其HAMD平均减分率渐升（分别为40％，66％和74％）。结论血清BDNF低下与负性生活事件、抑郁症发病密切相关，血清BDNF升高可能为抗抑郁治疗临床疗效的重要指标之一。

Objective To explore the correlations between serum levels of brain-derived neurotrophic factor （BDNF） and negative life events ,pathophysiology of depression and therapeutic effect in depressive patients before and after antidepressant treatment. Methods The serum BDNF levels in depressive patients （n = 63） before and after 2, 4, and 8 week antidepressant treatment and normal control subjects （n = 80） were assayed with the ELISA method. And the subjects were assessed with the Hamilton Depression Scale （HAMD） and Life Event Scale. Results The serum BDNF levels in depressive patients at baseline [ （ 24 ± 14 ） μg/L] were significantly lower than that in controls [ （ 36 ± 15 ） μg/L] （ t = - 4. 863, P=0. 000）, and were significantly negatively correlated with scores of the negative life events and HAMD scores （r = -0. 331, -0. 343, P = 0. 008, 0. 006）. The serum BDNF levels in depressive patients after 2 week treatment were still significantly lower than that in controls （ t = - 5. 990, P = 0. 000）, and were negatively correlated with the severity of depression （ r = - 0. 269, P = 0. 033 ） , and the rate of increase in the serum BDNF levels was positively correlated with the rate of decline in their HAMD scores （r = 0. 252, P = 0. 047）. The serum BDNF levels in depressive patients after 4 and 8 week treatment were higher than that before treatment （ by I.SD test, P = 0. 000 ; P = 0. 005 ）, and no longer differed from that in controls （ both P 〉 0. 05 ）. There were a gradual decrease in HAMD scores （ all were lower than that at baseline, all P = 0. 001 ） and a gradual increase of rate of decline in their HAMD scores （ respectively 40% , 66% and 74% ） in depressive patients after 2, 4 and 8 week treatment. Conclusions Low serum BDNF levels in depressive patients are possibly correlated with negative life events and pathophysiology of depression. Increase of serum BDNF levels in depressive patients may be a pivotal marker of antidepressant therapeutic effect.