原发性失眠患者与有失眠症状抑郁症患者的血清神经肽Y和P物质水平

Serum levels of neuropeptide Y and substance P between patients with primary insomnia and depressive patients with insomnia symptoms

目的:探讨原发性失眠症与伴有失眠症状的抑郁症患者血清神经肽Y(NPY)和P物质(SP)水平的变化及差异。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)之相应诊断标准的原发性失眠症患者42例、伴有失眠症状的抑郁症患者35例及38例正常对照,以酶联免疫吸附法测定血清NPY及SP水平,以汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及匹茨堡睡眠质量指数量表(PSQI)评定抑郁、焦虑症状和主观睡眠质量状况。结果:原发性失眠症组与伴有失眠症状的抑郁症组血清NPY水平均低于对照组[(5.6±3.9)ug/mL,(5.8±1.8)ug/mL vs.(8.7±5.0)ug/mL,P<0.05],血清SP水平均高于对照组[(5.0±1.5)ug/mL,(6.3±2.0)ug/mL vs.(3.7±1.2)ug/mL,均P<0.05],且伴有失眠症状的抑郁症组血清SP水平高于原发性失眠组(P<0.05),但两病例组间血清NPY水平差异无统计学意义。血清SP水平与病种、病程、性别、HAM A总分、HAM D总分、PSQI总分及各因子分无明显相关(r=0.01～0.15,均P>0.05),NPY水平仅与PSQI中的主观睡眠质量因子呈负相关(r=-0.24,P<0.05)。结论:原发性失眠症与伴有失眠症状的抑郁症患者均可能存在外周NPY及SP能神经元功能紊乱,伴有失眠症状的抑郁症患者的SP能神经功能紊乱可能更显著。

Objective： To explore the changes and differences of the serum levels of neuropeptide Y （NPY） and substance P （SP） between patients with primary insomnia and depressive patients with insomnia symptoms. Methods： Forty-two primary insomnia patients, 35 depressive patients with insomnia symptoms, and 38 healthy controls were enrolled in the study. The diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-1V） crizteria. The serum NPY and SP concentrations were deter- mined by enzyme-linked immunosorbent assay. The Hamilton Depression Scale （HAMD）, Hamilton Anxiety Scale （HAMA）, and Pittsburgh Sleep Quality Index （PSQI） were used to assess the severity of clinical symptoms. Results： Compared with the control group, the serum NPY levels in primary insomnia group and pa- tients with depression were significantly lower[（5.8±1.8） ug/mL, （5.6±2.9） ug/mL vs. （8.7±5.0） ug/ mL, Ps 〈0. 05], while serum SP levels were significantly higher [（6. 3±2.0） ug/mL, （5.0±1.5） ug/mL vs.（3.7±1.2） ug/mL, PS 〈0. 05]. The serum SP levels were significantly higher in patients with depression than that in primary insomnia patients, but there were no significant differences in serum NPY levels between the two pa- tients groups. The serum SP levels were not significant correlated with diagnoses, course, gender, total scores of HA- MA, HAMD, PSQI and each factor scores of PSQI （r =0. 01 -0. 15, Ps 〉0. 05）. The serum NPY levels were only negatively correlated with the PSQI subjective sleep quality factors （r = -0. 24, P 〈 0. 05）. Conclusion： It suggests that the dysfunction of NPY and SP neurons may occur both in patients with primary insomnia and depressive pa- tients with insomnia symptoms; and the dysfunction of SP neurons in depressive patients with insomnia symptoms may be severer.