焦虑抑郁情绪对烧伤后血小板5-羟色胺水平、血小板计数和细胞因子的影响

Anxiety-Depression Influence on Serum TNF-α,IL-6,Platelet 5-HT Level and Blood Platelet Count of Patients with Burn Injury

目的观察焦虑、抑郁情绪对烧伤后患者血小板5-羟色胺(5-HT)水平、血小板计数和细胞因子(血清TNF-α、IL-6水平)的影响,进一步探讨烧伤后患者心理与病理生理的相关性。方法于2003年4月至2005年2月期间,对51例在烧伤专科住院治疗的中、重度热力烧伤患者,采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)测评烧伤后3天内情绪,而后按照其焦虑抑郁值分为焦虑抑郁组(24例)和对照组(27例)。两组均给予烧伤常规治疗,疗程均为1个月,然后观察两组患者治疗前后焦虑、抑郁分值及创面愈合情况,检测并记录患者血清TNF-α、IL-6水平、血小板5-HT水平、血小板计数,并进行统计分析。结果与治疗前相比,治疗后30天,焦虑抑郁组患者抑郁分值无变化(P=0.12),其焦虑分值减少(P=0.00)。与对照组相比,治疗后30天,焦虑抑郁组创面愈合时间延长(P=0.00),血小板5-HT水平下降(P=0.04),血清TNF-α水平持续增高(P=0.00)。结论烧伤后患者的抑郁情绪是一种持久的负性情绪,可导致烧伤后患者血清TNF-α水平居高不下,血小板5-HT水平下降,延迟创面的愈合。受样本量较少所限,且患者来自两个不同城市,本研究结果可能存在偏倚。今后将进一步加大样本量、选择同一地区的患者进行相关后续研究。

Objective To observe the serum levels of tumor necrosis factor-ix （TNF-α）, interleukin-6 （IL-6）, plate- let 5-HT and blood platelet count, emotion and burn in）ury healing of patients with moderate and severe burn in）ury and anxiety-depression symptoms. Methods In-patients with moderate and severe burn in）ury were selected from 2003.4 to 2005.2 and then divided into anxiety-depression group and control group according to their anxiety-depression scores by Hamilton Rating Scale for Depression （HAMD） and Hamilton Rating Scale for Anxiety （HAMA） 3 days after being burnt. Routine therapy was given to two groups, which lasted 1 month. Their scores of anxiety and depression and the degree of injury healing were observed, and the serum levels of TNF-α and IL-6, platelet 5-HT and blood platelet count were measured in the two groups. Results Fifty-one in-patients with moderate and severe burn injury were divided into the anxiety-depression group （24 cases） and the control group （27 cases）. After 30-day treatment, the depression scores did not decrease in the anxiety-depression group （P=0.12）, but the anxiety scores decreased （P=0.00）. In the anxiety- depression group, the burn injury healing time was postponed （P=0.00）, the serum levels of TNF-α increased （P=0.00）, and the platelet 5-HT levels decreased （P=0.04） before and after treatment. Conclusion Depressive reaction occurs in patients with moderate and severe burn in）ury, which is a continuously negative emotion. It can lead to high levels of serum TNF-α, reduction in platelet 5-HT, and delayed burn injury healing time. Due to the limited sample size and differ- ent location of patients, there may be some bias in this conclusion patients in the same region in further relevant studies. We are prepared to increase the sample size and select