伴自杀未遂双相障碍患者的血清脑源性神经营养因子水平

Association of brain-derived neurotrophic factor and suicide attempts in patients with bipolar disorder

目的 分析伴自杀未遂的双相障碍（BD）患者与不伴自杀未遂患者及健康人群间血清BDNF水平的差异,探讨BDNF在预防BD患者自杀中的作用.方法 采用DSM-IV轴Ⅰ障碍用临床定式检查（患者版）（SCID-I/P）对临床诊断为心境障碍的患者进行评佑.纳入111例BD患者（26例有自杀未遂史）及41例健康对照.使用汉密尔顿抑郁量表（HAMD-17）及杨氏躁狂量表（YMRS）评估患者症状严重程度;使用酶联免疫吸附测定法测定所有研究对象的血清BDNF水平.结果 伴自杀未遂的BD患者血清BDNF水平（13.8±7.4） ng/ml显著低于无自杀未遂患者（18.7±11.9） ng/ml及健康对照组（26.0±12.9）ng/ml（F=9.371,P＜0.01）;伴自杀未遂的BD患者抑郁发作次数显著多于不伴自杀未遂患者,在控制抑郁发作次数后,两组间血清BDNF水平差异消失（P=0.236）;伴自杀未遂的BD患者血清BDNF水平和抑郁发作次数有相关性的倾向（r=-0.388,P=0.068）,与HAMD-17得分呈负相关（r=-0.585,P＜0.01）.结论 本研究提示BDNF在BD及BD患者自杀未遂的病理生理机制中起重要作用;伴自杀未遂的BD患者血清BDNF水平可能与抑郁发作次数、抑郁严重程度相关;通过有效治疗来提高BDNF水平可能通过减少抑郁发作次数,降低抑郁严重程度来降低自杀风险.

Objective Brain--derived neurotrophic factor（BDNF） is believed to play a role in the pathophysiology of suicidality and bipolar disorder（BD）. This study aims to explore the relation of BD- NF and suicide attempts in patients with bipolar disorder. Methods Totals of 111 BD patients （26 with history of suicide attempts） and 41 healthy persons were included. Patients were tested using DSM--IV Axis I disorders with clinical formulary checks （Patient Edition） （SCID--I/P）, Hamilton depression rat- ing scale（HAMD--17） and Young manic rating scale（YMRS）. We tested the serum level of BDNF in pa- tients with BD and healthy controls by ELISA, collect sociodemographic and clinical features as well. Re- sults The level of BDNF was significantly decreased in serum of BD patients, with or without a history of suicide attempts, when compared with healthy controls. Suicidal patients with BD had lower level of BDNF and more depressive episodes. When depressive episode was controlled, the difference of BDNF between patients with or without history of suicide attempts disappeared. Significant association was found between level of BDNF and severity of depression in patients with history of suicide attempts. Con- clusions It suggests that BDNF may play an important role in pathyphysiology of suieidality in patients with BD. Such a decrease in serum level of BDNF of patients with suicide attempts may be associated with depressive episodes and severity of depression. Prevent relapse of depressive episode, effective treatment of depressive symptoms may be helpful in preventing suicide in patients with BD who had suicide attempts.