皮质下缺血性抑郁患者血清胆红素水平与认知损害的关系

The relationship between serum bilirubin and cognitive impairment of patients with magnetic resonance imaging-defined subcortical ischemic depression

目的探讨皮质下缺血性抑郁(SID)患者的血清胆红素水平与认知损害。方法选择35例SID患者(SID)组、40例皮质下缺血性血管病不伴抑郁患者(SIVD组)、40例正常对照(NC组)为研究对象。SID组和SIVD组来自2014年7月到2016年4月安徽省立医院干部病房就诊患者,NC组来自同期健康体检老人。测定其血清直接胆红素(DBIL)、间接胆红素(IBIL)、总胆红素(TBIL)水平。采用老年抑郁量表(GDS)、汉密尔顿抑郁量表(HAMD)(17项)、简易智能精神状态检查量表(MMSE)、剑桥老年认知量表中文版(CAMCOG-C)等对抑郁症状和认知功能进行评定。结果 SID患者(24.03±2.22,75.11±10.27)的MMSE评分及COMCOG-C评分均显著低于SIVD组(25.75±1.97,85.15±5.61)和NC组(26.75±1.88,92.35±4.93)。从COMCOG-C子项来看,SID组(8.71±1.51,22.51±3.05,17.63±3.51,4.86±1.59,8.09±2.16,1.80±0.41,4.74±1.74)定向、语言、记忆、注意、执行、计算、思维评分均显著低于NC组(9.73±0.55,26.73±2.45,22.68±2.53,6.13±1.04,10.53±1.48,2.00±0.00,6.40±1.26)。SIVD组(9.23±1.07,24.85±2.32,20.98±3.03)定向、语言、记忆评分显著低于NC组(9.73±0.55,26.73±2.45,22.68±2.53)。SID组(22.51±3.05,17.63±3.51,4.86±1.59,8.09±2.16,1.80±0.41,4.74±1.74)的语言、记忆、注意、执行、计算、思维评分显著低于SIVD组(24.85±2.32,20.98±3.03,6.03±1.25,9.85±1.83,2.03±0.16,5.73±1.52)。SID组(2.71±0.48,5.12±1.12,7.95±1.10)和SIVD组(2.89±0.56,7.80±1.53,10.86±1.03)的DBIL、IBIL、和TBIL水平均显著低于NC组(4.23±1.09,12.09±2.73,16.35±3.47)。SID组(5.12±1.12,7.95±1.10)的IBIL和TBIL水平显著低于SIVD组(7.80±1.53,10.86±1.03)。对SID患者进行相关分析发现,总胆红素水平与认知功能、吸烟和受教育程度呈显著相关性。结论 SID患者认知功能下降、血清胆红素水平降低,且血清总胆红素水平与认知功能存在相关性。

Objective To detect the levels tients with magnetic resonance imaging-defined of serum bilirubin and cognitive function in pasubcortical ischemic depression. Methods Thirty-five SID patients, 40 patients with subcortical ischemic vascular disease without depression （SIVD） and 40 normal controls （NC） participated in this case-control study. The SID and SIVD groups were recruited from the cadre ward of Anhui Provincial Hospital between July 2014 and April 2016. And the NC group came from Medical Center over the same period. Serum direct bilirubin （DBIL）,indirect bilirubin （IBIL） and total bilirubin （TBIL） were analyzed in all individuals. Depression symptoms were assessed by the geriatric depression （GDS） and Hamilton depression scale （HAMD） while cognitive functions by the Mini-mental state examination （MMSE） and the cambridge cognitive examination-chinese version （COMCOG-C）. Results MMSE and COMCOG-C scores were significant lower in SID group （24.03± 2. 22,75. 11±10. 27） when compared with the SIVD groups（25.75±1.97,85.15±5.61） and the NC groups（26.75±1.88, 92.35± 4.93）. Among the subtests of CAMCOG- C, the orientation, language, memory, attention, praxis, calculate and thinking scores in SID group （8.71 ±1.51,22.51 ± 3.05,17.63 ± 3.51, 4. 86±1.59,8.09±2.16,1.80±0.41,4.74±1.74） were significant lower than in the NC group （9.73±0.55,26.73±2.45,22.68±2. 53,6. 13±1.04,10. 53±1.48,2.00±0.00,6.40±1.26）; the language , memory, attention, praxis , calculate and thinking scores in the SID group（22.51± 3.05,17.63±3.51,4.86±1.59,8.09±2.16,1.80±0.41,4.74±1. 74）were significant lower than in the SIVD group（24.85±2.32,20.98±3.03,6.03±1.25,9.85±1.83,2. 03±0.16,5.73 ±1. 52）. The orientation,language and memory scores in SIVD group （9. 23± 1. 07,24. 85 ±2.32,20.98±3.03）were significant lower than in the NC group（9.73±0.55,26.73±2.45,22.68±2.53）. Serum levels of DBIL,IBIL and TBIL in SID group （2. 71±0.48,5. 12±1.12,7. 95± 1.10）and in SIVD（2. 89 ± 0. 56, 7. 80 ±1. 53,10.86 ±1.03） were significant lower than in NC groups （4.23±1.09,12.09±2.73,16.35±3.47）. Also,serum IBIL and TBIL were significant lower in the SID group（5. 12±1. 12,7. 95±1. 10） compared to the SIVD group（7. 80±1. 53, 10.86±1.03））. In the SID group, TBIL level was correlated with cognitive function, smoking and education. Conclusion The SID patients demonstrate cognitive impairment and lower serum bilirubin,and serum TBIL is correlated with cognitive function.