老年抑郁障碍患者细胞因子及免疫相关性研究

The correlation between cytokines and immunity in elderly depression patients

目的:分析抑郁障碍老年患者的血清细胞因子及免疫因子变化及与临床症状、疗效之间的关联,为其诊断、治疗及疗效评估提供可能的客观标准。方法:收集符合ICD-10中抑郁发作、单次或复发性抑郁障碍诊断标准的住院患者,年龄≥60岁,共109例。检测细胞因子、免疫因子,同时采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估患者抑郁焦虑及各项因子分指标。在基线及治疗末4周评估完成各项检测及评估。结果:患者组治疗前白介素(interleukin,IL)-1β、IL-6、IL-10、肿瘤坏死因子(tumor necrosis factor,TNF)及治疗后IL-1β均较正常对照组高;患者组治疗后IL-6、IL-10及TNF均低于治疗前,差异均有统计学意义(P<0.001或P<0.05)。患者组治疗后CRF、补体C3均显著低于治疗前,Ig G及Ig M均显著高于治疗前,差异均有统计学意义(P<0.001或P<0.05)。基线处患者组IL-6与睡眠障碍,IL-8,IL-10与日夜变化,TNF与焦虑/躯体化、HAMA总分、精神性焦虑均正相关(P<0.05或P<0.001)。患者组治疗前后IL-8浓度变化与HAMD阻滞因子分减分负相关,TNF浓度变化与HAMA因子精神性焦虑减分、HAMA因子躯体性焦虑正相关(P<0.05)。结论:老年抑郁障碍患者存在细胞因子介导的免疫功能异常,可能以体液免疫应答介导为主;TNF浓度变化作为判断老年抑郁障碍疗效的指标之一。

Objective： Through detection of serum cytokines and immune factors from the hospitalized elderly patients with depression, and further analysis of the correlations between concentration variations and clinical symptoms and therapeutic effect, we sought to provide potential objective criteria for diagnosis, evaluation of therapeutic effect and treatment of depression in elderly patients. Methods： This study was an observational study on natural state. A total of 109 hospitalized patients meeting the diagnostic criteria for depressive episode, single or recurrent depressive disorder in ICD-10, aged ≥60, were enrolled in this study. Cytokines and immune factors were detected and meanwhile HAMD and HAMA were used to estimate depression and anxiety and each sub index of patients. The detection and assessment were completed at baseline and the end of treatment for 4 weeks. Results： The values of IL-1β, IL-6, IL-10 and TNF before treatment and IL-1β after treatment of the patient group were higher than those of the control group. In the patient group, the values of IL-6 , IL-10 and TNF after treatment were lower than those before treatment, and all the differences were statistically significant （P〈0.001 and P〈0.05）.The values of CRF and C3 of the patient group after treatment were significantly lower than those before treatment, and the values of IgG and IgM were significantly higher than those before treatment, and all the differences were statistically significant（P〈0.001 and P〈0.05）.At baseline of the patient group, positive correlations were found between IL-6 and sleep disorder, IL-8, IL-10 and diurnal variation, TNF and anxiety/somatic, HAMA total score, mental anxiety （P〈0.05 and P〈0.001）. In the patient group, before and after treatment, the change of IL-8 concentration was negatively related with the reductive scores of retardation factor of HAMD, and the change of TNF concentration was positively related with the reductive scores of mental anxiety factor and somatic anxiety factor of HAMA （P〈0.05）. Conclusion： In the elderly patients with depression, there is a cytokine mediated immune dysfunction, which may be mediated by humoral immune response. The change of TNF concentration may be an indicator of the efficacy of depression in elderly patients.