类风湿关节炎伴发抑郁患者外周血5-HT、DA和IL-6、IL-9的表达

Expression of neurotransmitters and cytokines in peripheral blood of rheumatoid arthritis with depression

目的探讨外周血5-HT、DA及IL-6、IL-9在类风湿关节炎(rheumatoid arthritis,RA伴发抑郁中的意义。方法根据PHQ-9抑郁症筛查量表将70例RA患者分为非抑郁组(36人)和抑郁组(34人)两组,测定血浆中5-HT、DA;血清中IL-9、IL-6、CD4^+、CD8^+T细胞、淋巴细胞计数、ESR、CCP、CRP、RF。结果①5-HT、DA水平比较:抑郁组5-HT、DA较非抑郁组高,但两者无统计学差异(P>0.05);②IL-6、IL-9水平比较:抑郁组IL-6显著高于非抑郁组(P<0.05);非抑郁组IL-9较抑郁组高,但无统计学差异(P>0.05);③T细胞亚群比较:抑郁组CD8^+T细胞计数显著高于非抑郁组(P<0.05);④一般情况比较:文化程度(高中以下)、病程、压痛关节数、肿胀关节数、ESR、CRP、VAS疼痛评分、DAS28在抑郁组和非抑郁组中有统计学差异(P<0.05);⑤多因素Logistic回归分析:IL-6、CD8^+T细胞计数、压痛关节数、文化程度与RA伴发抑郁疾病有相关性。结论 RA伴发抑郁患者外周血5-HT、DA和IL-9的水平变化不能反映RA和抑郁的关系,而IL-6、CD8^+T细胞计数、压痛关节数、文化程度与RA伴发抑郁有相关性。

Objective To explore the significance of peripheral blood neurotransmitters(5-HT,DA)and cytokines(IL-6,IL-9)in patients with depression associated with RA. Methods According to the PHQ-9 Depression Scale,70 RA patients were divided into two groups :non-depressed group(36 patients)and depression group(34 patients). Both groups of patients completed the general questionnaire,while the two groups of patients took peripheral blood on an empty stomach in the morning. Determination of 5-HT and DA in plasma by UPLC-MS/MS method;determination of serum IL-6 by chemiluminescence method;determination of serum IL-9 and anti-CCP antibodies by ELISA;determination of serum CD4^+ and CD8^+ T cells by flow cytometry;determination of serum ESR by Wei’s method;determination of serum CRP and RF by rate turbidity turbidimetry;determination of serum lymphocyte counts by electrical impedance method. Results ① Comparison of 5-HT and DA levels :5-HT and DA in the depression group were higher than those in the non-depression group,but the difference was not statistically significant(P>0.05). ② Comparison of IL-6 and IL-9 levels :IL-6 was significantly higher in the depression group than in the non-depression group,and the difference was statistically significant(P<0.05);IL-9 was higher in the non-depressed group than in the depression group,but the difference was not statistically significant(P>0.05). ③ Comparison of T cell subsets :The CD8^+ T cell count in the depression group was significantly higher than that in the non-depression group,and the difference was statistically significant(P<0.05);CD4^+ T cell counts were not statistically significant in the two groups(P>0.05). ④ Comparison of the general situation :The ESR,CRP,number of tender joints,number of swollen joints,VAS pain score,DAS28,duration of disease,and degree of education(below high school)were statistically significant in the two groups(P<0.05). ⑤ Multivariate logistic regression analysis :IL-6,CD8^+ T cell count,number of tender joints,and degree of education were associated with RA with depression. Conclusion The levels of 5-HT,DA and IL-9 in peripheral blood of RA patients with depression can not reflect the relationship between RA and depression,while IL-6,CD8^+ T cell count,tenderness joint number and education level are correlated with RA patients with depression.