肌萎缩侧索硬化症患者抑郁与代谢水平的相关性

Association between depression and metabolomic biomarkers of patients with amyotrophic lateral sclerosis

目的探讨肌萎缩侧索硬化症(ALS)患者抑郁的发生与代谢指标水平的相关性。方法选取2013年11月至2018年11月于西安交通大学第一附属医院神经内科就诊的206例ALS患者,采用汉密尔顿抑郁量表-17项评估其抑郁程度,并测定体质指数(BMI)、肌酐、尿酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等代谢指标,对上述患者的抑郁评分及各项代谢指标水平进行相关分析,并对抑郁相关因素进行回归分析。结果单因素分析显示,抑郁组女性占比高于非抑郁组(55.2%vs.35.4%,P=0.005);抑郁组BMI(21.36±2.70 vs.22.86±3.16,P=0.001)、肌酐(47.04±10.26 vs.52.18±10.70,P=0.001)、尿酸(279.39±70.30 vs.308.49±81.37,P=0.008)、三酰甘油(4.12±0.76 vs.4.38±0.83,P=0.024)水平低于非抑郁组。Spearman秩相关分析显示,抑郁评分与BMI(r s=-0.172,P=0.013)、肌酐(r s=-0.241,P<0.001)、尿酸(r s=-0.224,P=0.001)、总胆固醇(r s=-0.201,P=0.004)等指标呈负相关;多因素Logistic回归分析显示,女性[OR=2.585,CI(1.400,4.774),P=0.002]、BMI[OR=0.853,CI(0.769,0.947),P=0.003]、三酰甘油[OR=0.669,CI(0.449,0.999),P=0.049]与ALS患者的抑郁相关,进一步分析显示,当低BMI时,合并抑郁患者比例明显增加。结论低BMI、低三酰甘油及女性等因素可能会增加ALS患者罹患抑郁症的风险,在临床工作中须加强关注上述因素,及时给予合理干预。

Objective To investigate the association between the incidence of depression and the levels of metabolomic indexes of patients with amyotrophic lateral sclerosis(ALS).Methods We recruited 206 ALS patients admitted to The First Affiliated Hospital of Xi'an Jiaotong University between November 2013 and November 2018 using Hamilton Rating Scale for Depression(HRSD-17)to evaluate the degree of depression.Meanwhile,we also collected body mass index(BMI),creatinine,uric acid,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and other metabolic indexes of these patients.Correlation analysis and regression analysis were preformed between depression score and the metabolic indexes.Results Univariate analysis showed that the proportion of women was higher in the depression group than in the non-depression group(55.2%vs.35.4%,P=0.005).In the depression group,BMI(21.36±2.70 vs.22.86±3.16,P=0.001),creatinine(47.04±10.26 vs.52.18±10.70,P=0.001),uric acid(279.39±70.30 vs.308.49±81.37,P=0.008),and triglyceride(4.12±0.76 vs.4.38±0.83,P=0.024)were lower than those in the non-depression group.Spearman rank correlation analysis showed that depression score was negatively correlated with BMI(r s=-0.172,P=0.013),creatinine(r s=-0.241,P<0.001),uric acid(r s=-0.224,P=0.004),and total cholesterol(r s=-0.201,P=0.002).Multivariate Logistic regression analysis showed that female[OR=2.585,CI(1.400,4.774),P=0.002],BMI[OR=0.853,CI(0.769,0.947),P=0.003]and triglyceride[OR=0.669,CI(0.449,0.999),P=0.049]were negatively correlated with depression in ALS patients.Further analysis showed that when BMI was low,the proportion of patients with depression increased significantly.Conclusion Factors such as low BMI,low triglyceride and female may increase the risk of depression in ALS patients.More attention should be paid to these factors in clinical work and reasonable intervention should be given timely.