双相障碍患者血清中色氨酸羟化酶、5-羟色胺水平与临床特征的关系

Relationships between serum tryptophan hydroxylase,serotonin levels and clinical characteristics in patients with bipolar disorder

目的探讨双相障碍患者血清色氨酸羟化酶(TPH)、5-羟色胺(5-HT)水平与临床特征的关系。方法选取2017年6月至2019年2月在该院精神科首次诊断为双相障碍患者100例作为观察组,根据有无童年创伤分为无童年创伤组(39例)和有童年创伤组(61例);选取同期体检健康者100例作为对照组。采集清晨外周血提取血清,酶联免疫吸附试验(ELISA)法检测血清TPH、5-HT水平;对双相障碍患者进行汉密尔顿抑郁量表(HAMD)、Young躁狂量表(YMRS)、大体功能评定量表(GAF)测评;记录入组12个月内的抑郁发作次数、躁狂发作次数、抑郁发作时间和躁狂发作时间;采用Pearson法分析双相障碍患者血清TPH、5-HT水平与HAMD、YMRS、GAF评分、抑郁发作次数、躁狂发作次数、抑郁发作时间和躁狂发作时间的相关性;采用多因素Logistic回归分析影响双相障碍发生的因素。结果与对照组相比,观察组双相障碍患者血清TPH、5-HT水平均明显降低,差异有统计学意义(P<0.05);与无童年创伤组相比,有童年创伤组双相障碍患者血清TPH、5-HT水平、GAF评分均明显降低,HAMD、YMRS评分均明显升高,抑郁发作次数、躁狂发作次数、抑郁发作时间、躁狂发作时间均明显增加,差异均有统计学意义(P<0.05)。双相障碍患者血清TPH、5-HT水平与HAMD、YMRS评分、抑郁发作次数、躁狂发作次数,5-HT水平与躁狂发作时间均呈负相关(P<0.05)。血清TPH、5-HT水平与GAF评分均呈正相关(P<0.05);血清TPH、5-HT水平为影响双相障碍发生的保护因素(P<0.05),童年创伤是影响双相障碍发生的危险因素(P<0.05)。结论双相障碍患者血清TPH、5-HT水平明显降低,受童年创伤影响,与心理功能、社会功能及入组12个月内发病情况等临床特征关系紧密,是影响疾病发生的保护因素,可用来作为双相障碍患者病情的参考。

Objective To explore serum tryptophan hydroxylase(TPH)and 5-hydroxytryptamine(5-HT)levels in patients with bipolar disorder and explore the relationship between serum TPH,5-HT levels and clinical characteristics.Methods Totally 100 patients(observation group)with bipolar disorder diagnosed for the first time in the department of psychiatry of a hospital from June 2017 to February 2019 were selected,and divided into non-childhood trauma group(39 cases)and childhood trauma group(61 cases)according to whether there were childhood trauma or not;a total of 100 healthy persons were selected as control group during the same period.Morning peripheral blood was collected to extract serum,and the levels of TPH and 5-HT in serum were detected by enzyme-linked immunosorbent assay(ELISA);the Hamilton Depression Scale(HAMD),Young Manic Rating Scale(YMRS)and General Assessment of Functioning Scale(GAF)were used to evaluate bipolar disorder patients;the frequency of depressive episodes,the frequency of manic episodes,the duration of depressive episodes and the duration of manic episodes within 12 months after admission were recorded;Pearson method was used to analyze the correlations between serum TPH and 5-HT levels and HAMD,YMRS,GAF scores,frequency of depressive episodes,the frequency of manic episodes,the duration of depressive episodes and the duration of manic episodes in bipolar disorder patients;and multivariate logistic regression was used to analyze the factors affecting the occurrence of bipolar disorder.Results Compared with the control group,the serum TPH and 5-HT levels of bipolar disorder patients in the observation group were significantly lower,the difference was statistically significant(P<0.05);compared with the non-childhood trauma group,the levels of TPH,5-HT and GAF in childhood trauma group were significantly lower,the scores of HAMD and YMRS were significantly higher,and the frequency of depressive episodes,the frequency of manic episodes,the duration of depressive episodes and the duration of manic episodes were significantly increased,the differences were statistically significant(P<0.05).The levels of serum TPH and 5-HT were negatively correlated with HAMD,YMRS score,frequency of depressive episodes and frequency of manic episodes,and the level of 5-HT was negatively correlated with the duration of manic episodes(P<0.05),while the levels of serum TPH and 5-HT were positively correlated with GAF score(P<0.05).Serum TPH and 5-HT levels were protective factors for the occurrence of bipolar disorder(P<0.05),and childhood trauma was a risk factor for the occurrence of bipolar disorder(P<0.05).Conclusion The serum TPH and 5-HT levels in patients with bipolar disorder are significantly decreased,which are affected by childhood trauma,and closely related to clinical features such as psychological function,social function and morbidity within 12 months after admission.They are protective factors affecting the occurrence of the disease and can be used as a reference for patients with bipolar disorder.