大学生血清金属水平与抑郁、焦虑关联的横断面研究

Association between serum metal levels and risks of depression and anxiety in college students:A cross-sectional study

[背景]环境和饮食中多种金属的暴露与抑郁、焦虑的发生有关,但血清金属元素含量与抑郁、焦虑症状的发生以及神经递质水平的关系尚不明确。[目的]分析大学生血清金属元素含量与抑郁、焦虑量表评分及血清神经递质水平的关联。[方法]2017年12月招募河北省某医科大学86名在读本科学生,填写一般情况调查问卷、抑郁自评量表(PHQ-9)和焦虑自评量表(GAD-7)。采集空腹静脉血,离心分离血清,采用电感耦合等离子体-质谱法检测血清中11种金属元素含量,采用酶联免疫吸附测定法检测血清中皮质醇(CORT)、多巴胺(DA)和5-羟色胺(5-HT)的含量。采用套索(LASSO)模型筛选与PHQ-9、GAD-7评分及神经递质相关的金属元素,采用多元线性回归分析筛选出的血清金属元素含量与抑郁和焦虑量表评分、神经递质水平的关联。采用错误发现率(FDR)控制多重假设检验造成的假阳性率。[结果]本次调查中10.465%的大学生存在抑郁症状,5.814%的大学生存在焦虑症状。LASSO模型筛选出钴(Co)、砷(As)、硒(Se)、钼(Mo)和镉(Cd)含量与PHQ-9评分相关,As和铅(Pb)含量与GAD-7评分相关,Co和Cd含量分别与CORT和DA水平相关,Mo、Cd、锡(Sn)和锑(Sb)含量与5-HT水平相关。多元线性回归模型分析显示,校正年龄、性别、体重指数(BMI)后,Cd每增加10μg·L^(-1),PHQ-9量表评分增加2.180(95%CI:1.220~3.140)分;As每增加10μg·L^(-1),PHQ-9量表评分增加0.010(95%CI:0.001~0.020)分;Se每增加10μg·L^(-1),PHQ-9量表评分增加0.010(95%CI:0.001~0.010)分;Co每增加10μg·L^(-1),PHQ-9量表评分增加0.930(95%CI:0.410~1.460)分,CORT水平下降2.990(95%CI:-5.690~-0.330)ng·L^(-1);Mo每增加10μg·L^(-1),PHQ-9量表评分增加0.190(95%CI:0.030~0.340)分,5-HT水平升高0.980(95%CI:0.230~1.730)ng·L^(-1)(P_(FDR)<0.05)。[结论]部分大学生存在抑郁、焦虑表现。血清中金属元素Cd、Co、As、Se和Mo含量与PHQ-9评分存在关联,但未见血清中金属元素与GAD-7评分的关联;Co含量与CORT水平有负向关联,Mo含量与5-HT水平有正向关联。研究结果说明血清金属元素含量与大学生抑郁情绪有关。

[Background]Various metals in environment and diet are related to depression and anxiety.However,the relationships of serum metal element levels with depression,anxiety,and neurotransmitter levels are not clear.[Objective]This study aims to analyze the associations of serum metal element levels with depression and anxiety scale scores as well as serum neurotransmitter levels in college students.[Methods]A total of 86 college students,recruited from a medical university in Hebei Province in December 2017,were asked to fill in a general information questionnaire,the Patient Health Questionnaire-9(PHQ-9),and the Generalized Anxiety Disorder(GAD-7).Fasting venous blood was collected,and serum was separated by centrifugation.Inductively coupled plasma mass spectrometry(ICP-MS)was used to detect 11 metals in serum.ELISA was employed to measure cortisol(CORT),dopamine(DA),and 5-hydroxytryptamine(5-HT)levels in serum.LASSO was used to screen the metal elements related to the scores of PHQ-9 and GAD-7 as well as the levels of neurotransmitters.Then the associations of screened metal elements with the scores of PHQ-9 and GAD-7 and the levels of neurotransmitters were analyzed by multiple linear regression after adjusting for confounding factors.The false positive rate caused by multiple hypothesis tests was adjusted by false discovery rate(FDR).[Results]Depression or anxiety were found in 10.465%or 5.814%of the participants,respectively.The results of LASSO analysis showed that cobalt(Co),arsenic(As),selenium(Se),molybdenum(Mo),and cadmium(Cd)levels were related with PHQ-9 score,respectively;As and lead(Pb)levels were related with GAD-7 score,respectively;Co level was related with CORT level;Cd level was related with DA level;Mo,Cd,stannum(Sn),and antimony(Sb)levels were related with 5-HT level,respectively.The results of multiple linear regression analysis indicated that,after adjusting for age,sex,and body mass index(BMI),for each 10μg·L^(-1) increment in serum metal levels,Cd was positively associated with PHQ-9 score(b:2.180,95%CI:1.220-3.140);As was positively associated with PHQ-9 score(b:0.010,95%CI:0.001-0.020);Se was positively associated with PHQ-9 score(b:0.010,95%CI:0.001-0.010);Co was positively associated with PHQ-9 score(b:0.930,95%CI:0.410-1.460)and negatively associated with CORT level(b:-2.990,95%CI:-5.690--0.330);Mo was positively associated with PHQ-9 score(b:0.190,95%CI:0.030-0.340)and negatively associated with 5-HT level(b:0.980,95%CI:0.230-1.730),respectively(P_(FDR)<0.05).[Conclusion]A certain proportion of college students experience depression and anxiety in the study.The levels of Cd,Co,As,Se,and Mo in serum are significantly correlated with PHQ-9 score.However,no significant association between serum metal levels and GAD-7 score is found.Co level in serum is negatively associated with CORT level.Mo level in serum is positively associated with 5-HT level.The findings indicate that serum metal levels are associated with depression in college students.