双相抑郁及单相抑郁的免疫及应激相关因子的特征比较

Comparison of immune and stress-related indicators between patients with bipolar depression and unipolar depression

目的比较双相抑郁及单相抑郁在免疫及应激相关因子方面的差异,探索鉴别单相抑郁与双相抑郁潜在的外周血生物标志物。方法选取首都医科大学附属北京安定医院2018年1—12月的住院患者作为研究对象,本研究纳入单相抑郁患者933例,双相抑郁患者546例。对两组人群的一般人口学资料及生物指标进行比较,生物指标包括C反应蛋白(CRP)、补体3(C3)、补体4(C4)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、促肾上腺皮质激素(ACTH)及皮质醇。应用Logistic回归分析控制混杂因素,明确两种抑郁类型与各生物指标的相关性,并采用受试者工作特征(ROC)曲线分析上述与双相抑郁相关的人口学及生物学指标对双相抑郁的预测价值。结果双相抑郁及单相抑郁在C3(Z=3.41,P=0.001)、IgG(Z=-2.04,P=0.041)、IgA(Z=-4.30,P<0.001)、ACTH(Z=2.03,P=0.042)生物指标方面差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄(OR=0.98,95%CI=0.97~0.98)、性别(OR=0.62,95%CI=0.49~0.78)、C3(OR=3.45,95%CI=1.90~6.27)和IgA(OR=0.80,95%CI=0.71~0.91)与双相抑郁相关。ROC曲线分析示,C3、IgA及年龄单独对双相抑郁及单相抑郁分类的准确性较差,曲线下面积(AUC)为0.55~0.63,将上述指进行Logistic回归建模后,其对双相抑郁预测的AUC为0.66(P<0.05),灵敏度为65%,特异度为63%。结论年龄偏小、C3水平升高及IgA水平偏低是双相抑郁的相关影响因素;与单个生物指标相比,纳入C3、IgA、性别、年龄的联合诊断模型在区分单相抑郁及双相抑郁方面更有效。

Objective To compare the differences of immune and stress related factors between bipolar depression and unipolar depression,and to further explore potential peripheral blood biomarkers of these two kinds of depressions.Methods The inpatients of Beijing Anding Hospital Affiliated to Capital Medical University from January to December 2018 were selected as the research objects.933 patients with monophasic depression and 546 patients with bipolar depression were included in this study.Demographic data and biochemical indicators were compared between the two groups.The biochemical indicators included C-reactive protein(CRP),complement 3(C3),complement 4(C4),immunoglobulin M(IgM),immunoglobulin G(IgG),immunoglobulin A(IgA),adrenocorticotropic hormone(ACTH)and cortisol.Logistic regression analysis was used to control the confounding factors and clarify the correlation between the two types of depression and various biological indexes.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the above demographic and biological indexes related to bipolar depression.Results Bipolar depression and unipolar depression were different in the terms of C3(Z=3.41,P=0.001),IgG(Z=-2.04,P=0.041),IgA(Z=-4.30,P<0.001)and ACTH(Z=2.03,P=0.042),with statistical significance(P<0.05).Logistic regression analysis showed that age(OR=0.98,95%CI=0.97-0.98),gender(OR=0.62,95%CI=0.49-0.78),C3(OR=3.45,95%CI=1.90-6.27)and IgA(OR=0.80,95%CI=0.71-0.91)were associated with bipolar depression.ROC analysis showed that C3,IgA and age alone had poor accuracy in the classification of bipolar depression and monophasic depression,and the area under the curve(AUC)was 0.55-0.63.After logistic regression modeling,the AUC of predicting bipolar depression was 0.66(P<0.05),the sensitivity was 65%,and the specificity was 63%.Conclusions Younger age,higher levels of C3,and lower levels of IgA are related factors of bipolar depression.Compared with a single biological index,the combined diagnostic model including C3,IgA,gender and age is more effective in distinguishing monophasic depression from bipolar depression.