抗抑郁药对产前抑郁症产妇STAT3及胎盘生长因子水平的影响

Effects of antidepressants on STAT3 and placental growth factor levels in puerperae with antenatal depression

目的探讨产前抑郁症使用抗抑郁药对信号转导及转录激活因子3(STAT3)及胎盘生长因子(PIGF)水平的影响。方法90例产前抑郁症产妇为研究对象,均行选择性5-羟色胺再摄取抑制剂(SSRI)抗抑郁药物治疗,随访1年,比较产妇治疗前后的抑郁程度及STAT3及PIGF水平,观察产妇不良反应及不良妊娠结局。结果产妇治疗前的汉密尔顿抑郁量表(HAMD)评分为(24.63±6.15)分,治疗后的HAMD评分为(6.81±1.01)分。治疗后的HAMD评分显著低于治疗前,差异具有统计学意义(P<0.05)。治疗后,大多数产妇于1周后出现1种或多种不良反应,以神经功能异常占比最大,为50.00%。产妇治疗后的STAT3水平高于治疗前,产妇及胎儿的PIGF水平低于治疗前,差异具有统计学意义(P<0.05)。其中,5例产妇的STAT3处于较高水平,平均为(1.02±0.09),提示可能患有肝内胆汁淤积症等不良妊娠风险;3例产妇的PIGF水平<100 pg/mg,平均为(94.36±0.35)pg/mg,预测罹患子痫前期。治疗后,产妇发生肝内胆汁淤积症5例、流产2例、子痫前期3例、产后出血5例,产妇不良妊娠结局发生率为16.67%(15/90);胎儿发生畸形0例、生长受限2例、早产3例,胎儿不良妊娠结局发生率为5.56%(5/90)。结论抗抑郁药物可有效缓解产前抑郁症产妇的抑郁状况,但限于其药物存在不良反应,且可引发不良妊娠结局,致病机制则与STAT3传导抑制,致使PIGF水平表达降低有关。

Objective To discuss the effects of antidepressants on signal transducer and activator of transcription 3(STAT3)and placental growth factor(PIGF)levels in puerperae with antenatal depression.Methods All 90 puerperae with antenatal depression were treated with selective serotonin reuptake inhibitor(SSRI)antidepressants.During the 1-year follow-up,the degree of depression,adverse reactions,STAT3 and PIGF levels before and after treatment were compared,and maternal adverse reactions and adverse pregnancy outcomes were observed.Results The Hamilton depression scale(HAMD)score before treatment was(24.63±6.15)points,and the HAMD score after treatment was(6.81±1.01)points.The HAMD score after treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.05).After treatment,most puerperae had 1 or more adverse reactions after 1 week,with neurological dysfunction accounting for the largest proportion,accounting for 50.00%.The level of STAT3 after treatment in puerperae was higher than that before treatment,and the levels of PIGF in puerperae and fetuses were lower than those before treatment,and the differences were statistically significant(P<0.05).Of these,5 puerperae had high levels of STAT3 with a mean of(1.02±0.09),suggesting a possible risk of adverse pregnancy such as intrahepatic cholestasis;3 puerperae had PIGF levels<100 pg/mg with a mean of(94.36±0.35)pg/mg,predicting preeclampsia.After treatment,5 cases of intrahepatic cholestasis,2 cases of miscarriage,3 cases of preeclampsia and 5 cases of postpartum hemorrhage occurred in the puerperae,and the incidence of maternal adverse pregnancy outcome was 16.67%(15/90);0 case of fetal malformation,2 cases of growth restriction,and 3 cases of preterm delivery occurred in the fetus,and the incidence of adverse fetal outcomes was 5.56%(5/90).Conclusion Antidepressant drug treatment can effectively alleviate the depression of puerperae with prenatal depression,but it is limited to the adverse reactions of its drugs and can cause adverse pregnancy outcomes.The pathogenesis is related to the inhibition of STAT3 conduction,resulting in reduced expression of PIGF levels.