抑郁症患者血浆皮质醇与炎性细胞因子、脑源性神经营养因子的关系

Controlled study of Plasma cortisol levels and inflammatory cytokines, BDNF and BDNFmRNA in depression

目的:研究抑郁症患者高血浆皮质醇水平(COR)与炎性细胞因子、脑源性神经营养因子(BDNF)及BDNF mRNA的关系。方法:研究对象为176例符合DSM-5抑郁症诊断标准的住院患者,测定血浆皮质醇,将COR水平>22.4μg/dl的患者分为高COR组,COR水平≤22.4μg/dl的患者分为正常COR组。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、32项轻躁狂症状清单(HCL-32)评定患者的临床症状,采用ELISA法检测患者血清炎性细胞因子和BDNF水平,用实时荧光定量PCR检测外周血BDNF mRNA水平。结果:高血浆皮质醇组平均住院年龄为46.10±15.41岁,明显的高于正常血浆皮质醇组的41.27±16.22岁(Z=2.000,P=0.046)。以年龄、性别为协变量,一般线性模型结果显示高血浆皮质醇组患者的肿瘤因子2受体(TNF-2R)水平为149.19±169.02pg/ml,明显的高于正常血浆皮质醇组的95.09±103.92pg/ml(F=6.303,P=0.013);高血浆皮质醇组患者BDNF水平为2.54±3.28ng/ml,明显高于正常血浆皮质醇组的1.67±1.56ng/ml(F=4.222,P=0.041)。结论:血浆皮质醇水与临床症状之间无明显关系,较低的TNF-R2水平可能是对神经有保护作用,高血浆皮质醇患者BDNF水平明显高于正常组,但BDNFmMRNA水平在不同皮质醇水平间未发现明显区别,可能与BDNF调节HPA轴的活动及BDNF多态性有关。

Objective:To study the relationship between high plasma cortisol level(COR)and inflammatory cytokines, brain-derived neurotrophic factor(BDNF)and BDNF mRNA in patients with depression.Methods:The study included 176 hospitalized patients who met the DSM-5 diagnostic criteria for depression, Patients with COR level>22.4μg/dl were divided into high COR group, and patients with COR level ≤22.4μg/dl were divided into normal COR group.The clinical symptoms of the patients were assessed by Hamilton Depression Scale, Hamilton Anxiety Scale and 32-item hypsomia symptom checklist.Venous blood was collected on an empty stomach in the morning of the second day of admission, plasma cortisol was measured by automatic biochemical analyzer, and inflammatory cytokines and BDNF levels of the samples were measured by ELISA.BDNFmRNA was detected by real-time quantitative PCR.Results:The mean hospital age of the high plasma cortisol group was 46.10±15.41,which was significantly higher than that of the normal plasma cortisol group(41.27±16.22,Z=2.000;P=0.046);A general linear model was used to compare inflammatory cytokines between the two groups with age and gender as covariables.The results showed that the level of tumor factor 2 receptor(TNF-2 R)in patients with high plasma cortisol was 149.19±169.02 pg/ml, which was significantly higher than 95.09±103.92 pg/ml in normal plasma cortisol group(F=6.303;P=0.013);The BDNF level in the high cortisol group was 2.54±3.28 ng/ml, which was significantly higher than that in the normal cortisol group(1.67±1.56 ng/ml, F=4.222;P=0.041).Conclusion:There is no relationship between plasma cortisol water and clinical symptoms.Low TNF-R2 level may have a protective effect on nerves.The level of BDNF mrna in patients with high plasma cortisol is significantly higher than that in the normal group, but no difference is found in the level of BDNF mrna between different cortisol levels, which may be related to the regulation of HPA axis activity by BDNF and BDNF polymorphism.