血清标记物对胃食管反流病抑郁患者抑郁程度的预测作用

Predictive effect of serum markers on depression degree in patients with gastroesophageal reflux disease

目的分析血清标记物对胃食管反流病(GERD)患者抑郁程度的预测作用。方法选取2020年1月至2022年9月上海市浦东新区公利医院收治的96例GERD患者作为GERD组,另选取同期来我院体检的32例健康人员作为对照组。GERD组患者采用汉密顿抑郁量表(HAMD)进行检查,根据抑郁程度不同分为无抑郁、轻度、中度、重度四组。比较两组受检者及不同程度抑郁GERD患者的下丘脑-垂体-肾上腺轴(HPA轴)指标、神经营养指标、免疫炎症指标、代谢指标以及维生素D(VD)水平,患者抑郁程度的影响因素采用多元线性回归分析,指标预测价值采用受试者工作特征曲线(ROC)评价。结果GERD组患者的皮质醇(Cor)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平分别为(101.66±25.77)μg/L、(4.18±1.94)mg/L、(13.28±3.43)pg/mL、(22.02±6.83)ng/L,明显高于对照组的(70.23±9.76)μg/L、(1.87±0.31)mg/L、(9.65±1.66)pg/mL、(13.97±2.68)ng/L,差异均有统计学意义(P<0.05);GERD组患者的VD、脂肪因子瘦素(LEP)、精氨酸加压素(AVP)、脑源性神经营养因子(BDNF)、血管内皮生长因子(VEGF)水平分别为(18.63±8.60)ng/mL、(4.58±2.10)μg/L、(98.59±10.42)mg/L、(13.90±7.72)ng/mL、(556.14±102.32)ng/L,明显低于对照组的(33.21±8.41)ng/mL、(7.13±4.98)μg/L、(250.44±23.75)mg/L、(27.54±4.03)ng/mL、(619.43±78.46)ng/L,差异均有统计学意义(P<0.05);Cor、CRP、TNF-α、IL-1β水平随着患者抑郁程度加重而逐渐升高,而VD、LEP、AVP、BDNF、VEGF水平随着患者抑郁程度加重而逐渐降低,差异均有统计学意义(P<0.05);经多元线性回归分析结果显示,Cor、CRP、LEP、BDNF、VEGF、TNF-α均为GRED患者抑郁程度的影响因素(P<0.05);经ROC分析结果显示,BDNF、CRP预测GERD患者抑郁的曲线下面积(AUC)值较高,分别为0.925、0.881,其中BDNF敏感度最高为98.77%,CRP特异度最高为93.33%。结论GERD抑郁患者CRP、BDNF与患者抑郁程度密切相关,并且联合用于预测GERD患者抑郁状态有较高价值,可为临床提供参考。

Objective To explore the predictive effect of serum markers on depression degree in patients with gastroesophageal reflux disease(GERD).Methods A total of 96 patients with GERD(GERD group)admitted to the Shanghai Pudong New Area Gongli Hospital from January 2020 to September 2022 were analyzed retrospectively.At the same time,32 healthy individuals were selected as the healthy control group.According to the Hamilton Depression Scale(HAMD)score,patients in GERD group were divided into non-depression group,mild depression group,moderate depression group,and severe depression group.The levels of hypothalamus-pituitary-adrenal(HPA)axis indexes,neurotrophic indexes,immune-inflammatory indexes,metabolic indexes,and vitamin D(VD)indexes were detected and compared between the GERD group and healthy control group,as well as among patients with different severity of depression.The influencing factors of depression degree were analyzed by linear regression,and the predictive value of the index was evaluated by receiver operating curve(ROC).Results The levels of cortisol(Cor),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin-1β(IL-1β)in GERD group were(101.66±25.77)μg/L,(4.18±1.94)mg/L,(13.28±3.43)pg/mL,and(22.02±6.83)ng/L,significantly higher than(70.23±9.76)μg/L,(1.87±0.31)mg/L,(9.65±1.66)pg/mL,and(13.97±2.68)ng/L in healthy control group(P<0.05).The levels of VD,leptin(LEP),arginine vasopressin(AVP),brain-derived neurotrophic factor(BDNF),and vascular endothelial growth factor(VEGF)in GERD group were(18.63±8.60)ng/mL,(4.58±2.10)μg/L,(98.59±10.42)mg/L,(13.90±7.72)ng/mL,and(556.14±102.32)ng/L,significantly lower than(33.21±8.41)ng/mL,(7.13±4.98)μg/L,(250.44±23.75)mg/L,(27.54±4.03)ng/mL,and(619.43±78.46)ng/L in healthy control group(P<0.05).Cor,CRP,TNF-α,and IL-1βincreased gradually along with the aggravating of the severity of depression(P<0.05).VD,LEP,AVP,BDNF,and VEGF levels reduced gradually along with the aggravating of the severity of depression(P<0.05).Multivariate regression analysis showed that Cor,CRP,LEP,BDNF,VEGF,and TNF-αwere the influencing factors of the severity of depression in GERD patients(P<0.05).Area under curve(AUC)of BDNF and CRP for evaluating the severity of depression were 0.925 and 0.881,respectively.The sensitivity of BDNF was the highest(98.77%),while specificity of CRP was the highest(93.33%).Conclusion CRP and BDNF are significantly correlated with the severity of depression in GERD patients.The combined detection has high predictive value for depression,which can provide clinical reference.