中国中老年人C反应蛋白累积升高次数与躯体和非躯体抑郁症状的关系:前瞻性队列研究

Association between Cumulative Episodes of C-reactive Protein Elevations and Somatic/Nonsomatic Depressive Symptoms among Chinese Middle-aged and Older Adults:Prospective Cohort Study

背景 C反应蛋白(CRP)升高的累积效应及抑郁症状的不同维度是既往中老年人CRP与抑郁症状关联研究结论不一致的可能原因。目前中国关于CRP与抑郁症状的研究缺乏探索CRP累积升高次数对抑郁症状不同维度的影响。目的 探索中国中老年人CRP在2次连续测量中累积升高次数与抑郁症状及其躯体和非躯体症状之间的纵向关联。方法 本研究采用2011—2018年中国健康与养老追踪调查(CHARLS)公开数据,共纳入3 868名研究对象。依据CRP在2次连续测量中(2011年、2015年)的累积升高次数(CRP>3 mg/L)将研究对象分为累积升高0次组(n=2 918)、累积升高1次组(n=763)、累积升高2次组(n=187)。分别于2011年、2015年、2018年采用10项流行病学研究中心抑郁量表(CESD-10)评估抑郁症状,该量表分为躯体抑郁症状和非躯体抑郁症状。采用多重线性回归模型分析CRP在2次连续测量中累积升高次数与2018年抑郁症状总分/躯体抑郁症状得分/非躯体抑郁症状得分之间的纵向关联。采用Logistic回归模型分析CRP在2次连续测量中累积升高次数与2018年抑郁症状患病情况(是/否)之间的关联性。结果 多重线性回归分析结果显示,在调整所有协变量后,CRP在2次连续测量中升高2次相比于0次,是抑郁症状总分(β=1.22,P<0.05)、躯体抑郁症状得分(β=0.51,P<0.05)及非躯体抑郁症状得分(β=0.71,P<0.05)的影响因素。Logistic回归分析结果显示,在调整所有协变量后,CRP在2次连续测量中升高2次相比于0次,抑郁症状的患病风险更高(OR=1.64,95%CI=1.18~2.29)。结论 中国中老年人CRP累积升高次数与抑郁症状及其躯体和非躯体抑郁症状之间存在正向关联,及时治疗可能存在的慢性炎性疾病,避免其长期处于慢性炎症状态,可以降低抑郁的发生风险。

Background Whether considering the cumulative effect of sustained C-reactive protein(CRP)and distinguishing different aspects of depressive symptoms may be the reasons for the inconsistent conclusions of previous studies on the association between CRP and depressive symptoms among middle-aged and older adults.The relationship between cumulative effects of CRP elevations and different aspects of depressive symptoms in middle-aged and older adults in China is not well understood.Objective This study aims to examine the relationship between cumulative episodes of CRP elevations over two successive determinations and depressive symptoms,as well as somatic and non-somatic retardation,among Chinese middleaged and older adults.Methods This study used public data from the 2011-2018 Chinese Health and Retirement Longitudinal Study(CHARLS)and included 3 868 subjects.They were categorized based on the frequency of CRP elevations over two consecutive measurements:"elevated on zero occasion"(n=2 918),"elevated on one occasion"(n=763),and "elevated on two occasions"(n=187).Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale(CESD-10)in 2011,2015,and 2018,capturing both somatic and non-somatic dimensions.Multiple linear was used to explore the associations between cumulative episodes of CRP elevations over two successive determinations with depressive symptom scores in 2018,as well as the scores of somatic and non-somatic components separately.Multivariate Logistic regression was used to investigate the effects of cumulative episodes of CRP elevations on the risk of depressive symptoms in 2018.Results The results of multiple linear regression analysis showed that after adjusting for all covariates,elevated on two occasions compared with elevated on zero occasion,which was an influential factor for the total score of depressive symptoms(β=1.22,P<0.05),the score of somatic depressive symptoms(β=0.51,P<0.05) and the score of non-somatic symptoms(β=0.71,P<0.05).Logistic regression analysis showed that after adjusting for all covariates,elevated on two occasions were associated with a higher risk of depressive symptoms than elevated on zero occasion(OR=1.64,95%CI=1.18-2.29).Conclusion Among Chinese middle-aged and older adults,there is a positive association between cumulative effects of CRP elevations and depressive symptoms,encompassing both somatic and non-somatic retardation.Addressing chronic inflammation and treating chronic inflammatory diseases promptly may help mitigate depression risk.