不同性别老年抑郁症患者血脂水平与自杀风险的关系

Association between serum lipid levels and suicide risk in elderly depressive dissorder patients of different genders

目的分析有自杀风险的急性期住院老年抑郁症患者的血脂水平及临床症状的性别差异。方法采用横断面研究方法,选取2021年7月—2022年12月在首都医科大学附属北京安定医院住院的143例有自杀风险的急性期老年抑郁症患者为研究对象,男性63例,女性80例。收集患者的一般资料,采用汉密尔顿焦虑量表(HAMA)、24项汉密尔顿抑郁量表(HAMD-24)比较不同性别患者的焦虑、抑郁症状。比较不同性别患者的血清促肾上腺皮质激素(ACTH)、皮质醇、血清总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)及总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。采用Spearman相关分析不同性别患者的血脂水平与HAMD-24、HAMA评分的相关性。结果离异/丧偶的女性患者比例高于男性患者[32.50%(26/80)比7.94%(5/63)],差异有统计学意义(χ^(2)=12.525,P<0.001)。男性患者的体重减轻因子评分[0(0,2.00)比0(0,1.00)分]、HAMD-24总分[31.00(28.00,36.00)比28.00(25.25,33.75)分]、躯体焦虑因子评分[8.00(6.00,11.00)比6.00(4.00,8.00)分]、HAMA总分[23.00(20.00,27.00)比21.00(19.00,25.00)分]高于女性患者,差异均有统计学意义(均P<0.05)。男性患者的TC[(4.30±1.05)比(4.97±0.96)mmol/L]、HDL-C[(1.18±0.30)比(1.29±0.28)mmol/L]、LDC-C[(2.70±0.81)比(3.16±0.75)mmol/L]及TG[1.09(0.87,1.46)比1.45(1.09,2.02)mmol/L]水平低于女性,差异均有统计学意义(均P<0.05)。相关分析显示,男性患者的TC、LDL-C、TG水平与HAMD中的绝望感因子评分呈负相关(r=-0.280、-0341、-0.312;P<0.05);而女性患者的血脂指标水平与HAMD、HAMA评分不存在相关性(均P>0.05)。结论与女性患者相比,有自杀风险的男性急性期老年抑郁症患者临床症状更严重、血脂水平更低,且血脂水平与临床症状呈负相关。

Objective To analyze the differences in serum lipid levels and clinical symptoms among hospitalized elderly depressive dissorder patients of different genders who were at risk of suicide during the acute phase.Methods This study was a cross-sectional study.From July 2021 to December 2022,143 elderly inpatients with acute depressive dissorder at risk of suicide at Beijing Anding Hospital,Capital Medical University were selected as the study subject,with 63 males and 80 females.This study collected general information and compared the anxiety and depression of patients of different genders using the Hamilton Anxiety Rating Scale(HAMA)and the 24-item Hamilton Depression Rating Scale(HAMD-24).This study compared the levels of serum adrenocorticotropic hormone(ACTH),cortisol,total thyroxine(TT4),total triiodothyronine(TT3),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)in patients of different genders.Spearman correlation was used to analyze the correlation between serum lipid levels and HAMD-24 and HAMA scores in patients of different genders.Results The proportion of divorced/widowed female patients was higher than that of male patients[32.50%(26/80)vs 7.94%(5/63)],and the difference was statistically significant(χ^(2)=12.525,P<0.001).The weight loss factor score[0(0,2.00)vs 0(0,1.00)],total HAMD-24 score[31.00(28.00,36.00)vs 28.00(25.25,33.75)],somatic anxiety factor score[8.00(6.00,11.00)vs 6.00(4.00,8.00)],and total HAMA score[23.00(20.00,27.00)vs 21.00(19.00,25.00)]of male patients were higher than those of female patients,and the differences were statistically significant(all P<0.05).The levels of TC[(4.30±1.05)vs(4.97±0.96)mmol/L],HDL-C[(1.18±0.30)vs(1.29±0.28)mmol/L],LDC-C[(2.70±0.81)vs(3.16±0.75)mmol/L],and TG[1.09(0.87,1.46)vs 1.45(1.09,2.02)mmol/L]in male patients were lower than those in female patients,and the differences were statistically significant(all P<0.05).Correlation analysis showed that the levels of TC,LDL-C,TG in male patients were negatively correlated with the despair factor score in HAMD,and the differences were statistically significant(r=-0.280,-0.341,-0.312;P<0.05).There was no correlation between the levels of serum lipid and HAMD and HAMA scores in female patients(all P>0.05).Conclusions Compared with female patients,male elderly patients with acute depression at risk of suicide have more severe clinical symptoms and lower serum lipid levels,and serum lipid levels are negatively correlated with clinical symptoms.