IGF-1和FGF-9在青少年双相抑郁和单相抑郁患者中的表达及临床预测价值

A study on the expression of IGF-1 and FGF-9 in adolescent bipolar depression and unipolar depression and their clinical predictive value

目的探讨血清胰岛素样生长因子-1(IGF-1)和成纤维细胞生长因子9(FGF-9)鉴别诊断青少年双相抑郁和单相抑郁的价值。方法选取2022年9月—2023年9月在哈尔滨市第一专科医院门诊就诊或住院治疗的50例青少年单相抑郁患者为单相抑郁组,50例青少年双相抑郁患者为双相抑郁组。同期选取在哈尔滨医科大学附属第一医院体检中心进行健康体检的50名健康青少年为对照组。采集每组受试者血清IGF-1、FGF-9水平和炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、单核细胞趋化蛋白-1(MCP-1)水平。采用24项汉密尔顿抑郁量表(HAMD-24)评估抑郁严重程度。采用Spearman相关分析单相抑郁和双相抑郁组患者血清IGF-1、FGF-9水平与炎症因子、HAMD-24评分的相关性。分析血清IGF-1、FGF-9水平诊断青少年单相抑郁和双相抑郁的受试者工作特征(ROC)曲线下面积(AUC)。结果双相抑郁组血清IGF-1、FGF-9、IL-6水平高于单相抑郁组和对照组,单相抑郁组血清FGF-9水平高于对照组,双相抑郁组和单相抑郁组血清TNF-α水平高于对照组,差异均有统计学意义(均P<0.05)。3组受试者血清MCP-1水平比较,差异无统计学意义(P>0.05)。单相抑郁组及双相抑郁组患者血清IGF-1、FGF-9水平均与IL-6水平及HAMD-24评分呈正相关(r=0.354~0.730;P<0.05)。FGF-9诊断青少年单相抑郁的AUC为0.672,敏感度为46%,特异度为98%。IGF-1、FGF-9诊断青少年双相抑郁的AUC分别为0.711、0.792,敏感度分别为40%、58%,特异度分别为80%、98%;两者联合诊断青少年双相抑郁的AUC为0.805。结论IGF-1可能是区别双相抑郁和单相抑郁的预测因子,FGF-9对于诊断双相抑郁和单相抑郁均有意义,FGF-9联合IGF-1对诊断青少年双相抑郁有较高的临床价值。

Objective To explore the value of serum insulin like growth factor 1(IGF-1)and fibroblast growth factor 9(FGF-9)in differential diagnosis of bipolar depression and unipolar depression in adolescents.Methods From September 2022 to September 2023,a total of 50 adolescent patients with unipolar depression who received outpatient or inpatient treatment at Harbin First Specialized Hospital were selected as the unipolar depression group,while 50 adolescent patients with bipolar depression as the bipolar depression group.During the same period,50 healthy adolescents who underwent health examinations at the Physical Examination Center of the First Affiliated Hospital of Harbin Medical University were selected as the control group.The levels of serum IGF-1、FGF-9,interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)and monocyte chemoattractant protein-1(MCP-1)were measured in each group.The 24-items of Hamilton Depression Scale(HAMD-24)was used to assess the severity of depression.Spearman correlation analysis was used to investigate the correlation between serum IGF-1 and FGF-9 levels,inflammatory factors,and HAMD-24 scores in patients with unipolar and bipolar depression.The area under the curve(AUC)of receiver operating characteristic(ROC)of serum IGF-1 and FGF-9 levels in diagnosing unipolar and bipolar depression in adolescents were analyzed.Results The serum levels of IGF-1,FGF-9,and IL-6 in the bipolar depression group were higher than those in the unipolar depression group and control group.The serum FGF-9 levels in the unipolar depression group were higher than those in the control group.Serum TNF-αlevels in bipolar depression group and unipolar depression group were higher than those in the control group.The differences of the above were all statistically significant(P<0.05).There was no statistically significant difference in serum MCP-1 levels among the three groups of subjects(P>0.05).The serum IGF-1 and FGF-9 levels were positively correlated with IL-6 and HAMD-24 scores in patients with unipolar depression and bipolar depression(r=0.354 to 0.730;P<0.05).The AUC of FGF-9 in diagnosing unipolar depression in adolescents was 0.672,with a sensitivity of 46%and a specificity of 98%.The AUC of IGF-1 and FGF-9 in diagnosing bipolar depression in adolescents were 0.711 and 0.792,respectively,with sensitivity of 40%and 58%,specificity of 80%and 98%,respectively.The AUC for the combined diagnosis of bipolar depression in adolescents by IGF-1 and FGF-9 was 0.805.Conclusions IGF-1 may be a predictive factor for distinguishing between bipolar depression and unipolar depression.FGF-9 has implications for the diagnosis of bipolar depression and unipolar depression,and the combination of FGF-9 and IGF-1 has high clinical value in diagnosing adolescent bipolar depression.