原发性高血压合并抑郁生物标志物的性别差异及联合诊断价值

Gender differences and diagnostic value of biomarkers in patients with essential hypertension complicated by depression

目的探究原发性高血压合并抑郁生物标志物的性别差异及临床联合使用的诊断价值。方法纳入2019年7月1日至2021年3月31日于首都医科大学附属北京安贞医院就诊的原发性高血压人群。采用患者健康问卷量表(PHQ-9)评估患者近2周的抑郁状态,并行血常规、凝血及生化等检查。通过SPSS软件,运用t检验、秩和检验、Logistics回归、ROC曲线等统计方法,按照有无抑郁状态分组统计;按照性别分组统计。结果本研究中共纳入原发性高血压患者898例,其中高血压合并抑郁组266例,高血压无抑郁组632例,抑郁发生率为29.6%。按有无合并抑郁分组统计:ROC曲线结果显示白细胞计数(WBC,AUC:0.552,95%CI:0.503~0.600,P=0.034),中性粒细胞(NE,AUC:0.555,P=0.024,95%CI:0.507~0.603)对高血压患者抑郁有一定的诊断价值。按性别分组统计:男性高血压患者抑郁发生率为27.2%,女性高血压患者抑郁发生率为33.4%。对男性高血压患者抑郁有诊断价值的指标包括:总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、小而密低密度脂蛋白胆固醇(sdLDL)、脂蛋白a(Lpa),(AUC:0.769,95%CI:0.623~0.914,P=0.003),联合TC、TG、HDL-C、LDL-C、sdLDL、Lpa、游离脂肪酸(FFA),(AUC:0.807,95%CI:0.674~0.940,P=0.001)。对女性高血压患者的抑郁有诊断价值指标:联合补体C1q、hs-CRP、WBC、中性粒细胞百分比(NE%)、淋巴细胞百分比(LYM%)检测(AUC:0.852,95%CI:0.697~1.000,P=0.005)。结论利用生物标志物有助于及早发现高血压患者的抑郁状态,其中,血脂相关指标可能有利于男性高血压患者的抑郁状态预测,而免疫-炎症因子可能有利于女性高血压患者的抑郁状态预测。

Objective To investigate the gender differences and diagnostic value of biomarkers in patients with essential hypertension(EH)complicated by depression.Methods EH patients were chosen from Beijing Anzhen Hospital affiliated to Capital Medical University from July 1,2019 to Mar.31,2021.Patient Health Questionnaire-9 Items(PHQ-9)was used to assess depression status in patients in nearly 2 weeks.The fasting blood samples were collected for examinations of blood routine,blood coagulation and blood biochemistry.The statistical methods were used through SPSS software,including t test,rank sum test,Logistic regression analysis and ROC curve analysis.The patients were divided into groups according to depression status,and also divided into groups according to gender.Results There were totally 898 EH patients included,among them,266 with EH complicated by depression and 632 with EH without depression.The incidence of depression was 29.6%.In analysis according to depression group and non-depression group,the results of ROC curve analysis showed that white blood cell count(WBC,AUC=0.552,P=0.034,95%CI:0.503~0.600)and neutrophile(NE,AUC=0.555,P=0.024,95%CI:0.507~0.603)had some diagnostic value to depression in EH patients.In analysis according to male group and female group,the results showed that incidence of depression was 27.2%in male EH patients and 33.4%in female EH patients.The indexes with diagnostic value to depression in male EH patients included total cholesterol(TC),triglyceride(TG),small and dense low-density lipoprotein cholesterol(sdLDL-C),lipoprotein a(Lpa),(AUC=0.769,P=0.003,95%CI:0.623~0.914),and TC,TG,HDL-C,LDL-C,sdLDL,Lps,free fatty acid(FFA),(AUC=0.807,P=0.001,95%CI:0.674~0.940).The indexes with diagnostic value to depression in female EH patients included C1q,hs-CRP,WBC,NE%,Lymphocyte(LYM%),(AUC=0.852,P=0.005,95%CI:0.697~1.000).Conclusion The depression status can be found early with biomarkers in EH patients.Meanwhile,lipid-related biomarkers may be beneficial for predicting depression in male EH patients,and immune-inflammatory factors may be beneficial for predicting depression in female EH patients.