毕斌,何军,罗洁,尹科,张姝,许琦
BI Bing,HE Jun,LUO Jie,YIN ke,ZHANG Shu,XU Qi

• 1:贵州省第二人民医院心身科
• 2:贵州省第二人民医院检验科

摘要(Abstract)：

目的:观察首发抑郁症患者血清中白细胞介素6(IL-6)、IL-18及肿瘤坏死因子-α(TNF-α)水平变化,探讨首发抑郁症的发病机制。方法:采用ELISA法检测30例首发抑郁症患者(DP组)和30例正常人(NC组)血清中细胞因子(IL-6、IL-18及TNF-α)水平,电化学发光免疫法检测血清中甲状腺激素游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)以及促甲状腺素(TSH)水平;应用spearman相关分析细胞因子与甲状腺激素水平及汉密尔顿抑郁量表(HAMD)各因子分间的相关性,采用ROC曲线面积(AUC)评价细胞因子水平在首发抑郁症的检测价值。结果:DP组患者血清IL-6、IL-18及TNF-α水平均高于NC组(P<0.05),FT3、FT4、T3、T4及TSH水平与NC组间比较差异无统计学意义(P>0.05);IL-18水平与HAMD量表的自杀和早醒成正相关(r=0.364、0.404,P<0.05);TNF-α水平与抑郁情绪、工作兴趣和爱好成负相关(r=-0.430、-0.416,P<0.05),与全身症状成正相关(r=0.520,P<0.05);FT3水平与精神性焦虑成正相关(r=0.403,P<0.05);TSH水平与抑郁情绪成负相关(r=-0.417,P<0.05);IL-18水平与FT4成正相关(r=0.413,P<0.05);TNF-α与T4成负相关(r=-0.386,P<0.05);IL-6、IL-18、TNF-α的AUC面积分别为0.819(P<0.01)、0.633(P>0.05)、0.794(P<0.01)。结论:细胞因子可能参与了抑郁的发生发展,抑郁严重程度与甲状腺激素水平变化有一定关系,血清IL-6和TNF-α水平检测对首发抑郁症有一定的诊断价值。
Objective: To observe the changes of IL-6,IL-18 and TNF-α level in first episode depression and explore the pathogenesis of first episode depression. Methods: 30 cases of patients with first episode depression were enrolled as model groups( DP group),while 30 normal persons as control groups( NC group). The levels of cytokines( IL-6,IL-18 and TNF-α) in serum were measured by ELISA and the levels of serum free triiodothyronine( FT3),free thyroxine( FT4),triiodothyronine( T3),thyroxine( T4),thyrotropin( TSH) were detected by Electro-Chemiluminescence Immunoassay. Spearman correlation was used to analyze the correlation between the level of cytokines and thyroid hormone and Hamilton Depression Scale( HAMD) score. Moreover,ROC curve area( AUC) was used to evaluate the diagnostic value of IL-6,IL-18 and TNF-α for first episode depression. Results:Serum IL-6,IL-18 and TNF-α level in DP group were significantly higher than their counterparts in NC group( P < 0. 05). There was no significantly statistical difference of serum FT3,FT4,T3,T4 and TSH level between DP group and NC group( P > 0. 05). Serum IL-18 levels were positively correlated with suicide and early awakening( r = 0. 364,0. 404,P < 0. 05). TNF-α levels were negatively correlated with depression mood,interest in work and hobby( r =- 0. 430,- 0. 416,P < 0. 05),but positively correlated with systemic symptoms( r = 0. 520,P < 0. 05). Serum FT3 levels were positively correlated with mental anxiety( r = 0. 403,P < 0. 05). TSH levels were negatively correlated with depression mood was( r =- 0. 417,P < 0. 05). IL-18 levels were positively correlated with FT4 levels( r = 0. 413,P < 0. 05). TNF-α levels were negatively correlated with T4 levels( r =- 0. 386,P <0. 05). AUC of IL-6,IL-18 and TNF-α were 0. 819( P < 0. 01),0. 633( P > 0. 05) and 0. 794( P <0. 01),respectively. Conclusion: Inflammatory factors may involve in the occurrence and development of depression,whose severity is related to thyroid hormone levels to some degree. Therefore,the detection of serum IL-6 and TNF-α levels has a certain diagnostic value for first episode depression.

关键词(KeyWords)： 抑郁症;白细胞介素6;白细胞介素18;甲状腺激素类;肿瘤坏死因子-α;汉密尔顿抑郁量表
depression;interleukin-6;interleukin-18;thyroid hormone;tumor necrosis factor alpha;Hamilton Depression Scale

Abstract:

Keywords:

基金项目(Foundation): 贵州省科教青年英才培养工程资助项目[黔省专合字(2012)194号]

作者(Author): 毕斌,何军,罗洁,尹科,张姝,许琦
BI Bing,HE Jun,LUO Jie,YIN ke,ZHANG Shu,XU Qi

DOI: 10.19367/j.cnki.1000-2707.2016.05.013

参考文献(References)：

• [1]Mariana P,Simone A.The importance of cytokines and autoantibodies in depression[J].Autoimmun Rev,2015(1):30-35.
• [2]Kim YK,Na KS,Shin KH,et al.Cytokine imbalance in the pathophysiology of major depressive disorder[J].Prog Neuropsychopharmacol Biol Psychiatry,2007(5):1044-1053.
• [3]沈渔邨.精神病学[M].5版.北京:人民卫生出版社,2012:553.
• [4]Rudolfa S,Greggersena W,Kahl KG,et al.Elevated IL-6 levels in patients with atypical depression but not in patients with typical depression[J],Psychiatry Res,2014(1):34-38.
• [5]Papanicolaou DA,Wilder RL,Manolagas SC,et al.The pathophysiologic roles of interleukin-6 in human disease[J].Ann Intern Med,1998(2):127-137.
• [6]赵娜,刘薇,刘洋,等.首发抑郁症患者血清IL-18水平的研究[J].哈尔滨医科大学学报,2010(2):192-194,197.
• [7]Rajeev K,Jonathan C.Depression:an inflammatory illness[J].JNNP,2012(5):495-502.
• [8]Himmerich H,Fulda S,Linseisen J,et al.Depression,comorbidities and the TNF-alpha system[J].Eur Psychiatry,2008(6):423-429.
• [9]Black PH.Immune system-central nervous system interactions:effect and immunomodulatory consequences of immune system mediators on the brain[J].Antimicrob Agents Chemother,1994(1):7-12.
• [10]Berthold-Losleben M,Himmerich H.The TNF-alpha System:Functional Aspects in Depression,Narcolepsy and Psychopharmacology[J].Curr Neuropharmacol,2008(3):193-202.
• [11]Zhu CB,Blakely RD,Hewlett WA,et al.The Proinflammatory Cytokines Interleukin-1beta and Tumor Necrosis Factor-Alpha Activate Serotonin Transporters[J].Neuropsychopharmacology,2006(10):2121-2131.
• [12]Stolakis,Vasileios.The regulatory role of neurotensin on the hypothalamic-anterior pituitary axons:Emphasis on the control of thyroid-related functions[J].Neuropeptides,2010(1):1-7.
• [13]贾福军,张海燕,郭新胜,等.抑郁症患者的甲状腺功能和细胞因子的研究[J].上海精神医学杂志,2004(5):277-279.

文章评论(Comment)：