T2DM患者颅内血管狭窄程度与抑郁症发生的关系及对相关血清细胞因子的影响
|
摘要
目的探讨2型糖尿病(type 2 diabetes mellitus, T2DM)患者颅内血管狭窄程度与抑郁症发生的关系,以及T2DM合并抑郁症患者相关血清因子变化。方法选取2016年2月—2018年1月在我院接受治疗的265例伴有不同程度颅内血管狭窄的T2DM患者,根据Samuels制定的颅内血管狭窄程度划分标准分为轻度狭窄组(A组)136例、中度狭窄组(B组)73例和重度狭窄组(C组)56例。观察A、B、C组抑郁症发病率;根据是否发生抑郁症将265例分为抑郁症组和非抑郁症组,观察每组患者同型半胱氨酸(Hcy)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、脑源性神经营养因子(BDNF)变化;进一步观察不同颅内血管狭窄程度的抑郁症患者(轻度狭窄亚组、中度狭窄亚组、重度狭窄亚组)Hcy、hs-CRP、IL-6、TNF-α、BDNF变化情况。结果 3组抑郁症发生率比较差异有统计学意义(P<0.05);随着颅内血管狭窄程度的加重,抑郁症患病率逐渐升高(P<0.05或P<0.01)。抑郁症组患者血清IL-6、TNF-α、Hcy、hs-CRP水平显著高于非抑郁症组患者,BDNF水平低于非抑郁症组患者,差异均有统计学意义(P<0.05或P<0.01)。轻度狭窄亚组、中度狭窄亚组和重度狭窄亚组患者血清IL-6、TNF-α、Hcy、hs-CRP及BDNF水平比较差异均有统计学意义(P<0.05或P<0.01);且随着颅内血管狭窄程度的加重,T2DM合并抑郁症患者血清IL-6、TNF-α、Hcy、hs-CRP水平均呈升高趋势,BDNF水平呈下降趋势,差异均有统计学意义(P<0.05或P<0.01)。结论 T2DM患者颅内血管狭窄程度与抑郁症的发生存在密切联系,血管狭窄程度越重者越易患有抑郁症;合并抑郁症者血清IL-6、TNF-α、Hcy、hs-CRP水平升高,BDNF水平降低,且随血管狭窄程度的加重,血清IL-6、TNF-α、Hcy、hs-CRP升高及BDNF下降越明显。
Objective To investigate the relationship between the degree of intracranial vascular stenosis and depression in patients with type 2 diabetes melitus(T2 DM) and to explore changes in serum cytokines in patients with T2 DM combined with depression. Methods A total of 265 T2 DM patients treated in our hospital from February 2016 to January 2018 for varying degrees of intracranial vascular stenosis were enrolled in the study. According to the criteria for the classification of intracranial vascular stenosis set by Samuels, patients were divided into mild stenosis group(group A, n=136), moderate stenosis group(group B, n=73) and severe stenosis group(group C, n=56). The incidence of depression in each group was observed. According to the presence or absence of depression, 265 patients were divided into depression group and non-depression group. Changes in homocysteine(Hcy), hypersensitive C-reactive protein(hs-CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and brain-derived neurotrophic factor(BDNF) in each group were observed. The changes of Hcy, hs-CRP, IL-6, TNF-α, and BDNF were further observed in depression patients with different degrees of vascular stenosis(mild stenosis subgroup, moderate stenosis subgroup, and severe stenosis subgroup). Results The incidence of depression in the three groups was statistically significant(P<0.05); With the aggravation of intracranial vascular stenosis, the prevalence of depression was gradually increased(P<0.05 or P<0.01). The levels of serum IL-6, TNF-α, Hcy, and hs-CRP were significantly higher in depression group than in non-depression group, and the levels of BDNF were lower than those in non-depression group. The differences were statistically significant(P<0.05 or P<0.01). The levels of serum IL-6, TNF-α, Hcy, hs-CRP and BDNF were statistically significant in mild stenosis subgroup, moderate stenosis subgroup and severe stenosis subgroup(P<0.05 or P<0.01). With the aggravation of intracranial vascular stenosis, serum IL-6, TNF-α, Hcy, and hs-CRP in T2 DM patients with depression showed an increasing trend, while BDNF levels showed a declining trend, and the differences were statistically significant(P<0.05 or P<0.01). Conclusion The degree of intracranial vascular stenosis in T2 DM patients is closely related to the occurrence of depression. The more severe the stenosis, the more likely they suffer from depression. The serum IL-6, TNF-α, Hcy, and hs-CRP levels of patients with depression were increased, whereas the level of BDNF was decreased. With the aggravation of vascular stenosis, the increase of serum IL-6, TNF-α, Hcy, and hs-CRP and the decrease of BDNF were more obvious.
Objective To investigate the relationship between the degree of intracranial vascular stenosis and depression in patients with type 2 diabetes melitus(T2 DM) and to explore changes in serum cytokines in patients with T2 DM combined with depression. Methods A total of 265 T2 DM patients treated in our hospital from February 2016 to January 2018 for varying degrees of intracranial vascular stenosis were enrolled in the study. According to the criteria for the classification of intracranial vascular stenosis set by Samuels, patients were divided into mild stenosis group(group A, n=136), moderate stenosis group(group B, n=73) and severe stenosis group(group C, n=56). The incidence of depression in each group was observed. According to the presence or absence of depression, 265 patients were divided into depression group and non-depression group. Changes in homocysteine(Hcy), hypersensitive C-reactive protein(hs-CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and brain-derived neurotrophic factor(BDNF) in each group were observed. The changes of Hcy, hs-CRP, IL-6, TNF-α, and BDNF were further observed in depression patients with different degrees of vascular stenosis(mild stenosis subgroup, moderate stenosis subgroup, and severe stenosis subgroup). Results The incidence of depression in the three groups was statistically significant(P<0.05); With the aggravation of intracranial vascular stenosis, the prevalence of depression was gradually increased(P<0.05 or P<0.01). The levels of serum IL-6, TNF-α, Hcy, and hs-CRP were significantly higher in depression group than in non-depression group, and the levels of BDNF were lower than those in non-depression group. The differences were statistically significant(P<0.05 or P<0.01). The levels of serum IL-6, TNF-α, Hcy, hs-CRP and BDNF were statistically significant in mild stenosis subgroup, moderate stenosis subgroup and severe stenosis subgroup(P<0.05 or P<0.01). With the aggravation of intracranial vascular stenosis, serum IL-6, TNF-α, Hcy, and hs-CRP in T2 DM patients with depression showed an increasing trend, while BDNF levels showed a declining trend, and the differences were statistically significant(P<0.05 or P<0.01). Conclusion The degree of intracranial vascular stenosis in T2 DM patients is closely related to the occurrence of depression. The more severe the stenosis, the more likely they suffer from depression. The serum IL-6, TNF-α, Hcy, and hs-CRP levels of patients with depression were increased, whereas the level of BDNF was decreased. With the aggravation of vascular stenosis, the increase of serum IL-6, TNF-α, Hcy, and hs-CRP and the decrease of BDNF were more obvious.
引文
[1] 贾娜娜,苑杰,王萌,等.2型糖尿病患者抑郁与血同型半胱氨酸、血脂及颈动脉粥样硬化的关系研究[J].中国现代医学杂志,2018,28(16):38-43.
[2] Engum A, Mykletun A, Midthjell K, et al. Depression and diabetes: a large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes[J].Diabetes Care, 2005,28(8):1904-1909.
[3] 杨洋,张宁,李菁晶,等.“脑科学”背景下的抑郁症研究[J].中华医学杂志,2018,98(29):2317-2319.
[4] Prugger C, Godin O, Perier M C, et al. Longitudinal association of carotid plaque presence and intima-media thickness with depressive symptoms in the elderly: the three-City study[J].Arterioscler Thromb Vasc Biol, 2015,35(5):1279-1283.
[5] 潘庭荣,黄梅,潘丹丹,等.脑卒中患者Hcy、GFAP、BDNF和hs-CRP水平与血管性认知障碍相关性研究[J].东南大学学报(医学版),2018,37(4):648-652.
[6] 侯斌,石峻.2型糖尿病肾病患者血清hs-CRP、Hcy、TNF-α、IL-6和IL-8的水平检测及临床意义[J].中国煤炭工业医学杂志,2015,18(3):383-385.
[7] 杨权,林凌云,李景吾,等.抑郁症患者血清细胞因子水平的研究[J].中华精神科杂志,2001,34(1):13-14.
[8] Samuels O B, Joseph G J, Lynn M J, et al. A standardized method for measuring intracranial arterial stenosis[J].Am J Neuroradiol, 2000,21(4):643-646.
[9] 王露,白桦,韩梅,等.老年2型糖尿病患者慢性并发症患病率及其相关因素分析[J].中国现代医生,2018,56(26):22-26.
[10] 凌俊辉,汤兰花,蔺金华.2型糖尿病糖代谢指标与糖尿病病程及并发症的相关性[J].牡丹江医学院学报,2018,39(4):45-46,55.
[11] 罗勇.2型糖尿病患者血糖控制与心血管疾病预后的随访研究[J].临床误诊误治,2015,28(12):116.
[12] 蔡辰,陶河清.浅析抑郁症发病机制[J].世界最新医学信息文摘,2018,18(76):68,71.
[13] 马孟可,胡乃晓,樊一桦,等.探讨抑郁症发病机制的研究进展[J].按摩与康复医学,2018,9(13):85-87.
[14] 许二平,苗明三,尚立芝.基于抑郁症细胞因子、神经-内分泌发病机制的中医药治疗新进展[J].河南中医,2017,37(2):233-237.
[15] 蒋湘玲,郭敏,陈峰,等.老年卒中后抑郁患者血清细胞因子的研究[J].中华精神科杂志,2008,41(4):209-211.
[16] 游林林,吴爱勤.缺血性脑卒中后抑郁患者A型行为、BDNF和超敏C反应蛋白的相关性研究[J].中华行为医学与脑科学杂志,2015,24(12):1100-1104.
[17] 朱雯娱.BDNF与抑郁症患者认知功能障碍相关性的研究进展[J].卒中与神经疾病,2018,25(3):341-343.
[18] 余天浩,李瑜辉,伍灏堃,等.血清BDNF和Ghrelin水平与冠心病介入术后并发抑郁症的关系[J].中山大学学报(医学科学版),2018,39(5):717-723.
[19] 李婛,邹东华,徐丙超,等.血清脑源性神经营养因子水平与缺血性卒中后抑郁的相关性[J].国际脑血管病杂志,2016,24(9):815-818.
[20] 杨媛.炎性反应与抑郁症[J].神经疾病与精神卫生,2016,16(3):271-274.
[21] 金齐颖,吴红芳,马原源,等.抑郁症中细胞因子作用机制及其治疗进展[J].现代医药卫生,2018,34(1):44-46.
[2] Engum A, Mykletun A, Midthjell K, et al. Depression and diabetes: a large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes[J].Diabetes Care, 2005,28(8):1904-1909.
[3] 杨洋,张宁,李菁晶,等.“脑科学”背景下的抑郁症研究[J].中华医学杂志,2018,98(29):2317-2319.
[4] Prugger C, Godin O, Perier M C, et al. Longitudinal association of carotid plaque presence and intima-media thickness with depressive symptoms in the elderly: the three-City study[J].Arterioscler Thromb Vasc Biol, 2015,35(5):1279-1283.
[5] 潘庭荣,黄梅,潘丹丹,等.脑卒中患者Hcy、GFAP、BDNF和hs-CRP水平与血管性认知障碍相关性研究[J].东南大学学报(医学版),2018,37(4):648-652.
[6] 侯斌,石峻.2型糖尿病肾病患者血清hs-CRP、Hcy、TNF-α、IL-6和IL-8的水平检测及临床意义[J].中国煤炭工业医学杂志,2015,18(3):383-385.
[7] 杨权,林凌云,李景吾,等.抑郁症患者血清细胞因子水平的研究[J].中华精神科杂志,2001,34(1):13-14.
[8] Samuels O B, Joseph G J, Lynn M J, et al. A standardized method for measuring intracranial arterial stenosis[J].Am J Neuroradiol, 2000,21(4):643-646.
[9] 王露,白桦,韩梅,等.老年2型糖尿病患者慢性并发症患病率及其相关因素分析[J].中国现代医生,2018,56(26):22-26.
[10] 凌俊辉,汤兰花,蔺金华.2型糖尿病糖代谢指标与糖尿病病程及并发症的相关性[J].牡丹江医学院学报,2018,39(4):45-46,55.
[11] 罗勇.2型糖尿病患者血糖控制与心血管疾病预后的随访研究[J].临床误诊误治,2015,28(12):116.
[12] 蔡辰,陶河清.浅析抑郁症发病机制[J].世界最新医学信息文摘,2018,18(76):68,71.
[13] 马孟可,胡乃晓,樊一桦,等.探讨抑郁症发病机制的研究进展[J].按摩与康复医学,2018,9(13):85-87.
[14] 许二平,苗明三,尚立芝.基于抑郁症细胞因子、神经-内分泌发病机制的中医药治疗新进展[J].河南中医,2017,37(2):233-237.
[15] 蒋湘玲,郭敏,陈峰,等.老年卒中后抑郁患者血清细胞因子的研究[J].中华精神科杂志,2008,41(4):209-211.
[16] 游林林,吴爱勤.缺血性脑卒中后抑郁患者A型行为、BDNF和超敏C反应蛋白的相关性研究[J].中华行为医学与脑科学杂志,2015,24(12):1100-1104.
[17] 朱雯娱.BDNF与抑郁症患者认知功能障碍相关性的研究进展[J].卒中与神经疾病,2018,25(3):341-343.
[18] 余天浩,李瑜辉,伍灏堃,等.血清BDNF和Ghrelin水平与冠心病介入术后并发抑郁症的关系[J].中山大学学报(医学科学版),2018,39(5):717-723.
[19] 李婛,邹东华,徐丙超,等.血清脑源性神经营养因子水平与缺血性卒中后抑郁的相关性[J].国际脑血管病杂志,2016,24(9):815-818.
[20] 杨媛.炎性反应与抑郁症[J].神经疾病与精神卫生,2016,16(3):271-274.
[21] 金齐颖,吴红芳,马原源,等.抑郁症中细胞因子作用机制及其治疗进展[J].现代医药卫生,2018,34(1):44-46.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |