抑郁症患者血清hs-CRP水平变化及其对抗抑郁药疗效的预测作用

doi:10.6040/j.issn.1671-7554.0.2017.261

摘要/Abstract

摘要： 目的探讨抑郁症患者血清超敏C反应蛋白(hs-CRP)水平在治疗前后的变化,以及基线hs-CRP水平对抗抑郁药疗效的预测作用。方法 61例抑郁症患者(研究组)随机分为舍曲林治疗亚组(30例)和度洛西汀治疗亚组(31例),疗程8周,于基线及8周末测hs-CRP水平,并评定HAMD量表。32例健康受试者(对照组)在入组及8周后测hs-CRP水平。结果研究组基线hs-CRP水平高于对照组,抗抑郁治疗后显著下降,但仍高于同期对照组(P<0.05),研究组治疗前、后hs-CRP水平与HAMD评分均呈正相关(P<0.05)。度洛西汀亚组基线hs-CRP≥3 mg/L者的有效率及HAMD-17减分率显著高于<3 mg/L者;在基线hs-CRP≥3 mg/L的患者中,度洛西汀的有效率显著高于舍曲林。二元Logistic回归分析显示,基线hs-CRP水平、亚组组别×基线hs-CRP水平进入疗效的回归方程,析因设计的方差分析结果显示药物和基线hs-CRP水平的交互作用对疗效有一定的影响(P<0.05)。结论炎症反应参与了抑郁症的病理机制,血清hs-CRP水平可能在一定程度上反映抑郁严重程度;度洛西汀对基线hs-CRP水平较高的抑郁症患者可能有更好疗效,但尚需更大样本量的研究进行验证。

关键词: 抑郁症, 超敏C反应蛋白, 炎症, 度洛西汀, 舍曲林

Abstract: Objective To explore the changes of high sensitivity C reactive protein(hs-CRP)level before and after antidepressant treatment, as well as the predictive role of hs-CRP level at baseline for the efficiency of antidepressants. Methods A total of 61 patients with depression(study group)were randomized into the sertraline subgroup(n=30)and duloxetine subgroup(n=31). At baseline and the end of 8-week treatment, the serum level of hs-CRP was measured, and Hamilton Depression Scale-17 items(HAMD-17)were evaluated. Additionally, serum hs-CRP level was measured in 32 well-matched healthy controls(control group)and re-measured 8 weeks later. Results At baseline, the serum level of hs-CRP was higher in the study group than in control group, and it decreased significantly after 8-week treatment but was still significantly higher than that in the control group at the endpoint(P<0.05). Serum hs-CRP level in the study group was positively correlated with HAMD-17 score at baseline and endpoint(P<0.05). In the duloxetine subgroup, the effective rate and reduction rate of HAMD-17 in patients with higher level of baseline hs-CRP(≥3 mg/L)were significantly higher than those in patients with lower baseline hs-CRP(<3 mg/L)(P<0.05). Moreover, in patients with higher baseline hs-CRP level, the effective rate of duloxetine was significantly higher than that of sertraline(P<0.05). Binary Logistic regression analysis indicated that baseline hs-CRP level and subgroup × baseline hs-CRP level 山东大学学报 (医学版)56卷6期 -王丹,等.抑郁症患者血清hs-CRP水平变化及其对抗抑郁药疗效的预测作用 \=-entered the regression equation of efficacy. Factorial design ANOVA illustrated that interaction between antidepressant and baseline hs-CRP level had certain effects on the efficacy of treatment(P<0.05). Conclusion Elevated inflammatory response is involved in the pathophysiology of depression. Serum hs-CRP level may partly reflect the severity of depression. Depressive patients with high baseline hs-CRP level are more likely to respond to duloxetine. Validation in a larger sample is warranted.

Key words: Depression, High sensitivity C reactive protein, Inflammation, Duloxetine, Sertraline

中图分类号:

R749.4

王丹,杨晓华,郑云哨,阚伟京,寻广磊. 抑郁症患者血清hs-CRP水平变化及其对抗抑郁药疗效的预测作用[J]. 山东大学学报 (医学版), 2018, 56(6): 51-57.

WANG Dan, YANG Xiaohua, ZHENG Yunshao, KAN Weijing, XUN Guanglei. Serum level of hs-CRP in patients with depression and its predictive role for the efficiency of antidepressants[J]. Journal of Shandong University (Health Sciences), 2018, 56(6): 51-57.

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