Capuron Lucile, Ravaud Alain, Miller Andrew H, Dantzer Robert
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
Brain Behav Immun. 2004 May;18(3):205-13. doi: 10.1016/j.bbi.2003.11.004.
It has been suggested that patients with subclinical mood symptoms prior to initiating cytokine treatment (as revealed by elevated baseline scores on depression rating scales) are more likely to become clinically depressed during the course of cytokine therapy. The present study was designed to identify which specific preexisting symptoms predict development of depressive symptomatology during treatment with the cytokines, interleukin-2 (IL-2) and/or interferon-alpha (IFN-alpha), in patients with cancer. Thirty-two patients with renal cell carcinoma or malignant melanoma eligible to receive treatment with IL-2 and/or IFN-alpha were enrolled in the study. At baseline and after one month of cytokine therapy (endpoint), depressive symptoms were assessed using the clinician-administered Montgomery-Asberg depression rating scale (MADRS). Illness-related coping strategies, social support, somatic complaints, quality of sleep and demographic factors were also assessed as relevant baseline predictive factors. MADRS scores significantly increased during cytokine therapy. Patients with moderate to marked depressive symptomatology at study endpoint exhibited higher baseline scores in dimensions of the MADRS scale assessing emotional (especially reported sadness), cognitive (especially pessimistic thoughts) and neurovegetative (sleep disturbances) symptoms compared to patients who remained free of depressive symptoms during cytokine therapy. Interestingly, only emotional symptoms and sleep disturbance at baseline, along with low social support, predicted severity of depressive symptoms at the end of the first month of therapy. By documenting specific behavioral vulnerability factors for cytokine-induced depressive symptoms, these findings may help identify patients at risk for mood disturbances during cytokine treatment and help target specific patient populations and specific symptoms for preventative strategies.
有人提出，在开始细胞因子治疗之前有亚临床情绪症状的患者（如抑郁评定量表上的基线分数升高所示）在细胞因子治疗过程中更有可能出现临床抑郁。本研究旨在确定哪些特定的既往症状可预测癌症患者在接受细胞因子白细胞介素-2（IL-2）和/或干扰素-α（IFN-α）治疗期间抑郁症状的发展。32例符合接受IL-2和/或IFN-α治疗的肾细胞癌或恶性黑色素瘤患者被纳入研究。在基线和细胞因子治疗1个月后（终点），使用临床医生实施的蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评估抑郁症状。还评估了与疾病相关的应对策略、社会支持、躯体不适、睡眠质量和人口统计学因素作为相关的基线预测因素。在细胞因子治疗期间，MADRS评分显著增加。与在细胞因子治疗期间未出现抑郁症状的患者相比，在研究终点有中度至重度抑郁症状的患者在MADRS量表评估情绪（尤其是报告的悲伤）、认知（尤其是悲观想法）和神经植物性（睡眠障碍）症状的维度上基线分数更高。有趣的是，只有基线时的情绪症状和睡眠障碍，以及低社会支持，可预测治疗第一个月末抑郁症状的严重程度。通过记录细胞因子诱导的抑郁症状的特定行为易感性因素，这些发现可能有助于识别细胞因子治疗期间有情绪障碍风险的患者，并有助于针对特定患者群体和特定症状制定预防策略。
