Medizinische Klinik und Poliklinik II, Department of Gastroenterology, University of Würzburg, Klinikstr. 6-8, D-97070 Würzburg, Germany.
J Hepatol. 2010 Jan;52(1):10-5. doi: 10.1016/j.jhep.2009.10.007. Epub 2009 Oct 21.
BACKGROUND & AIMS: Interferon-associated depression is a frequent side effect of antiviral therapy for chronic hepatitis C. The aim of the present study was to investigate the correlation between platelet serotonin (5-hydroxytryptamine, 5-HT) concentrations and IFN-induced depression.
The study represents a secondary analysis of a previously published trial on the efficacy of SSRI medication in HCV patients on IFN therapy. Ninety-three patients were longitudinally assessed for depression and platelet serotonin. Evaluation time points were: prior to IFN therapy, at weeks 4, 12, and 24 of IFN treatment, and 4 weeks after antiviral treatment. Depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Platelet serotonin concentrations were measured by ELISA.
Platelet serotonin concentrations were significantly decreased during interferon therapy (p=0.001) in 74 of the 93 patients (79.6%). Clinically relevant depression occurred in 33.3% of patients - however, IFN-induced depression was not significantly linked to either baseline 5-HT concentrations or kinetics. In the subgroup of patients with IFN-induced depression who received the selective serotonin reuptake inhibitor (SSRI) citalopram (20 mg daily, n=17), serotonin levels declined further during anti-depressant medication, becoming statistically significant within the first 2 weeks (p<0.001) of SSRI treatment.
We demonstrate a significant impact of IFN and SSRI intake on platelet serotonin levels, suggesting a biochemical analogy between 5-HT metabolism in blood platelets and the CNS. Platelet 5-HT levels might serve as a surrogate marker for patient adherence to antiviral and anti-depressant medication. For the prediction of IFN-induced depression, however, platelet 5-HT measurements are not suitable.
干扰素相关的抑郁是慢性丙型肝炎抗病毒治疗的常见副作用。本研究的目的是探讨血小板血清素（5-羟色胺，5-HT）浓度与 IFN 诱导的抑郁之间的相关性。
本研究是对先前发表的关于 SSRI 药物在接受 IFN 治疗的 HCV 患者中的疗效的临床试验的二次分析。93 例患者进行了抑郁和血小板 5-HT 的纵向评估。评估时间点为：在开始 IFN 治疗前、治疗第 4、12 和 24 周以及抗病毒治疗结束后 4 周。采用医院焦虑抑郁量表（HADS）评估抑郁。通过 ELISA 测量血小板 5-HT 浓度。
在 93 例患者中的 74 例（79.6%）中，血小板 5-HT 浓度在干扰素治疗期间显著下降（p=0.001）。33.3%的患者出现临床相关的抑郁，但 IFN 诱导的抑郁与基线 5-HT 浓度或动力学均无显著关联。在接受选择性 5-HT 再摄取抑制剂（SSRI）西酞普兰（每天 20mg，n=17）治疗的 IFN 诱导性抑郁患者亚组中，在抗抑郁药物治疗期间，5-HT 水平进一步下降，在 SSRI 治疗的前 2 周内具有统计学意义（p<0.001）。
我们证明了 IFN 和 SSRI 摄入对血小板 5-HT 水平有显著影响，这表明血小板 5-HT 代谢与中枢神经系统之间存在生化相似性。血小板 5-HT 水平可能作为患者对抗病毒和抗抑郁药物治疗依从性的替代标志物。然而，对于 IFN 诱导性抑郁的预测，血小板 5-HT 测量并不适用。
