Leiden University Medical Centre, Department of Psychiatry, PO Box 9600, 2300 RC Leiden, The Netherlands.
J Clin Psychiatry. 2010 Jun;71(6):729-36. doi: 10.4088/JCP.08m04865blu. Epub 2009 Dec 15.
Several studies have suggested an association between lipids or lipoproteins and depression, but findings are contradictory. However, previous studies did not always take into consideration potentially mediating factors or heterogeneity of symptoms, which may clarify contradicting findings.
We compared levels of serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol and triglyceride between 761 subjects with current major depressive disorder (MDD) (Composite International Diagnostic Interview, based on the DSM-IV), 1,071 subjects with remitted MDD, and 629 controls, aged 18 to 65 years. Subjects participated in the baseline assessment of the Netherlands Study of Depression and Anxiety, which lasted from September 2004 to February 2007. We studied the impact of adjustment for sociodemographics, lifestyle-related covariates, and antidepressant use and examined the association between specific psychopathological characteristics and lipid/lipoprotein levels.
HDL cholesterol level was lower (P = .007) and triglyceride level was higher (P = .001) in current MDD versus remitted MDD and controls. After adjustment for level of education, body mass index (BMI), smoking status, and alcohol use, dissimilarities lost statistical significance. Depression severity, comorbid dysthymia, and melancholic and atypical features were all associated with lipids/lipoproteins, but most associations attenuated after adjustment for covariates, especially BMI. The association between melancholic features and lower HDL cholesterol (P = .038) and between atypical depression and higher total and LDL cholesterol (P = .004 and P = .002, respectively) persisted after full adjustment.
Adverse lipoprotein patterns were found in patients with MDD. The fact that these associations diminished after adjustment for lifestyle-related factors, especially BMI, suggests that the unfavorable lipid/lipoprotein pattern among depressed subjects is mainly secondary to lifestyle-related factors. However, melancholic features were independently associated with lower HDL cholesterol, and atypical depression was independently associated with higher total and LDL cholesterol.
多项研究表明血脂或脂蛋白与抑郁之间存在关联，但研究结果存在矛盾。然而，以前的研究并未始终考虑到潜在的中介因素或症状的异质性，这可能会澄清相互矛盾的发现。
我们比较了当前患有重度抑郁症（MDD）（基于 DSM-IV 的综合国际诊断访谈）的 761 名受试者、缓解期 MDD 的 1071 名受试者和年龄在 18 至 65 岁的 629 名对照者血清总胆固醇、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）胆固醇和甘油三酯的水平。受试者参加了荷兰抑郁和焦虑研究的基线评估，该研究从 2004 年 9 月持续到 2007 年 2 月。我们研究了调整社会人口统计学、生活方式相关协变量和抗抑郁药使用对血脂/脂蛋白水平的影响，并检查了特定精神病理学特征与脂质/脂蛋白水平之间的关联。
与缓解期 MDD 和对照组相比，当前 MDD 患者的 HDL 胆固醇水平较低（P =.007），甘油三酯水平较高（P =.001）。调整教育程度、体重指数（BMI）、吸烟状况和饮酒量后，差异失去统计学意义。抑郁严重程度、共病心境恶劣、忧郁和非典型特征均与脂质/脂蛋白有关，但大多数关联在调整协变量后减弱，尤其是 BMI。忧郁特征与较低的 HDL 胆固醇（P =.038）之间以及非典型抑郁与较高的总胆固醇和 LDL 胆固醇（P =.004 和 P =.002）之间的关联在充分调整后仍然存在。
在 MDD 患者中发现了不良的脂蛋白模式。这些关联在调整与生活方式相关的因素，尤其是 BMI 后减少，表明抑郁患者的不利血脂/脂蛋白模式主要是由与生活方式相关的因素引起的。然而，忧郁特征与较低的 HDL 胆固醇独立相关，非典型抑郁与较高的总胆固醇和 LDL 胆固醇独立相关。
