Cepeda M Soledad, Stang Paul, Makadia Rupa
Janssen Research & Development, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560.
Department of Epidemiology, Janssen Research & Development, LLC, Titusville, New Jersey, USA.
J Clin Psychiatry. 2016 Dec;77(12):1666-1671. doi: 10.4088/JCP.15m10267.
Major depressive disorder may be due to psychoneuroimmunological dysfunction, as studies have documented increased levels of a variety of inflammatory mediators in depressed subjects. Nitric oxide (NO) is marker of inflammation, and fractional exhaled NO (FeNO) is a marker of airway inflammation. Plasma NO and FeNO levels have been shown to be lower in subjects with depression in small studies. We sought to assess the association of depression with C-reactive protein (CRP) and FeNO levels in a large and representative sample of the US population.
Population-based cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES). NHANES collects health information about the US population through interviews, medical examinations, and laboratory tests. We included subjects ≥ 20 years old who participated in NHANES in 2007 to 2012, responded to the depression questions, and had CRP values or ≥ 2 reproducible FeNO measures. Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9). Subjects were classified as depressed if PHQ-9 scores were ≥ 10. FeNO and CRP levels were log transformed. Unadjusted and adjusted regression analyses were conducted.
A total of 14,276 subjects responded to the PHQ-9, and 7.73% had depressive symptoms. Of these subjects, 10,036 had CRP values and 12,513 had FeNO measurements. Subjects with depressive symptoms had, after adjustment, CRP levels that were 31% higher (95% confidence interval [CI], 14% to 50%) and FeNO levels that were 10.7% lower (95% CI, -2.5% to -17.1%) than in subjects with no depressive symptoms.
Depression is associated with high CRP levels and low FeNO levels. Of importance, this study (1) assesses the association of depression with CRP and exhaled NO levels in a large and representative sample of the US population, (2) contributes to the neuroimmunological dimension of depression, (3) confirms the association of depression with high levels of CRP, and (4) assesses, for the first time, the association of depression with peripheral NO in more than 10,000 subjects from the general population.
重度抑郁症可能归因于心理神经免疫功能障碍，因为研究表明抑郁症患者体内多种炎症介质水平升高。一氧化氮（NO）是炎症标志物，呼出一氧化氮分数（FeNO）是气道炎症标志物。在一些小型研究中，抑郁症患者的血浆NO和FeNO水平已被证明较低。我们试图在美国人群的一个大型代表性样本中评估抑郁症与C反应蛋白（CRP）和FeNO水平之间的关联。
基于人群的横断面研究，使用来自美国国家健康和营养检查调查（NHANES）的数据。NHANES通过访谈、医学检查和实验室检测收集美国人群的健康信息。我们纳入了2007年至2012年参加NHANES、回答了抑郁症相关问题且有CRP值或≥2次可重复的FeNO测量值的≥20岁的受试者。使用9项患者健康问卷（PHQ-9）测量抑郁症。如果PHQ-9得分≥10，则将受试者分类为抑郁症患者。对FeNO和CRP水平进行对数转换。进行了未调整和调整后的回归分析。
共有14276名受试者回答了PHQ-9，7.73%有抑郁症状。在这些受试者中，10036人有CRP值，12513人有FeNO测量值。调整后，有抑郁症状的受试者的CRP水平比无抑郁症状的受试者高31%（95%置信区间[CI]，14%至50%），FeNO水平低10.7%（95%CI，-2.5%至-17.1%）。
抑郁症与高CRP水平和低FeNO水平相关。重要的是，本研究（1）在美国人群的一个大型代表性样本中评估了抑郁症与CRP和呼出NO水平之间的关联，（2）为抑郁症的神经免疫维度做出了贡献，（3）证实了抑郁症与高CRP水平之间的关联，（4）首次在来自普通人群的10000多名受试者中评估了抑郁症与外周NO之间的关联。
