Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854, Oslo, Norway.
Norwegian Centre of Ageing and Health, and the Department of Old Age Psychiatry, Oslo, Norway.
BMC Geriatr. 2018 Jun 25;18(1):149. doi: 10.1186/s12877-018-0836-x.
The prevalence of major depression (MD) according to population studies is the same for old (65 years and older) and younger adults. In contrast, an elevated proportion of old MD patients are hospitalized compared to younger adults with MD, indicating a need to expand the characteristics of old inpatients with MD. To illustrate this point, the association between inflammation and MD in old psychiatric inpatients is sparsely investigated even though an association between inflammation and treatment resistance among younger adults with MD has been reported. In this study, we aimed to explore the plasma concentrations of 27 immune markers in old inpatients with MD, and our purpose was to expand the understanding of inflammatory mechanisms in these patients.
Prior to electroconvulsive treatment of MD, we compared 64 inpatients with unipolar MD (mean age 75.2 years) and 18 non-depressed controls (mean age 78.0 years). Symptoms characterizing MD were assessed by the Hamilton Rating Scale of Depression (HRSD)-17, and the immune markers from peripheral blood plasma were analysed using multiplex assay technology. For statistical analysis of data, we used the independent samples median test, independent samples t-test, χ-test, receiver operating characteristic curve analyses, stepwise discriminant analysis, and multivariate linear regression.
Twenty-two immune markers representing pro- and anti-inflammatory, adaptive and trophic signalling had higher concentrations in the inpatients compared to the controls. Only the four immune markers IL-1β, IL-5, IL-10 and IL-15 had concentrations below the lower detection limit in a considerable portion (above 20%) of the patient cases. A combination of the concentration in plasma of TNF, vascular endothelial growth factor (VEGF), IL-1β, IL-7 and monocyte chemotactic protein (MCP)-1, correctly classified 98.4% of the depressed patients and 83.3% of the non-depressed controls. Plasma concentration of TNF and VEGF were associated with the HRSD-17 scores (p = 0.017 and 0.005, respectively).
Our results indicate that several inflammatory mechanisms may be highly activated in old psychiatric inpatients with MD, and indicate that immune markers may contribute to a more comprehensive understanding of MD in old persons.
NCT01559324 ClinicalTrials.gov.
根据人群研究，重度抑郁症（MD）的患病率在老年人（65 岁及以上）和年轻人中相同。相比之下，与患有 MD 的年轻成年人相比，大量老年 MD 患者住院，这表明需要扩展老年 MD 住院患者的特征。为了说明这一点，尽管已经报道了炎症与年轻 MD 患者的治疗抵抗之间的关联，但在老年精神病住院患者中，炎症与 MD 之间的关联仍未得到充分研究。在这项研究中，我们旨在探讨 MD 老年住院患者的 27 种免疫标志物的血浆浓度，我们的目的是扩展对这些患者炎症机制的理解。
在对 MD 进行电惊厥治疗之前，我们比较了 64 名患有单相 MD 的住院患者（平均年龄 75.2 岁）和 18 名非抑郁对照者（平均年龄 78.0 岁）。用汉密尔顿抑郁量表（HRSD）-17 评估 MD 症状，用多重分析技术分析外周血血浆中的免疫标志物。对于数据的统计分析，我们使用独立样本中位数检验、独立样本 t 检验、卡方检验、受试者工作特征曲线分析、逐步判别分析和多元线性回归。
22 种代表促炎和抗炎、适应性和营养信号的免疫标志物在住院患者中的浓度高于对照组。只有四种免疫标志物 IL-1β、IL-5、IL-10 和 IL-15 的浓度在相当一部分（超过 20%）患者病例中低于下限。TNF、血管内皮生长因子（VEGF）、IL-1β、IL-7 和单核细胞趋化蛋白-1 血浆浓度的组合正确分类了 98.4%的抑郁患者和 83.3%的非抑郁对照组。TNF 和 VEGF 的血浆浓度与 HRSD-17 评分相关（p=0.017 和 0.005）。
我们的结果表明，几种炎症机制可能在患有 MD 的老年精神病住院患者中高度激活，并表明免疫标志物可能有助于更全面地了解老年人的 MD。
NCT01559324 ClinicalTrials.gov。
