Faculty of Medical Sciences, Department of Neurology, University of Kragujevac, 69 Svetozara Markovica St., 34000, Kragujevac, Serbia.
Clinic of Neurology, Clinical Center Kragujevac, 30 Zmaj Jovina St., 34000, Kragujevac, Serbia.
Acta Neurol Belg. 2020 Aug;120(4):853-861. doi: 10.1007/s13760-018-1015-8. Epub 2018 Sep 4.
Oxidative stress and neuroinflammation have a role in the pathogenesis of multiple sclerosis (MS) and in depression. Fatigue is the most disabling symptom in patients with MS and could also be a part of depressive symptomatology. In this study, we measured the serum levels of uric acid (UA) as a marker of oxidative stress and C-reactive protein (CRP) as an inflammatory marker, in 98 patients with MS in relapse and remitting phase of illness and 35 healthy subjects. Degree of depressive symptomatology and fatigue were assessed with Beck's Depression Inventory (BDI) and Fatigue Severity Scale (FSS). Further, we examined the possible correlation of these biomarkers with symptoms of depression and fatigue. Relapse and remitting MS had a lower serum UA levels than controls (236.97 ± 9.25 µmol/L vs. 268.27 ± 0.09 µmol/L vs. 314.82 ± 11.02 µmol/L; p = 0.000), while sera levels of CRP were higher in relapse than remitting patients (4.46 ± 0.40 mg/L vs. 1.01 ± 0.38 mg/L; p = 0.000). Patients in relapse had higher BDI scores (15.68 ± 16.62 vs. 8.36 ± 7.10; p = 0.045). Decreased UA levels showed weak negative correlation with the presence of sadness and disturbed daily activities, higher CRP levels positively correlated with severe depression and the correlation between depression and fatigue was also observed (p < 0.05). It is possible that decreased UA levels lead to sadness, disturbed daily activities and severe disability. Every attack of CRP elevation in relapse could additionally precipitate the depression onset. The clinicians must pay special attention to early detection of fatigue because it could precede depression and improve further treatment.
氧化应激和神经炎症在多发性硬化症 (MS) 的发病机制以及抑郁症中起作用。疲劳是 MS 患者最致残的症状，也可能是抑郁症状的一部分。在这项研究中，我们测量了 98 例处于疾病复发和缓解期的 MS 患者和 35 名健康对照者的血清尿酸 (UA) 水平作为氧化应激标志物和 C 反应蛋白 (CRP) 作为炎症标志物。使用贝克抑郁量表 (BDI) 和疲劳严重程度量表 (FSS) 评估抑郁症状和疲劳程度。此外，我们还检查了这些生物标志物与抑郁和疲劳症状的可能相关性。复发和缓解期 MS 患者的血清 UA 水平低于对照组 (236.97 ± 9.25 μmol/L 比 268.27 ± 0.09 μmol/L 比 314.82 ± 11.02 μmol/L；p = 0.000)，而 CRP 水平在复发期高于缓解期 (4.46 ± 0.40 mg/L 比 1.01 ± 0.38 mg/L；p = 0.000)。复发期患者的 BDI 评分更高 (15.68 ± 16.62 比 8.36 ± 7.10；p = 0.045)。UA 水平降低与悲伤和日常活动障碍呈弱负相关，CRP 水平升高与重度抑郁呈正相关，且抑郁与疲劳之间也存在相关性 (p < 0.05)。UA 水平降低可能导致悲伤、日常活动障碍和严重残疾。每次复发期 CRP 升高都会加重抑郁的发作。临床医生必须特别注意早期发现疲劳，因为它可能先于抑郁发生，并能改善进一步的治疗。
