Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
College of Korean Medicine, Dongshin University, Naju, Jeollanam-do, Republic of Korea.
Psychoneuroendocrinology. 2019 Mar;101:42-49. doi: 10.1016/j.psyneuen.2018.10.024. Epub 2018 Oct 29.
The present study investigated the longitudinal effects of NR3C1 1 F exon methylation on the risk of depression following ACS and treatment outcomes.
In total, 969 patients admitted for recent ACS were recruited within 2 weeks of ACS; 711 of these patients were followed up at 1 year. Depressive disorder was diagnosed according to DSM-IV criteria and included prevalent depressive disorder at baseline and incident or persistent depressive disorder at follow-up based on depression status at the two examinations. Of the 378 baseline participants who were diagnosed with depression, 255 participated in a randomized double-blind placebo-controlled trial of escitalopram, while the remaining 123 were managed with the usual medical treatment for ACS.NR3C1 1 F exon methylation was measured using peripheral blood samples, and various demographic and clinical characteristics were assessed as covariates.
Higher NR3C1 1 F exon methylation levels were independently associated with prevalent depressive disorder at baseline but not with incident or persistent depressive disorder at follow-up based on logistic regression analyses adjusted for covariates. The effects of escitalopram on the remission of depressive symptoms was not influenced by NR3C1 1 F exon methylation status in ACS patients, but a placebo effect on the remission of depressive symptoms was observed, particularly in patients with lower methylation levels.
ACS patients with higher NR3C1 1 F exon methylation levels were at higher risk of developing depressive disorder within 2 weeks of ACS. Additionally, adequate antidepressant treatment may be effective for the remission of depressive symptoms regardless of NR3C1 1 F exon methylation status.
本研究旨在探讨 NR3C1 1F 外显子甲基化对 ACS 后抑郁风险及治疗结局的纵向影响。
共招募了 969 例近期 ACS 住院患者，在 ACS 后 2 周内进行招募；其中 711 例患者进行了 1 年随访。根据 DSM-IV 标准诊断抑郁障碍，包括基线时存在的现患抑郁障碍和基于两次检查时的抑郁状态在随访时出现的新发或持续抑郁障碍。在 378 例基线时被诊断为抑郁症的参与者中，255 例参加了艾司西酞普兰的随机双盲安慰剂对照试验，而其余 123 例接受 ACS 的常规医学治疗。使用外周血样本测量 NR3C1 1F 外显子甲基化，评估各种人口统计学和临床特征作为协变量。
逻辑回归分析调整协变量后，较高的 NR3C1 1F 外显子甲基化水平与基线时现患抑郁障碍独立相关，但与随访时新发或持续抑郁障碍无关。在 ACS 患者中，NR3C1 1F 外显子甲基化状态并不影响艾司西酞普兰对抑郁症状缓解的作用，但观察到安慰剂对抑郁症状缓解的影响，尤其是在甲基化水平较低的患者中。
ACS 患者 NR3C1 1F 外显子甲基化水平较高，在 ACS 后 2 周内发生抑郁障碍的风险较高。此外，无论 NR3C1 1F 外显子甲基化状态如何，充分的抗抑郁治疗可能对缓解抑郁症状有效。
