Tartu University Hospital, Tartu, Estonia.
Tartu University, Tartu, Estonia.
BMC Neurol. 2020 Apr 18;20(1):142. doi: 10.1186/s12883-020-01727-y.
Emotional health disturbances are common after aneurysmal subarachnoid hemorrhage (aSAH) and their causes are largely unexplored. Corticotropin-releasing hormone receptor 1 (CRHR1) is a key factor in stress reactivity and development of mental health disturbances after adverse life-events.
We explore the effect of CRHR1 genotype on mental health after aSAH in a retrospective cohort study. One hundred twenty-five patients have been assessed using EST-Q mental health questionnaire. Genotyping of CRHR1 single nucleotide polymorphisms (SNP-s) was performed (Rs7209436, Rs110402, Rs242924).
Fatigue was present in almost half of aSAH patients, depression and anxiety in one-third. There was a high prevalence of insomnia and panic complaints. Rs110402 minor allele decreased the risk of depression (OR = 0.25, p = 0.027 for homozygotes). Depression was present in 14% vs 41% in minor and major allele homozygotes, respectively. Rs110402, Rs242924 and Rs7209436 minor alleles and TAT-haplotype, formed by them, were protective against fatigue. After Bonferroni correction only the association of Rs110402 with fatigue remained statistically significant (OR = 0.21, p = 0.006 for minor allele homozygotes). Results remained statistically significant when adjusted for gender, admission state, age and time from aSAH. In multiple regression analysis occurrence of fatigue was dependent on anxiety, modified Rankin score and Rs110402 genotype (R = 0.34, p < 0.001).
CRHR1 minor genotype was associated with a lower risk of fatigue and depression after aSAH. Genetic predisposition to mental health disturbances associated with negative life-events could be a risk factor for fatigue and depression after aSAH and selected patients might benefit from advanced counselling in the recovery phase.
情绪健康障碍在蛛网膜下腔出血（aSAH）后很常见，但其病因在很大程度上尚未得到探索。促肾上腺皮质素释放激素受体 1（CRHR1）是应激反应和不良生活事件后心理健康障碍发展的关键因素。
我们在一项回顾性队列研究中探讨了 CRHR1 基因型对 aSAH 后心理健康的影响。使用 EST-Q 心理健康问卷评估了 125 名患者。对 CRHR1 单核苷酸多态性（SNP-s）进行了基因分型（Rs7209436、Rs110402、Rs242924）。
几乎一半的 aSAH 患者存在疲劳，三分之一的患者存在抑郁和焦虑。失眠和惊恐发作的发生率很高。Rs110402 次要等位基因降低了抑郁的风险（杂合子的 OR = 0.25，p = 0.027）。在 minor 和 major 等位基因纯合子中，分别有 14%和 41%的患者存在抑郁。Rs110402、Rs242924 和 Rs7209436 次要等位基因以及由它们形成的 TAT 单倍型对疲劳具有保护作用。经 Bonferroni 校正后，只有 Rs110402 与疲劳的关联具有统计学意义（OR = 0.21，p = 0.006，minor 等位基因纯合子）。当调整性别、入院状态、年龄和 aSAH 后时间时，结果仍具有统计学意义。在多元回归分析中，疲劳的发生取决于焦虑、改良 Rankin 评分和 Rs110402 基因型（R = 0.34，p < 0.001）。
CRHR1 次要基因型与 aSAH 后疲劳和抑郁的风险降低相关。与负面生活事件相关的心理健康障碍的遗传易感性可能是 aSAH 后疲劳和抑郁的危险因素，选择的患者可能受益于康复阶段的高级咨询。
