Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Psychoneuroendocrinology. 2020 Jun;116:104682. doi: 10.1016/j.psyneuen.2020.104682. Epub 2020 Apr 18.
Young adults with depression and evidence of inflammation may represent a high-risk group for cardiometabolic disorders, but studies of cardiometabolic risk in this population are scarce. We aimed to examine: (1) the prevalence of low-grade inflammation in young-adults with depression; (2) cross-sectional and longitudinal associations between cardiometabolic risk factors and depression with or without evidence of inflammation.
The ALSPAC birth cohort participants were assessed for depression and serum high-sensitivity C-Reactive Protein (CRP) levels at age 18, alongside cardiometabolic measures (fasting insulin, fasting plasma glucose, low-density lipoprotein, high-density lipoprotein, triglycerides, smoking, alcohol intake) at age 18 years, and body mass index at ages 9, 13 and 18 years. Low-grade inflammation was defined as CRP>3 mg/L. Multinomial regression was used to examine associations of cardiometabolic markers with depression cases with and without evidence of inflammation. Sensitivity analyses were conducted to examine for interactions between depression, inflammation and cardiometabolic traits.
Out of 2932 participants, 215 met ICD-10 criteria for depressive episode at age 18 years; 23 (10.7 %) had CRP>3 mg/L and 57 (26.5 %) had CRP 1-3 mg/L. Depressive episode with raised CRP (>3 mg/L) was associated with higher triglycerides (adjusted OR = 2.09; 95 % C.I., 1.35-3.24), higher BMI (adjusted OR = 1.13; 95 % C.I., 1.05-1.22) and insulin insensitivity (adjusted OR = 1.12; 95 % C.I., 1.01-1.26), and longitudinally with higher BMI at ages 9 (adjusted OR = 1.27; 95 % C.I., 1.10-1.48) and 13 (adjusted OR = 1.23; 95 % C.I., 1.09-1.38). There was evidence for interaction between BMI and CRP for the risk of depression at age 18 (adjusted OR for the interaction term = 1.56; 95 % C.I. 0.98-2.02) and between CRP and depressive symptoms for the risk of increased BMI at age 18 (adjusted β for the interaction term = 0.05; 95 % C.I. 0.00-0.12).
A notable proportion of young adults with depression have evidence of inflammation. These individuals are at increased risk of cardiometabolic disorders. Management of cardiometabolic risk in depressed individuals with evidence of inflammation should form part of routine clinical practice.
患有抑郁症且有炎症证据的年轻人可能代表了患心脏代谢疾病的高风险群体，但针对该人群心脏代谢风险的研究却很少。本研究旨在探究：（1）年轻的抑郁症患者中低度炎症的流行程度；（2）伴有或不伴有炎症证据的抑郁症与心脏代谢风险因素之间的横断面和纵向关联。
ALSPAC 出生队列参与者在 18 岁时接受抑郁评估和血清高敏 C 反应蛋白（CRP）水平检测，同时在 18 岁时进行心脏代谢指标（空腹胰岛素、空腹血糖、低密度脂蛋白、高密度脂蛋白、甘油三酯、吸烟、饮酒量）和体重指数（BMI）检测，在 9、13 和 18 岁时进行 BMI 检测。低度炎症定义为 CRP>3mg/L。采用多项回归分析来检测心脏代谢标志物与伴有或不伴有炎症证据的抑郁症病例之间的关联。进行了敏感性分析，以检验抑郁、炎症和心脏代谢特征之间的相互作用。
在 2932 名参与者中，有 215 名在 18 岁时符合 ICD-10 抑郁发作标准；23 名（10.7%）CRP>3mg/L，57 名（26.5%）CRP 为 1-3mg/L。伴有 CRP 升高（>3mg/L）的抑郁发作与更高的甘油三酯（调整后的 OR=2.09；95%CI，1.35-3.24）、更高的 BMI（调整后的 OR=1.13；95%CI，1.05-1.22）和胰岛素不敏感（调整后的 OR=1.12；95%CI，1.01-1.26）相关，且与 9 岁（调整后的 OR=1.27；95%CI，1.10-1.48）和 13 岁（调整后的 OR=1.23；95%CI，1.09-1.38）时的 BMI 增加存在纵向关联。在 18 岁时，BMI 和 CRP 之间存在抑郁风险的交互作用（调整后的交互作用项 OR=1.56；95%CI，0.98-2.02），而 CRP 和抑郁症状之间存在 BMI 增加风险的交互作用（调整后的交互作用项β=0.05；95%CI，0.00-0.12）。
相当一部分患有抑郁症的年轻人有炎症的证据。这些人患心脏代谢疾病的风险增加。对于有炎症证据的抑郁症患者，应将心脏代谢风险的管理作为常规临床实践的一部分。
