Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea.
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
Brain Behav Immun. 2021 Jul;95:61-67. doi: 10.1016/j.bbi.2021.01.029. Epub 2021 Feb 4.
Inflammation is an important contributor in the pathophysiology of depression and recent evidence suggests that systemic inflammation and life stressors have interactive roles in depression onset. The aim of the present study was to investigate the individual and interactive effects of systemic inflammation and life stressors with short- and long-term treatment responses in outpatients with depressive disorders in a naturalistic one-year prospective design. Serum high-sensitivity C-reactive protein (hsCRP) levels were measured and number of stressful life events (SLEs) during the last 3 months were ascertained from 1094 patients at baseline. These patients received initial antidepressant monotherapy, then, for patients with an insufficient response or uncomfortable side effects, next treatment with alternative strategies were administered at every 3 weeks in the acute treatment phase (3, 6, 9, and 12 weeks) and at every 3 months in the continuation treatment phase (6, 9, and 12 months). 12-week and 12-month remission was estimated, defined as a Hamilton Depression Rating Scale score of ≤ 7. In multivariable logistic regression analyses, individual effects were found only between higher baseline serum hsCRP levels (≥1.0 vs. < 1.0 mg/L) and 12-week non-remission. Significant interactive effects between higher hsCRP levels and higher number of SLEs (≥2 vs. < 2) on both 12-week and 12-month non-remission were observed. Combining serum hsCRP levels and number of SLEs might therefore be a useful predictor for short- and long-term treatment responses in patients with depressive disorders receiving pharmacotherapy.
炎症是抑郁症病理生理学的一个重要因素，最近的证据表明，全身炎症和生活应激源在抑郁症发病中具有相互作用。本研究的目的是在自然前瞻性设计中，调查全身炎症和生活应激源对抑郁障碍门诊患者短期和长期治疗反应的单独和交互作用。在基线时，从 1094 名患者中测量了血清高敏 C 反应蛋白 (hsCRP) 水平，并确定了过去 3 个月内的生活应激事件 (SLE) 数量。这些患者接受了初始抗抑郁单药治疗，然后对于反应不足或副作用不适的患者，在急性治疗阶段（3、6、9 和 12 周）每 3 周和延续治疗阶段（6、9 和 12 个月）每 3 个月用替代策略进行进一步治疗。估计了 12 周和 12 个月的缓解，定义为汉密尔顿抑郁评定量表评分≤7。在多变量逻辑回归分析中，仅发现基线时较高的血清 hsCRP 水平（≥1.0 与 <1.0mg/L）与 12 周时无缓解之间存在单独的影响。在 12 周和 12 个月时无缓解方面，均观察到较高的 hsCRP 水平与较高的 SLE 数量（≥2 与 <2）之间存在显著的交互作用。因此，结合血清 hsCRP 水平和 SLE 数量可能是接受药物治疗的抑郁障碍患者短期和长期治疗反应的有用预测指标。
