Liu Hongmei, Wu Xiaohui, Wang Yun, Liu Xiaohua, Peng Daihui, Wu Yan, Chen Jun, Su Yun'ai, Xu Jia, Ma Xiancang, Li Yi, Shi Jianfei, Yang Xiaodong, Rong Han, Forti Marta Di, Fang Yiru
Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
Gen Psychiatr. 2022 Sep 8;35(4):e100844. doi: 10.1136/gpsych-2022-100844. eCollection 2022.
The association between inflammation and major depressive disorder (MDD) remains poorly understood, given the heterogeneity of patients with MDD.
We investigated inflammatory markers, such as interleukin (IL)-6, high-sensitivity C reactive protein (hsCRP) and tumour necrosis factor-α (TNF-α) in melancholic, atypical and anxious depression and explored whether baseline inflammatory protein levels could indicate prognosis.
The sample consisted of participants (aged 18-55 years) from a previously reported multicentre randomised controlled trial with a parallel-group design registered with ClinicalTrials.gov, including melancholic (n=44), atypical (n=37) and anxious (n=44) patients with depression and healthy controls (HCs) (n=33). Subtypes of MDD were classified according to the 30-item Inventory of Depressive Symptomatology, Self-Rated Version and the 17-item Hamilton Depression Rating Scale. Blood levels of TNF-α, IL-6 and hsCRP were assessed using antibody array analysis.
Patients with MDD, classified according to melancholic, atypical and anxious depression subtypes, and HCs did not differ significantly in baseline TNF-α, IL-6 and hsCRP levels after adjustment. In patients with anxious depression, hsCRP levels increased significantly if they experienced no pain (adjusted (adj.) p=0.010) or mild to moderate pain (adj. p=0.038) compared with those with severe pain. However, the patients with anxious depression and severe pain showed a lower trend in hsCRP levels than patients with atypical depression who experienced severe pain (p=0.022; adj. p=0.155). Baseline TNF-α (adj. p=0.038) and IL-6 (adj. p=0.006) levels in patients in remission were significantly lower than those in patients with no remission among the participants with the atypical depression subtype at the eighth-week follow-up.
This study provides evidence of differences in inflammatory proteins in patients with varied symptoms among melancholic, atypical and anxious depression subtypes. Further studies on the immunoinflammatory mechanism underlying different subtypes of depression are expected for improved individualised therapy.
NCT03219008.
鉴于重度抑郁症（MDD）患者的异质性，炎症与MDD之间的关联仍未得到充分理解。
我们研究了忧郁型、非典型型和焦虑型抑郁症患者的炎症标志物，如白细胞介素（IL）-6、高敏C反应蛋白（hsCRP）和肿瘤坏死因子-α（TNF-α），并探讨基线炎症蛋白水平是否可以指示预后。
样本来自一项先前报道的多中心随机对照试验的参与者（年龄18 - 55岁），该试验采用平行组设计并在ClinicalTrials.gov上注册，包括忧郁型（n = 44）、非典型型（n = 37）和焦虑型（n = 44）抑郁症患者以及健康对照（HCs）（n = 33）。MDD的亚型根据30项抑郁症状自评量表和17项汉密尔顿抑郁量表进行分类。使用抗体阵列分析评估TNF-α、IL-6和hsCRP的血液水平。
根据忧郁型、非典型型和焦虑型抑郁症亚型分类的MDD患者与HCs在调整后的基线TNF-α、IL-6和hsCRP水平上没有显著差异。在焦虑型抑郁症患者中，与有重度疼痛的患者相比，如果他们没有疼痛（调整后（adj.）p = 0.010）或有轻度至中度疼痛（adj. p = 0.038），hsCRP水平显著升高。然而，有重度疼痛的焦虑型抑郁症患者的hsCRP水平趋势低于有重度疼痛的非典型型抑郁症患者（p = 0.022；adj. p = 0.155）。在非典型抑郁症亚型的参与者中，在第八周随访时，缓解患者的基线TNF-α（adj. p = 0.038）和IL-6（adj. p = 0.006）水平显著低于未缓解患者。
本研究提供了证据，表明忧郁型、非典型型和焦虑型抑郁症亚型中具有不同症状的患者在炎症蛋白方面存在差异。期望对抑郁症不同亚型潜在的免疫炎症机制进行进一步研究，以改善个体化治疗。
NCT03219008。
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