视网膜微血管功能与临床相关抑郁症状的发生和轨迹：马斯特里赫特研究。
Retinal microvascular function and incidence and trajectories of clinically relevant depressive symptoms: the Maastricht Study.
机构信息
Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands.
出版信息
Psychol Med. 2024 Jul;54(10):2482-2491. doi: 10.1017/S0033291724000618. Epub 2024 Mar 12.
BACKGROUND
Cerebral microvascular dysfunction may contribute to depression via disruption of brain structures involved in mood regulation, but evidence is limited. We investigated the association of retinal microvascular function, a proxy for microvascular function in the brain, with incidence and trajectories of clinically relevant depressive symptoms.
METHODS
Longitudinal data are from The Maastricht Study of 5952 participants (59.9 ± 8.5 years/49.7% women) without clinically relevant depressive symptoms at baseline (2010-2017). Central retinal arteriolar equivalent and central retinal venular equivalent (CRAE and CRVE) and a composite score of flicker light-induced retinal arteriolar and venular dilation were assessed at baseline. We assessed incidence and trajectories of clinically relevant depressive symptoms (9-item Patient Health Questionnaire score ⩾10). Trajectories included continuously low prevalence (low, = 5225 [87.8%]); early increasing, then chronic high prevalence (early-chronic, = 157 [2.6%]); low, then increasing prevalence (late-increasing, = 247 [4.2%]); and remitting prevalence (remitting, = 323 [5.4%]).
RESULTS
After a median follow-up of 7.0 years (range 1.0-11.0), 806 (13.5%) individuals had incident clinically relevant depressive symptoms. After full adjustment, a larger CRAE and CRVE were each associated with a lower risk of clinically relevant depressive symptoms (hazard ratios [HRs] per standard deviation [s.d.]: 0.89 [95% confidence interval (CI) 0.83-0.96] and 0.93 [0.86-0.99], respectively), while a lower flicker light-induced retinal dilation was associated with a higher risk of clinically relevant depressive symptoms (HR per s.d.: 1.10 [1.01-1.20]). Compared to the low trajectory, a larger CRAE was associated with lower odds of belonging to the early-chronic trajectory (OR: 0.83 [0.69-0.99]) and a lower flicker light-induced retinal dilation was associated with higher odds of belonging to the remitting trajectory (OR: 1.23 [1.07-1.43]).
CONCLUSIONS
These findings support the hypothesis that cerebral microvascular dysfunction contributes to the development of depressive symptoms.
背景
脑微血管功能障碍可能通过破坏参与情绪调节的大脑结构导致抑郁，但证据有限。我们研究了视网膜微血管功能（大脑微血管功能的替代指标）与临床相关抑郁症状的发生和轨迹之间的关联。
方法
这项来自马斯特里赫特研究的纵向数据纳入了 5952 名参与者（59.9 ± 8.5 岁/49.7%为女性），基线时无临床相关抑郁症状（2010-2017 年）。在基线时评估中央视网膜小动脉等效值和中央视网膜小静脉等效值（CRAE 和 CRVE）以及闪烁光诱导的视网膜小动脉和小静脉扩张的综合评分。我们评估了临床相关抑郁症状（9 项患者健康问卷评分 ⩾10）的发生率和轨迹。轨迹包括持续低患病率（低， = 5225 [87.8%]）；早期增加，然后慢性高患病率（早慢性， = 157 [2.6%]）；低，然后增加患病率（晚增， = 247 [4.2%]）；以及缓解患病率（缓解， = 323 [5.4%]）。
结果
中位随访 7.0 年后（范围 1.0-11.0 年），806 名（13.5%）参与者出现了临床相关抑郁症状。经过完全调整后，较大的 CRAE 和 CRVE 与较低的临床相关抑郁症状风险相关（每标准差的危害比 [HRs]：0.89 [95%置信区间（CI）0.83-0.96]和 0.93 [0.86-0.99]），而较低的闪烁光诱导视网膜扩张与较高的临床相关抑郁症状风险相关（每标准差的 HR：1.10 [1.01-1.20]）。与低患病率轨迹相比，较大的 CRAE 与属于早慢性轨迹的可能性较低相关（OR：0.83 [0.69-0.99]），而较低的闪烁光诱导视网膜扩张与属于缓解轨迹的可能性较高相关（OR：1.23 [1.07-1.43]）。
结论
这些发现支持脑微血管功能障碍导致抑郁症状发展的假说。
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