Geng Dandan, Wang Wenxin, Du Ning, Niwenahisemo Lisa Cynthia, Xu Heyan, Wang Yuna, Kuang Li
Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Mental Health Center, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Psychiatry. 2024 Nov 25;15:1413608. doi: 10.3389/fpsyt.2024.1413608. eCollection 2024.
Major depressive disorder (MDD) is one of the most serious mental disorders affecting adolescents worldwide. Electroconvulsive therapy (ECT) is widely acknowledged as a first-line treatment for severe depression, but the clinical response varies. Neutrophils and platelets are both related to the progression of MDD. The aim of this study was to investigate the correlation between the neutrophil-to-platelet ratio (NPR) during the acute phase and the effectiveness of ECT treatment.
A total of 138 adolescent MDD patients who received ECT were included in the study. Neutrophil and platelet levels were obtained upon admission. At the same time, treatment response was the primary outcome measure, defined as a reduction of ≥ 50% in the HAMD-17 score from baseline to treatment endpoint, and the secondary outcome measure was remission of depression, defined as a HAMD-17 score ≤ 7.
After receiving ECT, 103(74.6%) of all patients responded to treatment and 72(52.2%) achieved remission. Non-responders/non-remitters to ECT tended to have higher levels of NPR at baseline compared to ECT responders/remitters [Non-responder: 3.4 (2.5-4.8) vs 2.7 (2.2-3.5), P = 0.002; Non-remitter: 0.014 (0.011-0.017) vs 0.011 (0.008-0.015), P = 0.03]. In multiple logistic regression, high NPR (≥ 0.014) remained independently associated with ECT non-response/non-remission after adjusting for confounding factors [Non-responder: OR = 4.911, 95% CI (2.052 - 11.754), P < 0.001; Non-remitter: OR = 2.704, 95% CI (1.262 - 5.796), P = 0.011].
High NPR correlates with poor ECT efficacy in adolescents with MDD, particularly among female and overweight patients.
重度抑郁症（MDD）是影响全球青少年的最严重精神障碍之一。电休克疗法（ECT）被广泛认为是重度抑郁症的一线治疗方法，但临床反应各不相同。中性粒细胞和血小板均与MDD的进展有关。本研究的目的是探讨急性期中性粒细胞与血小板比值（NPR）与ECT治疗效果之间的相关性。
本研究共纳入138例接受ECT治疗的青少年MDD患者。入院时获取中性粒细胞和血小板水平。同时，治疗反应是主要结局指标，定义为从基线到治疗终点汉密尔顿抑郁量表（HAMD-17）评分降低≥50%，次要结局指标是抑郁缓解，定义为HAMD-17评分≤7。
接受ECT治疗后，所有患者中有103例（74.6%）对治疗有反应，72例（52.2%）实现缓解。与ECT有反应者/缓解者相比，ECT无反应者/未缓解者在基线时的NPR水平往往更高[无反应者：3.4（2.5-4.8）对2.7（2.2-3.5），P = 0.002；未缓解者：0.014（0.011-0.017）对0.011（0.008-0.015），P = 0.03]。在多因素logistic回归中，校正混杂因素后，高NPR（≥0.014）仍与ECT无反应/未缓解独立相关[无反应者：OR = 4.911，95%CI（2.052-11.754），P < 0.001；未缓解者：OR = 2.704，95%CI（1.262-5.796），P = 0.011]。
高NPR与青少年MDD患者ECT疗效不佳相关，尤其是在女性和超重患者中。
