| Objective1.To investigate the changes of cortisol circadian rhythm and immune function in patients with depression and anxiety.2.To analyze the relationship between cortisol circadian rhythm,CRP,IL-6,blood lipid and depression with anxiety,and to explore its role and mechanism in the occurrence and development of depression with anxiety.Methods1.Research methods: case control study design was adopted.Anxiety depression group(hereinafter referred to as A-MDD group,n=43)was selected as the research group,and depression patients without anxiety symptoms(hereinafter referred to as NA-MDD group,n=44)were selected as the control group.2.Test method: hamd-24 items of the Hamilton depression scale were used to evaluate the severity of the patient's condition and solid phase bilocus sequence.Plasma levels of interleukin-6(IL-6)and c-reactive protein(CRP)were determined by electrochemical luminescence.Plasma levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL)and low-density lipoprotein(LDL)were detected by automatic biochemical analyzer.3.SPSS20.0 statistical software package was used for statistical analysis.Quantitative data were expressed as mean±standard deviation(?X±S).T-test,chi-square test and multivariate logistic regression analysis were used to analyze the data.p<0.05 was statistically significant.Results1.Comparison of general data of the two groupsComparison of general data between the A-MDD group and the NA-MDD group showed that the age of onset,body mass index(BMI),waist circumference and systolic blood pressure were significantly higher than those in the NA-MDD group(p <0.05).There was no significant difference between the two groups in gender,years of education,course of disease and family history of mental illness(p>0.05).2.Comparison of Hamilton Depression Scale(HAMD-24)between the two groupsBy comparison,the total score of Hamilton scale in A-MDD group was 31.81 ±5.39,and that in NA-MDD group was 25.25±5.02,with statistical significance(p<0.05).Among the seven factors of HAMD-24 scale,cognitive impairment factor,day-night change factor,retardation factor,sleep disorder factor and despair factor in A-MDD group were higher than those in NA-MDD group,and the difference was statistically significant(p<0.05).3.ACTH and COR release levels,diurnal cortisol slope and the incidence of circadian rhythm disorders were compared between the two groupsPlasma ACTH and COR levels were compared at three time points within 24 hours(8:00,16:00 and 24:00)between the A-MDD group and the NA-MDD group.It was found that plasma cortisol level at 8:00 in the A-MDD group was 15.44±4.68?g /ml,and that in the NA-MDD group was 13.63±3.58?g/ml.The difference between the A-MDD group and the NA-MDD group was statistically significant(p< 0.05).Plasma COR levels at the other two time points in the A-MDD group were 8.32±3.25?g/ml and 3.82±3.22?g/ml,plasma COR levels at the other two time points in the NA-MDD group were 8.29±3.91?g/ml and 3.85±4.00?g/ml,there was no statistically significant difference between the two groups(p>0.05).The plasma ACTH levels at the three time points of the A-MDD group were 27.30±16.65pg/ml,19.02±15.46pg/ml,and 12.85±9.62pg/ml,the plasma ACTH levels at the three time points of the NA-MDD group were 22.26±12.71pg/ml,17.42±9.35pg/ml,and 12.24±7.66pg/ml,there was no statistically significant difference between the two groups(p>0.05).Comparing the daily cortisol slope between the A-MDD group and the NA-MDD group,it was found that the daily cortisol slope of the A-MDD group was 0.89±0.56,and that of the NA-MDD group was 0.67±0.44.The difference between the A-MDD group and the na-mdd group was statistically significant(p<0.05).A total of 31 patients(72%)in the A-MDD group had circadian rhythm disorder,and 21 patients(48%)in the NA-MDD group.The incidence of circadian rhythm disorder in the A-MDD group was significantly higher than that in the NA-MDD group(p<0.05).ACTH showed no significant difference between the two groups.4.Comparison of inflammatory markers between the two groupsBy comparison,the plasma levels of IL-6 and CRP(3.54±1.90?1.20±0.77)in A-MDD group were higher than those in NA-MDD group(2.65±1.34,0.93±0.89),with statistical significance(p<0.05).5.Comparison of blood lipid between two groupsCompared with NA-MDD group,the level of triglyceride in A-MDD group(1.63±1.11mmol/L)was higher than that in NA-MDD group(1.19±0.66mmol/L),The A-MDD group was significantly higher than the NA-MDD group,and the difference was statistically significant(p<0.05).There was no significant difference in total cholesterol,high density lipoprotein and low density lipoprotein between the two groups(p>0.05).6.Multivariate Logistic Regression Analysis of Affecting Anxious DepressionMultiple logistic regressiregression found that the high risk factors for anxious depression were sleep disorder((?=0.729,OR=2.072,95%CI=1.018?3.119),IL-6(?=0.583,OR=1.792,95%CI=1.168?2.748);cognitive disorder(?=0.099,OR=1.104,95%CI=1.022?1.193),cortisol disorder(?=0.075,OR=1.078,95%CI=1.014?1.146).Conclusions1.Compared with patients with pure depression,anxious depression patients have a later onset age,a more serious overall condition,more obvious cognitive dysfunction,despair,sleep disorders,and more tendency to merge metabolic disorders,suggesting that depression and anxiety have differences in etiology and clinical prognosis compared with patients with simple depression.2.Two groups of patients' ACTH,COR levels are within the normal range,but the anxious depression patients with COR8 level and COR biological rhythm disorders incidence were higher than pure depression,cortisol rhythm disorders may is one of the biomarker of anxious depression patients,may also be the subtypes of depression clinical treatment of poor results,the biological basis of immune function of patients with depression associated with anxiety disorder,it may be one of cortisol rhythm disorders intermediary factors.3.Sleep disorder,IL-6,cortisol rhythm disorder and cognitive impairment constitute the high risk factors of anxious depression.Sleep disorder is the main risk factor of anxious depression,which increases the risk of depression with anxiety by two to three times.. |
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