| Objective:To investigate the incidence of depression and its related factors in patients with malignant tumor in Xinjiang.Objective to analyze the characteristics of neuroendocrine immune network disorder and its influence on prognosis in patients with depressive symptoms in cancer patients.By the four diagnostic methods,namely inspection,olfaction,inquiry,and pulse-taking and palpation,to obtain the TCM syndromes in cancer patients with depression.Cluster analysis and principal component analysis are used to obtain the common syndromes of Chinese medicine combined with depression,and provide a theoretical basis for the combination of traditional Chinese and Western medicine for the treatment of cancer.Materials and methods:(1)Using cross-sectional epidemiological survey method,collected from January 2015 to December 2015,the patients with malignant tumors were diagnosed in the Department of Gastroenterology,Department of internal medicine,Department of radiotherapy,and department of integrated traditional Chinese and Western medicine in the Affiliated Tumor Hospital of Xinjiang Medical University,in accordance with the inclusion criteria and consent,questionnaire survey was conducted for each patient and the content of the questionnaire included demographic signs,signs of disease(disease duration,staging,treatment,pain and metastasis),nearly a week of psychological status,Depression was assessed using Self Rating Depression Scale(Self-Rating Depression Scale,SDS)and Hamilton Depression Rating Scale(Hamilton Depression Scale,HAMD).SPSS 21.0software is used to evaluate the incidence and influencing factors of depression in patients with malignant tumors in Xinjiang.Univariate and multivariate logistic regression analysis were used to analyze risk factors for depression in patients with malignant tumors.Test level alpha=0.05.(2)Randomly selected 260 cases of cancer patients in department of Integrated TCM and Western Medicine,according to the score of HAMD and SDS,the patients were divided into three groups:malignant tumor without depression group(n=39),malignant tumor complicated with mild depression group(n=160)and malignant tumor complicated with moderate and severe depression group(n=61),at the same time,sex,age,ethnic groups were matched with malignant tumor patients in the healthy control group(n=40).Enzyme linked immunosorbent assay(ELSIA)was used to detect the levels of plasma interleukin-1α(IL-1α)in each group;Plasma cortisol(CORT)was measured by radioimmunoassay in each group;Plasma interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(IL-10),interleukin-17A(IL-17A)and interferon-γ(INF-γ)and tumor necrosis factor-a(TNF-a)were detected by cytometric bead array;The levels of dopamine(DA)and 5-HT were determined by ultra performance liquid chromatography mass spectrometry(UPLC-MS/MS);The levels of adrenocorticotropic hormone(ACTH)were measured by electrochemiluminescence assay.The two groups were compared with t test,and multiple groups were compared by rank sum test,Correlation analysis using Pearson/Spearman correlation.Survival analysis using Kaplan-Meier method.(3)Using cross-sectional epidemiological survey method,design of Chinese medicine symptom questionnaire for cancer patients with depression,the data of the four diagnostics of traditional Chinese medicine were collected from 1099 patients with depressive symptoms in malignant tumors,who met the inclusion criteria.Cluster analysis was used to analyze and induce the TCM syndromes of patients with malignant tumor complicated with depression.Then application of principal component analysis to each type of TCM syndrome,comprehensive of symptoms of various syndromes associated with depressionwere studied completely.Objective to evaluate the contribution of each symptom to the syndrome.Results:(1)There were 2079 cases of patients with malignant tumor in this study.The incidence of depression was 62.10%in cancer patients.Risk factors were Monthly family income≤5000 yuan(odds ratio[OR]:4.966,95%confidence interval[CI]:2.938–8.395)and 5001–10,000 yuan(OR:3.111,95%CI:1.840–5.260);Karnofsky Performance Status of 70(OR:2.783,95%CI:1.281–6.042)and 80(OR:1.834,95%CI:1.139–2.953);disease course<1 year;palliative treatment(OR:2.288,95%CI:1.292–4.055);progressive disease(OR:1.876,95%CI:1.284–2.739);pain(OR:1.973,95%CI:1.555–2.505);cancer type:lung(OR:3.199,95%CI:1.938–5.279),oesophagus(OR:3.288,95%CI:1.673–6.464),cervix(OR:1.542,95%CI:1.056–2.253)and partial knowledge of disease condition(OR:2.366,95%CI:1.653–3.385).Return to work(OR:0.503,95%CI:0.348–0.727)and physical exercise(OR:0.437,95%CI:0.347–0.551)were protective against depressive symptoms.(2)The levels of IL-4,IL-6,IL-1α,proinflammatory cytokinessum and IL-6/IL-10 ratio in malignant tumor group were higher than those in normal control group(P<0.01);The levels of cytokines sum in patients with malignant tumor were higher than those in normal control group(P<0.05);ACTH in patients with malignant tumor was higher than that in normal control group(P<0.05);5-HT in malignant tumor patients was lower than that in normal control group(P<0.01);The level of IL-4 and the ratio of IFN-γ/IL-10 in malignant tumor metastasis group were lower than those without metastasis(P<0.05);The level of IL-6、proinflammatory cytokines sumand the ratio of IL-6/IL-10 in malignant tumor metastasis group were higher than that of malignant tumor without metastasis(P<0.01);The level of IL-6,proinflammatory cytokines sum and the ratio of IL-6/IL-10 in malignant tumor stage I-II group were lower than III-IV group(P<0.05);The level of 5-HT in malignant tumor stage I-II group was higher than III-IV group(P<0.01);Clinical stage(I stage,II stage,III stage and IV stage)in patients with malignant tumor were positively correlated with IL-6,proinflammatory cytokines sum and the ratio of IL-6/IL-10(P<0.05),and negatively correlated with 5-HT,IFN-gamma/IL-10 ratio(P<0.05);The level of IL-6,cytokine sum and IL-6/IL-10 ratio in the treatment group were higher than those in the no treatment group(P<0.05),and the proinflammatory cytokines sum in the treatment group was higher than that in the no treatment group(P<0.01).There was no significant difference in the levels of CORT,IL-2,IL-17A and DA in the patients with malignant tumor without depression,malignant tumor with mild depression,malignant tumor with moderate to severe depression and normal control group(P>0.05);Malignant tumor of the non depression group in IL-6,IFN-gamma,IL-1 alpha,IL-6/IL-10 ratio,proinflammatory cytokines sum were higher than the normal control group(P<0.05);The 5-HT in the non depression group was lower than that in the normal control group(P<0.01).Malignant tumor complicated with mild depression group in IL-4,IL-6,TNF-alpha and IL-1 alpha,ACTH,IL-6/IL-10 ratio,proinflammatory cytokines sum and cytokines sum were higher than the normal control group(P<0.05);5-HT in the malignant tumor group was lower than that in the normal control group(P<0.01).Malignant tumor complicated with severe depression group in IL-4,IL-6,IL-10,IL-1alpha,IL-6/IL-10 ratio,proinflammatory cytokines sum and cytokines sum,were higher than the normal control group(P<0.05);The 5-HT in the moderate and severe depression group was lower than that in the normal control group(P<0.01);The level of IL-6 and IL-6/IL-10 ratio in the patients with malignant tumor combined with moderate and severe depression were higher than that in non and mild depression group.IL-6,proinflammatory cytokines sum and cytokines sum,were positively correlated with the scores of SDS(P<0.05)(r=0.23,0.22,0.16);the ratio of IL-6/IL-10 was positively correlated with SDS score(r=0.18,P=0.015).There was significant difference in the mortality rate between moderate to severe depression group and mild depression in cancer patients(P<0.01);There was significant difference the incidence of disease progression between moderate to severe depression group and mild depression in cancer patients(P<0.01);There was a significant difference in the PFS curve between the IL-6low expression group and IL-6 high expression group in the patients with malignant tumor and depression(χ~2=11.745,P<0.001);There was a significant difference in the PFS curves between the low expression group of proinflammatory cytokines sum and the high expression group in patients with malignant tumor and depression(χ~2=4.858,P=0.028);There was a significant difference in the PFS ratio between the low expression ratio of the IL-6/IL-10 ratio and the high expression ratio group in cancer patients with depression(χ~2=14.272,P<0.001).(3)64 TCM symptoms,tongue manifestation and pulse taking data,which were collected from cancer patients with depression,were systematically clustered.Combined with professional and clinical knowledge,4 TCM Syndromes were Identified:spleen stomach qi deficiency and yin deficiency syndrome,stagnation of liver qi and yin deficiency of liver and kidney syndrome,liver depression and spleen deficiency and heart blood deficiency syndrome,syndrome of deficiency of spleen qi and stagnation of blood stasis.Shortness of breath,low voice,thready pulse,weak pulse,gastricupset,belching,red tongue were the diagnosis of malignant tumor complicated with depression spleen and stomach qi deficiency and yin deficiency symptoms,with the contribution of 17.50%,15.08%,14.76%,13.91%;Tidal fever sweating,palpitation soreness and weakness of waist and knees,dry mouth string pulse were the diagnosis of malignant tumor complicated with depression stagnation of liver qi and yin deficiency of liver and kidney syndrome,with the contribution of 23.44%,22.20%,15.05%.Dizzing dry eye heavy body,difficulty in initiating,easy to wake up,dreaminess,want to cry,irritability sighing,plump tongue and teeth-printed tongue,greasy fur were the diagnosis of malignant tumor complicated with depression liver depression and spleen deficiency andheart blood deficiency syndrome,with the contribution of 14.68%,13.19%,12.72%,8.61%,7.50%;Nausea and vomiting,retching hiccup,sallow complexion emaciation,tongue petechia or ecchymosis,little/rootless fur were the diagnosis of malignant tumor complicated with depression syndrome of deficiency of spleen qi and stagnation of blood stasis,withthe contribution of 20.28%,15.36%,14.65%,13.02%.Conclusion:(1)Several factors affected depressive symptoms in malignant tumour patients,including income,cancer type and course,palliative treatment,return to work and physical exercise.(2)Neuro-endocrine-immune network of malignant tumor patients is disorder,mainly for the immune system to increase inflammatory cytokines,especially IL-4,IL-6,IL-6/IL-10 ratio increased,ACTH increased in the endocrine system,neurotransmitters in 5-HT decreased.Neuro-endocrine-immune network of cancer patients with depression is also disordered,with proinflammatory cytokines increased,especially in patients with malignant tumor in patients with severe depression by the level of IL-6 and the ratio of IL-6/IL-10 and proinflammatory cytokines sum increased significantly.The level of IL-6,proinflammatory cytokines sum and IL-6/IL-10 ratio may be used as a biological marker for judging the severity of depression in patients with malignant tumors.The mortality rate of cancer patients with moderate to severe depression was higher than that of malignant tumor patients with mild depression.Cancer patients with moderate to severe depression had higher rates of disease progression than those with mild depression.The rise of IL-6,proinflammatory cytokines sum and the high IL-6/IL-10 ratio in the questionnaire had a significantly effect on progression-free survival of cancer patients with depression.Therefore,we can conclude that the concentration of IL-6 and proinflammatory cytokines and the ratio of IL-6/IL-10 may be related to the severity and prognosis of patients with malignant tumor,we need further research in this field.(3)Starting from the TCM symptoms,according to the thinking of TCM treatment based on syndrome differentiation and clinical symptoms to diagnosis model of TCM syndrome type 4 tumor complicated with depression:spleen stomach qi deficiency and yin deficiency syndrome,stagnation of liver qi and yin deficiency of liver and kidney syndrome,liver depression and spleen deficiency andheart blood deficiency syndrome,syndrome of deficiency of spleen qi and stagnation of blood stasis.Liver qi stagnation was the main pathogenesis of malignant tumor complicated with depression syndrome,and was also a basic symptom throughout the course of the disease.In this study,we found that yin deficiency was more common with depression in cancer patients,which further supports the view that Xinjiang was prone to yin deficiency due to its regional characteristics of dry and cold.(4)In this study,doctors and nurses have a clearer understanding of the malignant tumor with depression.We suggest that health care workers can give more attention to the psychological aspects of cancer patients,so as to improve the quality of life of patients and treatment effectiveness.Chinese medicine liver qi stagnation and depression may be different system of medicine of traditional Chinese medicine and Western medicine of different views of the same disease,We propose to exert fully advantages of traditional Chinese medicine in the clinic,not only strengthening body resistance to eliminate pathogenic factors,while softening liver,dispersing stagnated liver qi and nourishing yin in the clinical treatment of malignant tumors. |
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