Changes Of HPA Axis Function In Overweight/obese Patients With Depression And Its Relationship With Traditional Chinese Medicine Syndromes

Objective: 1.This study mainly studied the functional changes of the hypothalamic-pituitary-adrenal axis in overweight and obese patients with depression,and compared the relationship between different obesity types and various clinical reference indicators;2.Analyzed the distribution of TCM syndrome types in overweight and obese patients,studied the relationship between clinical reference indicators and TCM syndrome types,and provided references for the clinical treatment of obesity;Methods: a total of 92 overweight and obese patients who visited the department of endocrinology,affiliated hospital of Chengdu University of Traditional Chinese Medicine from January 2019 to January 2020 were selected as the study subjects.In addition,23 normal BMI patients without history of endocrine and metabolic diseases and mental disorders who underwent health examination at the physical examination center during the same period were collected as the control group.According to the self-rating depression scale,depression status of all subjects was evaluated,general medical history data were collected,laboratory related indicators were improved,and TCM diagnosis information was collected.BMI and waist circumference were used as the grouping basis to study the changes of relevant indicators.In addition,the distribution of TCM syndrome types in overweight and obese patients and their relationship with various clinical indicators were studied.Results: 1.There were no statistically significant differences in age,gender,ethnicity,marital status,smoking history,drinking history and history of hypertension among the groups(P >0.05),but there were statistically significant differences in the nature of work(P < 0.05).2.When grouped according to BMI and waist circumference,the levels of ACTH and COR were statistically different between groups(P < 0.05).Correlation analysis showed that COR was positively correlated with BMI?waist circumference? WHt R?SDS standard score?TG?LDL-C and UA levels(p < 0.05),and negatively correlated with HDL-C levels(p < 0.05).ACTH level was positively correlated with BMI?waist circumference? WHt R? SDS standard score?HOMA-IR and CRP levels(p < 0.05).3.When grouping according to BMI,there were statistically significant differences in UA,TG,LDL-C,HDL-C,HOMA-IR,HOMA-B and SDS standard score(p < 0.05),while there were no statistically significant differences in FPG,CRP and TC levels(p > 0.05).According to waist circumference,there were statistically significant differences in CRP?UA? TG?LDL-C?TC?HDL-C?HOMA-IR?HOMA-B? SDS standard score and systolic blood pressure between groups(p < 0.05),while there were no statistically significant differences in FPG(p > 0.05).4.Compared with BMI,CRP? TG?LDL-C?TC?HOMA-IR? SDS standard score and SBP indicators were more significantly different in the groups based on waist circumference.To further compare the correlation between BMI ? waist circumference and each indicator,The correlation between waist circumference and COR? ACTH?SDS standard score?TG? TC?LDL-C? HOMA-IR and CRP was more significant than that of BMI.5.The sensitivity and specificity analyses showed that COR was predictive of depression in overweight/obese patients(AUC=0.729,P < 0.05).6.The syndrome type with the highest proportion of overweight/obese patients with depression was liver stagnation and qi stagnation,while the syndrome type with the highest proportion of overweight/obese patients without depression was spleen deficiency and dampness resistance.There was no significant difference in the level of ACTH among all TCM syndromes(P >0.05).COR levels were statistically different between liver stagnation and qi stagnation and stomach heat and humidity resistance(P < 0.05),and COR level of liver stagnation and qi stagnation was higher.Conclusion:1.In overweight/obese patients with depression,the levels of ACTH and COR increased,and the levels of COR and ACTH increased with the increase of BMI,waist circumference and merge depression,suggesting that the active function of the HPA axis is one of the co-pathogenesis of obesity and depression.2.Sensitivity and specificity analysis suggested that COR could predict the occurrence of depression in overweight/obese patients.3.Obesity is more likely to produce abnormal metabolites such as blood lipid,uric acid and insulin resistance.Compared with systemic obesity,abdominal obesity has a stronger correlation with depression and a more significant effect on insulin resistance,dyslipidemia and inflammatory response.4.In the overweight/obesity group with depression,the syndrome of liver stagnation and qi stagnation was the main dialectical syndrome.Compared with other syndromes,COR level of liver stagnation and qi stagnation is higher,and COR level has certain correlation with TCM syndromes of obesity,which can be used as a reference index for clinical diagnosis and efficacy judgment.