抑郁症患者糖代谢、铁代谢的相关性研究

发布时间：2019-06-18 17:16

【摘要】：研究背景抑郁症是一种严重的精神疾病,引起明显的情感障碍,并导致沉重的社会经济负担。国外流行病学研究提示,除抑郁症自身对患者带来不良影响,且常与其他躯体疾病或精神障碍共存。糖尿病是抑郁症常见的共存病,糖尿病患者中抑郁症发病率较正常人群高,而抑郁症也将加重糖尿病自身的并发症。同时,也有研究报道抗抑郁药物治疗也会增加糖尿病的发病率。不同研究团队对抑郁症、抗抑郁药物增加抑郁症的患病的研究结论还不一致。基于这些研究结果,抑郁症与糖尿病、抗抑郁药物治疗与糖尿病的关系仍不清楚,国内外学者提出抑郁症与糖尿病之间、抗抑郁药物治疗与糖尿病之间可能存在一定潜在的生物学相关性。血清铁负荷超载可增加胰岛素抵抗,可能是糖尿病发病的重要因素。同时,研究发现铁超负荷引起过量的活性氧自由基生成,活性氧自由基氧化活性引起神经元损伤,从而导致中枢神经系统变性性疾病,而抑郁症研究也证实海马神经元凋亡增加。参与血清铁的储存和转运的铁蛋白和中性粒细胞明胶酶相关脂质运载蛋白在抑郁症研究中也出现表达异常。因而,抑郁症中铁蛋白和中性粒细胞明胶酶相关脂质运载蛋白可能通过铁负荷超载,增加神经元损伤,从而参与抑郁症发病。目的通过检测初治抑郁症、抗抑郁药物治疗患者血清空腹血糖、空腹胰岛素、铁蛋白及中性粒细胞明胶酶相关脂质运载蛋白水平,比较胰岛β细胞功能,胰岛素敏感指数及胰岛素抵抗指数的变化,探讨抑郁症患者或者抗抑郁药物治疗是否可能导致糖代谢异常,增加糖尿病发病率。通过检测铁蛋白和中性粒细胞明胶酶相关脂质运载蛋白的变化,探讨铁负荷超载可能是抑郁症发病的重要因素。方法本实验被分为两部分,第一部分：抑郁症患者糖代谢的初步研究；第二部分：抑郁症患者铁代谢的初步研究。方法和技术路线1.检测初治抑郁症患者、抗抑郁药物患者及与正常对照血清空腹血糖和空腹胰岛素水平；2.通过血清空腹血糖、空腹胰岛素水平计算胰岛β细胞功能及胰岛素抵抗的相关指标,包括胰岛素敏感指数及胰岛素抵抗指数；3.检测初治抑郁症患者与正常对照、初治抑郁症患者与抗抑郁药物患者之间血清中铁蛋白和中性粒细胞明胶酶相关脂质运载蛋白浓度变化情况。结果1.初治抑郁症组患者较正常对照组血清空腹血糖和空腹胰岛素水平明显升高,胰岛β细胞功能和胰岛素抵抗指数明显升高,胰岛素敏感指数明显降低,但都没有统计学差异。2.抗抑郁药物治疗组患者较初治抑郁症患者血清空腹血糖明显升高,但无统计学差异；而空腹胰岛素水平显著性升高,有统计学差异；胰岛β细胞功能和胰岛素抵抗指数显著性升高,有统计学差异；胰岛素敏感指数显著性降低,有统计学差异。3.初治抑郁症组患者与正常对照组比较,血清铁蛋白水平显著性升高,有统计学差异。抗抑郁药物组与初治抑郁症血清铁蛋白水平比较,没有统计学差异。4.抑郁组(包括初治抑郁症患者和抗抑郁药物治疗组患者)与正常对照比较,血清中性粒细胞明胶酶相关脂质运载蛋白水平降低,有显著性统计学差异。结论1.抑郁症患者胰岛β细胞功能亢进,胰岛素敏感性降低,胰岛素抵抗指数升高,故抑郁症患者有罹患糖尿病的趋势,患抑郁症是糖尿病患病的危险因素。2.抑郁症患者给予抗抑郁药物治疗后,胰岛β细胞功能显著亢进,胰岛素敏感性显著性降低,胰岛素抵抗指数显著性升高,故抗抑郁药物治疗可增加糖尿病的发病率。3.抑郁症患者血清铁蛋白、中性粒细胞明胶酶相关脂质运载蛋白异常,它们参与血清铁储存与转运,可能通过调节铁代谢增加神经细胞氧化损伤参与抑郁症的发病。
[Abstract]:The study of the background of depression is a serious mental illness, which causes obvious affective disorder and leads to a heavy social economic burden. Foreign epidemiological studies suggest that, in addition to depression itself, there is no adverse effect on the patient and often co-exist with other body diseases or mental disorders. Diabetes is a common disease of depression, and the incidence of depression in patients with diabetes is higher than that of normal people, and depression will also aggravate the complications of diabetes. At the same time, it is also reported that the treatment of antidepressants also increases the incidence of diabetes. The findings of the different study groups on depression, antidepressants, and the prevalence of depression were not consistent. Based on these findings, the relationship between depression and diabetes, antidepressants and diabetes is not clear, and there may be some potential biological correlation between depression and diabetes, and there may be some potential biological correlation between depression and diabetes. The overload of serum iron can increase the insulin resistance and may be an important factor in the pathogenesis of diabetes. At the same time, the study found that iron overload caused excessive reactive oxygen free radical generation, reactive oxygen free radical oxidation activity caused neuronal damage, thus leading to the degeneration of the central nervous system, and the study of depression also confirmed the increase of the neuronal apoptosis in the hippocampus. Ferritin and neutrophil gelatinase-related lipid-carrying proteins involved in the storage and transport of serum iron also showed an abnormal expression in the study of depression. Therefore, the related lipid-carrying proteins of the ferritin and the neutrophil gelatinase in the depression can be overloaded by the iron load, and the damage of the neurons can be increased, thereby participating in the pathogenesis of the depression. Objective To compare the changes of serum fasting blood glucose, fasting insulin, ferritin and neutrophil gelatinase-related lipid-carrying protein level in patients with primary depression and antidepressants, and to compare the changes of islet cell function, insulin sensitivity index and insulin resistance index. To explore whether the treatment of patients with depression or antidepressants may lead to abnormal glucose metabolism and increase the incidence of diabetes. By detecting the changes of the related lipid-carrying proteins of the ferritin and the neutrophil gelatinase, it is suggested that the overload of iron-load may be an important factor in the pathogenesis of depression. Methods The experiment was divided into two parts: the first part: the primary study of the sugar metabolism in the patients with depression, and the second part: the primary study of iron metabolism in the patients with depression. Method and technical route 1. Patients with primary depression, patients with antidepressants, and fasting blood glucose and fasting insulin levels in normal control serum;2. The insulin resistance index and the insulin resistance index were calculated by fasting blood glucose, fasting insulin level, insulin resistance index and insulin resistance index. The changes of serum ferritin and neutrophil gelatinase-related lipid-carrying protein concentration in the serum of patients with primary depression and anti-depression drugs were detected in the patients with primary depression and normal control. Results 1. In the first treatment group, the fasting blood glucose and the fasting insulin level in the normal control group were significantly increased, the function of the islet cell and the insulin resistance index were significantly increased, and the insulin sensitivity index was significantly decreased, but there was no statistical difference. There was no significant difference in fasting blood glucose in patients with depression in the treatment group of antidepressants, but there was no significant difference in fasting insulin level, and there was a significant difference in the function of islet cell and insulin resistance index. There was a significant decrease in the sensitivity index of insulin, and there was a statistical difference. Compared with the normal control group, the level of serum ferritin increased significantly, and there was a statistical difference. There was no statistical difference in the levels of serum ferritin in antidepressants and primary depression. There was a significant difference in serum neutrophil gelatinase-related lipid-carrying protein levels compared to normal controls in the depression group (including patients with primary and antidepressants) compared to the normal controls. Conclusion 1. The function of islet cell hyperfunction, insulin sensitivity and insulin resistance index in the patients with depression are higher, so the patients with depression have the tendency of developing diabetes, and the risk factors of depression are the risk factors of diabetes. Antidepressant medication could increase the incidence of diabetes after the treatment of depression with antidepressants, the function of pancreatic islet cells was significantly increased, the sensitivity of insulin was significantly lower, and the insulin resistance index was significantly higher. The serum ferritin and the neutrophil gelatinase-related lipid-carrying protein in the patients with depression are abnormal. They are involved in the storage and transfer of serum iron. It is possible to participate in the pathogenesis of depression by regulating iron metabolism and increasing the oxidative damage of the nerve cells.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749.4

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