目的 分析难治性抑郁症(TRD)患者血清神经生长因子(NGF)水平与电休克治疗(ECT)效果的相关性。方法 选择2020-02至2021-12解放军联勤部队第987医院收治的60例TRD患者(TRD组),另选取同期60例健康志愿者作为对照组。所有TRD患者均接受8次氯胺酮单独麻醉ECT治疗。采用酶联免疫吸附试验(ELISA)法检测血清NGF水平。应用汉密尔顿抑郁量表(HAMD-17)、简明精神病评定量表(BPRS)评估疾病严重程度。结果 TRD组患者基线血清NGF水平显著低于对照组(P＜0.001)。经受试者工作特征(ROC)曲线分析,基线血清NGF水平诊断TRD的曲线下面积(AUC)为0.953。抗抑郁缓解率为76.7%(46/60)。ECT治疗后,血清NGF水平升高(P＜0.001);缓解组TRD患者的血清NGF水平始终高于未缓解组(P＜0.001);缓解组TRD患者血清NGF水平上升趋势较未缓解组明显(P=0.001)。血清NGF水平变化分别与HAMD-17评分变化、BPRS评分变化呈负相关性(P＜0.05)。基线血清NGF水平预测TRD患者ECT治疗未缓解的AUC为0.750。经多因素Logistics回归分析,基线血清NGF水平＞7.97 pg/ml仍是影响TRD患者ECT治疗结局的独立危险因素(P=0.015)。结论 在ECT治疗过程中,TRD患者血清NGF水平随疾病好转而逐渐升高,且基线血清NGF水平可作为预测TRD患者ECT治疗缓解情况的生物标志物。
Abstract
Objective To analyze the correlation between serum nerve growth factor (NGF) level and the effect of electroconvulsive therapy (ECT) in patients with treatment-resistant depression (TRD). Methods Sixty patients with TRD (TRD group) in the 987th Hospital of PLA Joint Logistics Support Force from February 2020 to December 2021 were enrolled, and 60 healthy volunteers in the same period were selected as control group. All patients with TRD received ECT treatment with ketamine alone for 8 times. Serum NGF level was detected by enzyme-linked immunosorbent assay (ELISA). Hamilton Depression Rating Scale (HAMD-17) and Brief Psychiatric Rating Scale (BPRS) were used to evaluate the severity of illness. Results The baseline serum NGF level in TRD group was significantly lower than that in the control group (P＜0.001). According to the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of baseline serum NGF level in diagnosing TRD was 0.953. The remission rate of antidepressant was 76.7% (46/60). With ECT treatment, serum NGF level increased (P＜0.001). The serum NGF level of TRD patients in the remission group was always higher than that in the non-remission group (P＜0.001). The increase trend of serum NGF level in TRD patients in the remission group was significantly higher than that in non-remission group (P=0.001). The changes of serum NGF level were negatively correlated with the changes of HAMD-17 score and BPRS score P＜0.05). The AUC of baseline serum NGF level in predicting non-remission of ECT treatment in TRD patients was 0.750. Baseline serum NGF level＞7.97 pg/ml was still an independent risk factor affecting the remission outcome of ECT in TRD patients (P=0.015). Conclusions During ECT treatment, the serum NGF level of TRD patients gradually increases with the improvement of the disease, and the baseline serum NGF level can be used as a biomarker to predict the remission of TRD patients after ECT treatment.
关键词
难治性抑郁症 /
神经生长因子 /
电休克治疗 /
神经可塑性
Key words
treatment-resistant depression /
nerve growth factor /
electroconvulsive therapy /
neural plasticity
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