|国家预印本平台
首页|青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D3和血脂水平的相关性研究

青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D3和血脂水平的相关性研究

orrelation of Non-suicidal Self-injury with 25-Hydroxyvitamin D3 and Blood Lipid Levels in Adolescents with Major Depressive Disorder

中文摘要英文摘要

背景 抑郁障碍(MDD)在青少年人群中的发病率逐年增高,非自杀性自伤(NSSI)行为也是其常见的临床表现。有研究结果显示维生素D和血脂水平与抑郁障碍有关,但是其是否与 NSSI 有关尚不清楚。目的 比较伴不伴有 NSSI 行为青少年 MDD 患者的 25 羟维生素 D3[25(OH)D3]和血脂水平,并探索其对 NSSI 的诊断价值。方法 选取自 2020 年 10 月—2022 年 3 月在安徽医科大学附属巢湖医院精神科和合肥市第四人民医院就诊的青少年 MDD 患者 129 例,参考《精神障碍诊断与统计手册》第 5 版(DSM-5)中 NSSI 的诊断标准将其分为 NSSI 组(77例)和非 NSSI 组(52 例)。采用青少年自杀意念量表(PANSI)、失眠严重指数(ISI)、流调抑郁量表(CES-D)评估患者的临床症状。采集空腹静脉血,检测样本中 25(OH)D3 和血脂水平,并进行两两比较。进一步采用多因素Logistic 回归分析探究青少年 MDD 患者发生 NSSI 行为的影响因素,并绘制受试者工作特征(ROC)曲线评估 25(OH)D3 和血脂水平对 NSSI 行为的诊断价值。结果 NSSI 组的年龄低于非 NSSI 组,而 PANSI 总分、ISI 总分、CES-D 总分高于非 NSSI 组(P<0.05)。NSSI 组 25(OH)D3 水平低于非 NSSI 组,而 TC、HDL-C 和 LDL-C 水平高于非 NSSI组(P<0.05)。多因素 Logistic 回归分析显示,LDL-C(OR=5.695,95%CI=2.422~13.388,P<0.001)和 25(OH)D3(OR=0.871,95%CI=0.768~0.987,P<0.05)是青少年 MDD 患者伴有 NSSI 行为的影响因素。LDL-C 和 25(OH)D3 评估青少年 MDD 患者 NSSI 行为发生风险的 AUC 分别为 0.73(95%CI=0.65~0.82,P<0.001)、0.62(95%CI=0.52~0.72,P=0.023), 最 佳 截 断 值 分 别 为 1.89 mmol/L、19.15 μg/L;LDL-C 联 合 25(OH)D3 水 平[ln(p/1-p)=1.364X1-0.143X2-0.161,其中 X1、X2 分别为 LDL-C、25(OH)D3]预测青少年 MDD 患者 NSSI 行为的 ROC 曲线下面积(AUC)为 0.77(95%CI=0.69~0.85,P<0.001),灵敏度为 77.92%、特异度为 67.31%。结论 伴有 NSSI 行为的青少年 MDD患者存在一定水平的 25(OH)D3 和血脂水平紊乱,且 LDL-C 联合 25(OH)D3 水平对评估青少年 MDD 患者 NSSI 行为的发生有一定的参考价值,临床应定期检测其动态变化并对症处理。

BackgroundThe incidence of major depressive disorderMDDin adolescents is annually elevated. Non-suicidal self-injuryNSSIis a common clinical manifestation of MDD. Evidence suggested that vitamin D and lipid levels are associated with MDDbut whether they are related to NSSI is unclear. ObjectiveTo compare the levels of 25OHD3 and blood lipids in MDD adolescents with or without NSSI behavior and to explore their diagnostic value for NSSI. MethodsA total of 129 MDD adolescents who received treatment in the Department of PsychiatryChaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei from October 2020 to March 2022 were recruited. They were assigned into NSSI group n=77and non-NSSI groupn=52based on the diagnostic criteria of NSSI in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM-5. The Positive and Negative Suicide Ideation InventoryPANSIInsomnia Severity IndexISIand Center for Epidemiological Survey Depression ScaleCES-Dwere used to evaluate the clinical symptoms. Fasting venous blood samples were collected to measure the levels of 25OHD3 and blood lipids and compared between groups. In additionmultivariate logistic regression analysis was performed to identify influencing factors for NSSI behavior in MDD adolescents. The diagnostic value of 25OHD3 and lipid levels in NSSI behaviors was assessed by plotting the receiver operating characteristicROC curves. ResultsThe age of the NSSI group was significantly lower than that of the non-NSSI groupwhereas the total scores of PANSIISIand CES-D were significantly higher than those of the non-NSSI groupP<0.05. The level of 25OHD3 in the NSSI group was significantly lower than that in the non-NSSI groupwhereas the levels of total cholesterolTChigh-density lipoprotein cholesterolHDL-Cand low-density lipoprotein cholesterolLDL-C were significantly higher than those in the non-NSSI groupP<0.05. Multivariate Logistic regression analysis showed that both LDL-COR=5.69595%CI=2.422-13.388P<0.001and 25OHD3OR=0.87195%CI=0.768-0.987P<0.05 were the influencing factors of MDD adolescents with NSSI. The area under curveAUCof LDL-C and 25OHD3 levels in assessing the risk of developing NSSI behavior in MDD adolescents was 0.7395%CI=0.65-0.82P<0.001and 0.62 95%CI=0.52-0.72P=0.023respectively. Their optimal cut-off value was 1.89 mmol/L and 19.15 g/Lrespectively. The AUC of 25OHD3 combined with LDL-C levels lnp/1-p=1.364X1-0.143X2-0.161where X1 and X2 was LDL-C and 25OHD3respectively in diagnosing NSSI behavior in MDD adolescents was 0.7795%CI=0.69-0.85 P<0.001with 77.92% of sensitivity and 67.31% of specificity. Conclusion25OHD3 and lipid levels are out of normal ranges in MDD adolescents with NSSI. Measurement of LDL-C combined with 25OHD3 levels may provide information to predict the occurrence of NSSI behaviors in MDD adolescents. A regular measurement of LDL-C and 25OHD3 and a dynamic monitor is valuable to provide symptomatic supports.

郝明茹、赵鑫、申晴晴、莫大明、耿峰、刘寰忠、凡豪杰、刘乐伟、夏磊、田英汉、杨铖

10.12114/j.issn.1007-9572.2024.0127

神经病学、精神病学基础医学临床医学

抑郁抑郁障碍青少年非自杀性自伤25 羟维生素 D3血脂异常

郝明茹,赵鑫,申晴晴,莫大明,耿峰,刘寰忠,凡豪杰,刘乐伟,夏磊,田英汉,杨铖.青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D3和血脂水平的相关性研究[EB/OL].(2024-07-17)[2025-08-18].https://chinaxiv.org/abs/202407.00166.点此复制

评论