职业性噪声性聋并抑郁症状患者的皮质醇及免疫水平研究
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摘要
目的探讨职业性噪声性聋患者体内皮质醇水平及相关炎症细胞因子的变化与听力损伤后抑郁情绪发生的相关性。方法以2016年3月至2017年10月入住广东省职业病防治院的职业性噪声性聋患者为研究对象,根据抑郁自评量表得分分为合并抑郁症状组57例和未合并抑郁症状组(单纯噪声性聋组)49例,分别检测2组外周血皮质醇(COR)水平及相关免疫因子,如:淋巴细胞亚群(B淋巴细胞、NK细胞及T淋巴细胞亚群)、炎症细胞因子如肿瘤坏死因子-a(TNF-a)、白细胞介素-6(IL-6)及C反应蛋白(CRP)的变化。结果 (1)职业性噪声性聋合并抑郁症状组外周血清COR水平明显高于单纯噪声性聋组(P<0.05);(2)职业性噪声聋合并抑郁症状组患者NK细胞百分比较单纯噪声聋组高,而B细胞、CD8~+T细胞所占淋巴细胞的百分比较单纯噪声性聋组低(P<0.05),但两组间CD3~+、CD4~+及CD4~+/CD8~+T细胞的水平差异无统计学意义(P>0.05);(3)噪声性聋合并抑郁症状组患者IL-6、TNF-a水平高于单纯噪声性聋组(P<0.05),但两组患者的CRP水平差异无统计学意义(P>0.05);(4)Logistic回归分析结果显示,COR、TNF-a水平越高,CD3~+CD8~+T细胞水平越低,发生抑郁的可能性越大(P<0.05)。结论职业性噪声性聋伴抑郁症状的患者COR水平及炎症因子IL-6、TNF-a水平升高,且与抑郁的发生密切相关,表明噪声暴露后下丘脑-垂体-肾上腺轴(HPA轴)功能失调、免疫激活及炎症细胞因子的释放增多可能是导致其并发抑郁的机制之一。
Objective To investigate the changes of HPA axis functions and inflammatory immune disorders in occupational noise-induced hearing loss(ONIHL)patients with depressive symptoms.Methods Patients with ONIHLwere recruited from the Guangdong Prevention and Treatment Center for Occupational Disease from September 2016 to September 2017.According to the self-rating depression scales(SDS),we classified 57 NIHL patients in the depression group and 49 in the non-depression group.We analyzed their peripheral blood COR,lymphocytic subsets,TNF-a,IL-6 and CRP.Results(1)The level of COR in ONIHL patients with depressive symptoms were higher than those without depressive symptoms(P<0.05).(2)ONIHL patients with depressive symptoms had a higher NK cell(%),lower B cell(%)and CD8~+T cell(%)than those without depressive symptoms(P<0.05).(3)There were significant differences between the two groups in terms of IL-6,TNF-a(P<0.05),but no significant differences in CRP.(4)Logistic regression analysis showed that the higher index's differences of COR,TNF-a and the lower CD8~+Tcell were,the higher risk of depressive symptoms(P<0.05).Conclusion ONIHL patients with depressive symptomshad hyperactivity of HPA axis and inflammationactivation.COR,TNF-awere positively correlated withdepressive states.After noise exposure,HPA axis dysfunction,immune activation and increased release of inflammatory cytokines may be one of the mechanisms of depressive symptoms in ONIHLpatients.
Objective To investigate the changes of HPA axis functions and inflammatory immune disorders in occupational noise-induced hearing loss(ONIHL)patients with depressive symptoms.Methods Patients with ONIHLwere recruited from the Guangdong Prevention and Treatment Center for Occupational Disease from September 2016 to September 2017.According to the self-rating depression scales(SDS),we classified 57 NIHL patients in the depression group and 49 in the non-depression group.We analyzed their peripheral blood COR,lymphocytic subsets,TNF-a,IL-6 and CRP.Results(1)The level of COR in ONIHL patients with depressive symptoms were higher than those without depressive symptoms(P<0.05).(2)ONIHL patients with depressive symptoms had a higher NK cell(%),lower B cell(%)and CD8~+T cell(%)than those without depressive symptoms(P<0.05).(3)There were significant differences between the two groups in terms of IL-6,TNF-a(P<0.05),but no significant differences in CRP.(4)Logistic regression analysis showed that the higher index's differences of COR,TNF-a and the lower CD8~+Tcell were,the higher risk of depressive symptoms(P<0.05).Conclusion ONIHL patients with depressive symptomshad hyperactivity of HPA axis and inflammationactivation.COR,TNF-awere positively correlated withdepressive states.After noise exposure,HPA axis dysfunction,immune activation and increased release of inflammatory cytokines may be one of the mechanisms of depressive symptoms in ONIHLpatients.
引文
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2 Fouladi DB,Nassiri P,Monazzam EM,et al.Industrial noise exposure and salivary cortisol in blue collar industrial workers[J].Noise Health,2012,14:184.
3 Hodes GE,Kana V,Menard C,et al.Neuroimmune mechanisms of depression[J].Nat Neurosci,2015,18:1386.
4中华人民共和国国家卫生和计划生育委员会.职业性噪声聋的诊断[S].北京:人民卫生出版社,2014.1.
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6王征宇,迟玉芬.抑郁自评量表(SDS)[J].上海精神医学,1984(02):71.
7 Lee HC,Chiu HF,Wing YK,et al.The zung self-rating depression scale:screening for depression among the Hong Kong Chinese elderly[J].J Geriatr Psychiatry Neurol,1994,7:216.
8 Shen LL,Lao LM,Jiang SF,et al.A survey of anxiety and depression symptoms among primary-care physicians in China[J].Int J Psychiatry Med,2012,44:257.
9 Sjodin F,Kjellberg A,Knutsson A,et al.Noise and stress effects on preschool personnel[J].Noise Health,2012,14:166.
10 Stokholm ZA,Hansen AM,Grynderup MB,et al.Recent and long-term occupational noise exposure and salivary cortisol level[J].Psychoneuroendocrinology,2014,39:21.
11 Green A,Jones AD,Sun K,et al.The association between noise,cortisol and heart rate in a small-scale gold mining community-apilot study[J].Int J Environ Res Public Health,2015,12:9952.
12 Holsboer F.Prospects for antidepressant drug discovery[J].Biol Psychol,2001,57:47.
13 Gupta D,Radhakrishnan M,Kurhe Y.Effect of a novel 5-HT3receptor antagonist 4i,in corticosterone-induced depression-like behavior and oxidative stress in mice[J].Steroids,2015,96:95.
14王长虹,李晏,谢春朋,等.抑郁症的神经内分泌研究进展[J].新乡医学院学报,2011,28:776.
15 Herbert J.Cortisol and depression:three questions for psychiatry[J].Psychol Med,2013,43:449.
16胡军祥,黄佩龙,姜玉新,等.噪声应激对大鼠免疫功能的影响[J].浙江大学学报(理学版),2009,36:211.
17 Pascuan CG,Uran SL,Gonzalez-Murano MR,et al.Immune alterations induced by chronic noise exposure:comparison with restraint stress in BALB/c and C57Bl/6mice[J].JImmunotoxicol,2014,11:78.
18 Kobayashi T,Yamauchi M.A case of serial nightmares and oneiroid state under paroxetine for senile depression[J].Psychogeriatrics,2012,12:54.
19 Fujise N,Ikeda M.The relationship between depression and dementia in elderly[J].Seishin Shinkeigaku Zasshi,2012,114:276.
20林文娟,王东林,潘玉芹.抑郁症的心理神经免疫学研究:细胞因子的作用[J].心理科学进展,2008,16:404.
21 Haapakoski R,Mathieu J,Ebmeier KP,et al.Cumulative meta-analysis of interleukins 6and 1beta,tumour necrosis factor alpha and C-reactive protein in patients with major depressive disorder[J].Brain Behav Immun,2015,49:206.
22 Hestad KA,Engedal K,Whist JE,et al.Patients with depression display cytokine levels in serum and cerebrospinal fluid similar to patients with diffuse neurological symptoms without a defined diagnosis[J].Neuropsychiatr Dis Treat,2016,12:817.
23 Janssen DG,Caniato RN,Verster JC,et al.A psychoneuroimmunological review on cytokines involved in antidepressant treatment response[J].Hum Psychopharmacol,2010,25:201.
24 Wichers MC,Kenis G,Koek GH,et al.Interferon-alphainduced depressive symptoms are related to changes in the cytokine network but not to cortisol[J].J Psychosom Res,2007,62:207.
2 Fouladi DB,Nassiri P,Monazzam EM,et al.Industrial noise exposure and salivary cortisol in blue collar industrial workers[J].Noise Health,2012,14:184.
3 Hodes GE,Kana V,Menard C,et al.Neuroimmune mechanisms of depression[J].Nat Neurosci,2015,18:1386.
4中华人民共和国国家卫生和计划生育委员会.职业性噪声聋的诊断[S].北京:人民卫生出版社,2014.1.
5全国声学标准化技术委员会.声学测听方法:纯音气导和骨导听阈基本测听法[S].北京:中国标准出版社,1996.5.
6王征宇,迟玉芬.抑郁自评量表(SDS)[J].上海精神医学,1984(02):71.
7 Lee HC,Chiu HF,Wing YK,et al.The zung self-rating depression scale:screening for depression among the Hong Kong Chinese elderly[J].J Geriatr Psychiatry Neurol,1994,7:216.
8 Shen LL,Lao LM,Jiang SF,et al.A survey of anxiety and depression symptoms among primary-care physicians in China[J].Int J Psychiatry Med,2012,44:257.
9 Sjodin F,Kjellberg A,Knutsson A,et al.Noise and stress effects on preschool personnel[J].Noise Health,2012,14:166.
10 Stokholm ZA,Hansen AM,Grynderup MB,et al.Recent and long-term occupational noise exposure and salivary cortisol level[J].Psychoneuroendocrinology,2014,39:21.
11 Green A,Jones AD,Sun K,et al.The association between noise,cortisol and heart rate in a small-scale gold mining community-apilot study[J].Int J Environ Res Public Health,2015,12:9952.
12 Holsboer F.Prospects for antidepressant drug discovery[J].Biol Psychol,2001,57:47.
13 Gupta D,Radhakrishnan M,Kurhe Y.Effect of a novel 5-HT3receptor antagonist 4i,in corticosterone-induced depression-like behavior and oxidative stress in mice[J].Steroids,2015,96:95.
14王长虹,李晏,谢春朋,等.抑郁症的神经内分泌研究进展[J].新乡医学院学报,2011,28:776.
15 Herbert J.Cortisol and depression:three questions for psychiatry[J].Psychol Med,2013,43:449.
16胡军祥,黄佩龙,姜玉新,等.噪声应激对大鼠免疫功能的影响[J].浙江大学学报(理学版),2009,36:211.
17 Pascuan CG,Uran SL,Gonzalez-Murano MR,et al.Immune alterations induced by chronic noise exposure:comparison with restraint stress in BALB/c and C57Bl/6mice[J].JImmunotoxicol,2014,11:78.
18 Kobayashi T,Yamauchi M.A case of serial nightmares and oneiroid state under paroxetine for senile depression[J].Psychogeriatrics,2012,12:54.
19 Fujise N,Ikeda M.The relationship between depression and dementia in elderly[J].Seishin Shinkeigaku Zasshi,2012,114:276.
20林文娟,王东林,潘玉芹.抑郁症的心理神经免疫学研究:细胞因子的作用[J].心理科学进展,2008,16:404.
21 Haapakoski R,Mathieu J,Ebmeier KP,et al.Cumulative meta-analysis of interleukins 6and 1beta,tumour necrosis factor alpha and C-reactive protein in patients with major depressive disorder[J].Brain Behav Immun,2015,49:206.
22 Hestad KA,Engedal K,Whist JE,et al.Patients with depression display cytokine levels in serum and cerebrospinal fluid similar to patients with diffuse neurological symptoms without a defined diagnosis[J].Neuropsychiatr Dis Treat,2016,12:817.
23 Janssen DG,Caniato RN,Verster JC,et al.A psychoneuroimmunological review on cytokines involved in antidepressant treatment response[J].Hum Psychopharmacol,2010,25:201.
24 Wichers MC,Kenis G,Koek GH,et al.Interferon-alphainduced depressive symptoms are related to changes in the cytokine network but not to cortisol[J].J Psychosom Res,2007,62:207.