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Received:October 21, 2021 Published Online:July 20, 2022
Received:October 21, 2021 Published Online:July 20, 2022
中文摘要: 目的 探讨5羟色胺（5-HT）、褪黑素（MT）、白介素（IL）-1β、巨噬细胞移动抑制因子（MIF）与肝豆状核变性（Wilsons disease, WD）抑郁障碍的相关性，及肝豆汤（GDD）干预治疗对其的影响。
方法 采用回顾性研究方法，选取安徽省中医院脑病科2017年1月至2020年12月收治的92例湿热内蕴型WD伴抑郁障碍患者，进行大体评定量表(GAS)及汉密尔顿抑郁量表-24（HDRS-24）评分；选取同期健康体检者40例为健康对照组。ELISA法测定研究对象血清5-HT、MT、IL-1β、MIF水平，并分析WD抑郁障碍患者四项指标水平与GAS评分及HDRS-24评分的相关性。92例患者中，予二巯基丙磺酸钠（DMPS）驱铜治疗的42例为对照组；予GDD+DMPS治疗的50例为GDD组，分析GDD治疗对患者血清5-HT、MT、IL-1β、MIF水平、GAS及HDRS-24评分的影响。
结果 与健康对照组比较，WD抑郁障碍患者血清5-HT、MT水平下降明显，IL-1β、MIF水平上升显著(P<0.01)。GAS、HDRS-24分别与5-HT、MT呈负相关，与IL-1β、MIF呈正相关(P<0.01)。联合GDD治疗后WD抑郁障碍患者5-HT、MT水平上升显著，IL-1β、MIF下降明显(P<0.01)。治疗4周后，两组HDRS-24评分均降低，GDD组GAS评分降低（P<0.01）。与对照组相比，治疗后GDD组的GAS和HDRS-24评分均更低（P<0.05，P<0.01）。
结论 5-HT、MT、IL-1β、MIF可考虑作为评估WD抑郁障碍及WD脑损害程度的生物学指标，驱铜治疗基础上联合GDD干预对改善WD抑郁障碍具有重要意义。
Abstract:Objective To explore the relationship between serotonin (5-HT), melatonin (MT), interleukin (IL)-1 β, macrophage migration inhibitory factor (MIF) and depressive disorder in Wilsons disease (WD), and the effect of Gandou Dcoction (GDD) intervention on it.
Methods A retrospective study was conducted on 92 damp-heat internal accumulation type WD patients with depressive disorder treated in the Department of Encephalopathy, Anhui Hospital of Chinese Medicine from January 2017 to December 2020, and scored by Global assessment scale (GAS) and Hamilton depression rating scale-24 (HDRS-24). Forty healthy subjects in the same period were selected as healthy control group. The serum levels of 5-HT, MT, IL-1β and MIF were measured by ELISA, and the correlations between the levels of the four indicators and GAS scores and HDRS-24 scores in WD with depressive disorder were analyzed. Among the 92 patients, 42 patients were treated with dimercaptopropanesulfonic acid (DMPS) as control group, and 50 patients treated with GDD+DMPS as GDD group. The effects of GDD on serum levels of 5-HT, MT, IL-1 β, MIF, GAS and HDRS-24 depression score were analyzed.
Results Compared with healthy control group, the levels of 5-HT and MT in WD with depressive disorder decreased significantly, while the levels of IL-1β, MIF increased remarkably(P<0.01). GAS and HDRS-24 were negatively correlated with 5-HT and MT, and positively correlated with IL-1β and MIF, respectively (P<0.01). After combined with GDD treatment, the levels of 5-HT and MT in WD with depressive disorder patients increased significantly, while IL-1β and MIF decreased significantly(P<0.01). After 4 weeks of treatment, HDRS-24 scores decreased in both groups, and GAS scores decreased in GDD group (P<0.01). Compared with the control group, the GAS and HDRS-24 scores of GDD group were lower after treatment （P<0.05，P<0.01）.
Conclusion 5-HT, MT, IL-1 β and MIF can be considered as biological indexes to evaluate the degree of depressive disorder and the degree of brain damage in WD. De-coppering therapy combined with GDD intervention is of great significance in improving depressive disorder in WD.
keywords: Gandou Decoction Wilsons disease Depressive disorder Global assessment scale Hamilton depression rating scale
文章编号： 中图分类号：R742.4 文献标志码：B
基金项目:国家自然科学基金青年项目（82104783）；安徽省高校自然科学研究项目（KJ2019A0457）；安徽省重点研究与开发计划项目（1804h08020243）
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