血清尿酸水平与青少年发病、成年发病抑郁症患者自杀风险的关联研究

Study on the Association of Serum Uric Acid Levels with Suicide Risk in Patients with Juvenile-Onset and Adult-Onset Depression

摘要: 背景：氧化应激假说被认为是抑郁症(Depression)病理生理过程的核心参与机制，血清尿酸(Serum Uric Acid, SUA)作为重要的非酶类抗氧化物，当前研究对SUA与抑郁症的关联存在争议。目的：探讨SUA在青少年发病、成年发病抑郁症患者以及性别上的异质性，明确其与自杀风险的特异性联系。方法：采用横断面设计，共纳入来自重庆医科大学附属大学城医院2025年3月~10月门诊、住院部及体检中心就诊的600名被试者，包括符合《精神障碍诊断与统计手册(第五版)》(DSM-V)中抑郁症的诊断标准的抑郁症患者307名、患者健康问卷-9 (PHQ-9)筛查结果为阴性的健康对照者293名。采集空腹血清测定SUA水平，采用汉密尔顿抑郁量表(HAMD-17)与汉密尔顿焦虑量表(HAMA-14)评估抑郁、焦虑严重程度。结果：女性、男性成年发病抑郁症患者SUA水平均低于健康对照组。抑郁症患者的SUA水平与抑郁、焦虑严重程度呈显著负相关。女性自杀未遂抑郁症患者的SUA水平(247.70 ± 40.70 µmol/L)低于无自杀行为者(265.65 ± 42.10 µmol/L, P = 0.02)，以及有自伤或自杀意念者(267.53 ± 48.85 µmol/L, P = 0.02)。结论：抑郁症患者存在SUA水平降低，女性成年发病抑郁症患者尤为显著，且与女性自杀未遂风险具有特异性关联。检测SUA或可为临床评估女性抑郁症的自杀风险提供参考。

Abstract: Background: The oxidative stress hypothesis is considered a core mechanism in the pathophysiology of depression. Serum uric acid (SUA), as an important non-enzymatic antioxidant, has shown an inconsistent association with depression in current research. Objective: This study aimed to investigate the heterogeneity of SUA levels in patients with juvenile-onset and adult-onset depression across genders and to clarify its specific association with suicide risk. Methods: A cross-sectional design was adopted. A total of 600 participants were recruited from the outpatient clinics, inpatient wards, and health examination center of the University-Town Hospital of Chongqing Medical University between March and October 2025. The sample included 307 patients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and 293 healthy controls who screened negative on the Patient Health Questionnaire-9 (PHQ-9). Fasting serum was collected to measure SUA levels. The severity of depressive and anxiety symptoms was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) and the 14-item Hamilton Anxiety Rating Scale (HAMA-14). Results: SUA levels were lower in both female and male patients with adult-onset depression compared to their respective healthy control groups. Among patients with depression, SUA levels showed a significant negative correlation with the severity of both depressive and anxiety symptoms. Female depression patients with a history of suicide attempt had significantly lower SUA levels (247.70 ± 40.70 µmol/L) compared to those without suicidal behavior (265.65 ± 42.10 µmol/L, P = 0.02) and those with non-suicidal self-injury or suicidal ideation only (267.53 ± 48.85 µmol/L, P = 0.02). Conclusion: Patients with depression exhibit decreased SUA levels, which is particularly pronounced in females with adult-onset depression and shows a specific association with suicide attempt risk in women. Measuring SUA levels may provide a reference for the clinical assessment of suicide risk in female patients with depression.