肿瘤患者共病抑郁的 研究进展

Research Progress on Comorbid Depression in Cancer Patients

摘要: 肿瘤患者中抑郁障碍的患病率显著高于普通人群，且与全因死亡及肿瘤特异性死亡风险升高独立相关。不同系统来源的肿瘤在抑郁患病率及死亡风险上存在显著差异，提示其生物学机制具有系统特异性。本文从人体八大系统(呼吸、消化、生殖、泌尿、内分泌、血液、神经、运动系统)出发，系统综述肿瘤患者共病抑郁的流行病学特征、临床表现差异、相关生存结局，并重点探讨其多轴生物学机制，包括下丘脑–垂体–肾上腺轴、交感–肾上腺髓质轴、肠脑轴、神经递质信号轴、免疫炎症轴及代谢相关轴等。此外，本文还总结了肿瘤患者抑郁的筛查诊断工具及干预策略，如心理治疗、抗抑郁药物、重复经颅磁刺激及运动疗法等。深入理解不同系统肿瘤与抑郁交互的特异性机制，有助于实现个体化筛查与精准干预，改善肿瘤患者的整体预后。

Abstract: The prevalence of depressive disorder in cancer patients is significantly higher than that in the general population, and it is independently related to the increased risk of all-cause death and tumor-specific death. There are significant differences in the prevalence of depression and the risk of death among tumors from different systems, suggesting that their biological mechanisms are system-specific. Based on the eight systems of human body (respiratory system, digestive system, reproductive system, urinary system, endocrine system, blood system, nervous system and motor system), this paper systematically reviews the epidemiological characteristics, clinical manifestations and related survival outcomes of comorbid depression in cancer patients, and focuses on its multi-axis biological mechanism, including hypothalamus-pituitary-adrenal axis, sympathetic-adrenal medullary axis, intestinal brain axis, neurotransmitter signal axis, immune inflammatory axis and metabolism. In addition, this paper also summarizes the screening and diagnosis tools and intervention strategies for depression in tumor patients, such as psychotherapy, antidepressants, repetitive transcranial magnetic stimulation and exercise therapy. A deep understanding of the specific mechanism of interaction between tumor and depression in different systems is helpful to realize individualized screening and accurate intervention and improve the overall prognosis of tumor patients.