心境障碍患者外周血中炎性比率的横断面研究

A Cross-Sectional Study of Peripheral Blood Inflammatory Ratios in Mood Disorder Patients

摘要: 目的：探讨抑郁障碍和双相障碍以及双相障碍抑郁发作和双相障碍躁狂发作患者之间中性粒细胞–淋巴细胞比率(neutrophil-lymphocyte ratio, NLR)、血小板–淋巴细胞比率(platelet-lymphocyte ratio, PLR)、单核细胞–淋巴细胞比率(monocyte-lymphocyte ratio, MLR)和系统炎症反应指数(system in-flammation response index, SIRI)的差异。方法：我们共纳入229名中国汉族患者(抑郁障碍128人；双相障碍抑郁发作49人；双相障碍躁狂发作52人)，根据血液分析结果得出白细胞计数及各细胞亚型计数，并计算NLR、PLR、MLR和SIRI。采用SPSS 26.0进行统计分析，抑郁障碍和双相障碍患者两组间的比较采用Mann-Whitney U检验，抑郁障碍与双相障碍抑郁发作及躁狂发作之间的比较采用Kruskal Wallis H检验，同时采用Bonferroni校正进行事后多重比较。最后以单相、双相抑郁为结局变量，对变量进行单因素及多因素Logistic回归分析，并绘制受试者工作特征曲线。P < 0.05为差异有统计学意义。结果：1) 与抑郁组相比，双相组患者的NLR和SIRI显著升高(P < 0.05)。2) 抑郁组、双相抑郁组和双相躁狂组相比，三组的NLR、MLR和SIRI总体分布存在着统计差异(P < 0.05)。其中，与抑郁组相比，双相躁狂组的NLR、MLR、SIRI显著升高，差异有统计学意义(校正P < 0.05)。抑郁组与双相抑郁组在炎性比率方面均无统计学差异(校正P > 0.05)。(3) 双相躁狂组的NLR和MLR显著高于双相抑郁组，差异有统计学意义(校正P < 0.05)。4) 年龄和白细胞计数对单相和双相抑郁诊断的影响具有统计学意义(P < 0.05)，二者联合诊断时的准确率相对较高(AUC = 0.716)。结论：本研究发现双相躁狂患者的NLR和MLR较高，表明躁狂患者的炎症变化相较于抑郁及双相抑郁患者更为明显。此外，联合使用年龄和白细胞计数可以在一定程度上提高鉴别单相和双相抑郁的能力。

Abstract: Objective: To explore the differences in neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ra-tio (PLR), monocyte-lymphocyte ratio (MLR), and system inflammation response index (SIRI) among patients with major depressive disorder (MDD), bipolar disorder (BD), bipolar disorder depressive episode (BDD) and bipolar disorder manic episode (BDM). Methods: We included a total of 229 Chi-nese Han patients (128 with MDD, 49 with BDD, and 52 with BDM). The leukocyte counts and vari-ous cell subtype counts were obtained from blood analyses, and NLR, PLR, MLR, and SIRI were cal-culated. Statistical analysis was conducted using SPSS 26.0. Comparisons between MDD and BD pa-tients were performed using the Mann-Whitney U test, while comparisons among MDD, BDD, and BDM were analyzed using the Kruskal-Wallis H test, followed by Bonferroni corrections for post hoc multiple comparisons. Finally, MDD and BDD were used as the outcome variables, and the variables were analyzed by univariate and multivariate Logistic regression analysis, and receiver operating characteristic curve was drawn. Differences were considered statistically significant at P < 0.05. Results: 1) Compared to the MDD, BD exhibited significantly elevated NLR and SIRI (P < 0.05). 2) When comparing the MDD, BDD, and BDM, there were overall statistical differences in NLR, MLR, and SIRI (P < 0.05). Specifically, in comparison to the MDD, the BDM showed significantly higher NLR, MLR, and SIRI, with statistical significance (adj. P < 0.05). There were no statistically signifi-cant differences in inflammatory ratios between MDD and BDD (adj. P > 0.05). 3) The BDM exhibited significantly higher NLR and MLR compared to the BDD, with statistical significance (adj. P < 0.05). 4) The influence of age and leukocyte counts on the diagnosis of MDD and BDD (P < 0.05) was statisti-cally significant (P < 0.05), and the accuracy of the combination of the two was relatively high (AUC = 0.716). Conclusion: This study found that NLR and MLR are higher during BDM, indicating a more pronounced inflammatory response compared to MDD and BDD. In addition, the combined use of age and leukocyte counts improved the ability to discriminate MDD from BDD to some extent.