抗鬱劑治療前後重鬱症病人之細胞因子、治療反應、以及體重變化之關係

Cytokines, Treatment Responses, and Body Weight Changes in Major Depressive Patients Treated with Antidepressants

目的：血清中的細胞因子濃度可能與重鬱症急性期之致病機轉有關。此研究探討細胞 因子濃度、治療反應、以及體重變化在重鬱症病人接受四週抗鬱劑治療後的關係。方法： 五十四位重鬱症病人血清中的干擾素 γ (interferon-γ, IFN-γ)、腫瘤壞死因子 α (tumor necrosis factor-α, TNF-α)、白細胞介素 10 (interleukin-10, IL-10)、以及轉化生長因子 β1 (transforming growth factorβ1, TGF-β1) 以酵素免疫分析法測量。精神科診斷依據 DSM-IV。重鬱症之嚴重 度則以十七題漢式憂鬱量表評估。結果：接受治療前，之後對抗鬱劑反應佳的病人有顯著較 低的 IL-10 濃度 (p = 0.001) 及顯著較低的 IL-10/TGF-β1 比例 (p < 0.01)。接受抗鬱劑治療後， 在所有的病人中，體重變化與 TNF-α/TGF-β1 比例變化有顯著的正相關 (p < 0.05)。若只分 析對抗鬱劑反應佳的病人，體重變化與 TNF-α/TGF-β1 比例變化仍有有顯著的正相關 (p < 0.05)。但若只分析對抗鬱劑反應不佳的病人，體重變化則與 IL-10/TGF-β1 比例變化有顯著 的負相關 (p < 0.01)。結論：血清中的 TNF-α、IL-10、以及 TGF-β1 可能可以用來預測重鬱 症病人對抗鬱劑治療之反應及治療後體重的變化。

Objectives:Serum cytokine levels are implicated in the action of mechanism for acute-phase major depression. In this study, we intended to investigate the re-lationships between cytokine serum levels and treatment responses as well as body weight changes after a four-week antidepressant treatment in patients with major depressive disorders. Methods: Fifty-four major depressive patients were recruit-ed. Their serum cytokine levels of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), and transforming growth factor β1 (TGF-β1) were examined using ELISA kits. Psychiatric diagnoses were made using the DSM-IV criteria. Severity of major depression was assessed using the 17-item Hamilton Depression Rating Scale. Results: We found significantly lower base-line serum IL-10 level (p = 0.001) and significantly lower baseline IL-10/TGF-β1 ratio (p < 0.01) in responders compared to those in non-responders. In all patients after antidepressant treatment, we found a significant positive correlation between body weight change and TNF-α/TGF-β1 ratio change (p < 0.05). In responders alone, a significant positive correlation between body weight change and TNF-α/ TGF-β1 ratio change (p < 0.05) was found. In non-responders, a significant nega-tive correlation between body weight change and IL-10/TGF-β1 ratio change (p < 0.01) was found. Conclusion: Serum levels of TNF-α, IL-10 and TGF-β1 could be used to predict the treatment response and body weight change in patients with major depression.