抑郁症患者睡眠障碍与血浆增食欲素A的关系

目的 探讨抑郁症患者睡眠障碍与血浆增食欲素A的关系,以期为抑郁症睡眠障碍的干预提供理论基础.方法 67例抑郁症患者行24项汉密尔顿抑郁量表(HAMD-24)及匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评定,根据睡眠情况分为睡眠障碍组(研究组,n=37)及非睡眠障碍组(阳性对照组,n =30),多导睡眠图检测睡眠情况,放射免疫法检测血浆增食欲素-A水平,并与26例健康体检者进行对比(阴性对照组).结果 与正常对照组及非睡眠障碍组比较,抑郁症睡眠障碍组患者HAMD抑郁量表评分及血浆Orexin-A水平均明显增加(P＜ 0.05,P＜0.01);总睡眠时间减少,睡眠潜伏期长,觉醒次数及时间增多,睡眠效率及维持率明显下降,浅睡(S1期睡眠)增加而深睡(S3、S4期睡眠)减少(P＜0.05,P＜ 0.01)；REM潜伏期缩短,REM睡眠时间增多,REM活动度、强度及密度明显增强(P＜0.05,P＜0.01)；相关性分析表明,血浆Orexin-A水平与睡眠潜伏期、觉醒时间、觉醒次数均呈正相关(r分别为0.447、0.591、0.670,P＜0.01),与S3％+S4％呈负相关(r=-0.872).结论 睡眠障碍者抑郁程度较非睡眠障碍者更高,血浆Orexin-A水平升高可能是引起抑郁症睡眠障碍的一项重要因素,其机制可能与其促进觉醒有关.

The relationships between plasma Orexin-A and sleep disorder in patients with depression

Objective To explore the relationships between sleep disorder and the plasma levels of orexin--A in depressive patients. Methods 67 patients with depression were evaluated using HAMD and PSQI. They were assigned the sleep disorder group（experimental group, n =37） and non sleep disorder group（positive control group, n = 30） according to the quality of sleep. The quality of sleep was assessed by polysomonography （PSG）. The level of plasma orexin--A was detected by radioimmunoassay. The control groups were 26 individuals having general physical examination. Results Compared with the control groups and non sleep disorder group, the HAMD score and the level of plasma orexin--A of the sleep disorder group were remarkably higher. The sleep disorder group showed many abnormal polysomno- graphic parameters, including reduced total sleep time, prolonged sleep latency, increased awakening time and number of awakening, decreased sleep efficiency and maintenance rate, increased the percentage of light sleep（Stage 1 sleep）, decreased the percentage of deep sleep（Stage 3,4 sleep） （P 〈 0.05,P〈 0.01）; shortened REM sleep latency,increased REM sleep time ,mobility. density and intensity （P 〈0.05, P 〈 0.01）. Correlation analysis showed that the level of plasma orexin--A was positively correlated with sleep latency.awakening time and number, but negatively correlated with the S3%＋S4 %. Conclnsiuns The degree of depression of the patients with sleep disorder were higher than whose who have no sleep disorder. The increased plasma orexin--A level may be an important factor leading to sleep disorder. Arouse The mechanism may be related to the promotion of awakening.