犬尿氨酸通路代谢产物与产后抑郁关联研究

目的：研究产后抑郁患者血浆犬尿氨酸(kynurenine，KYN)通路代谢产物变化情况。方法：收集2014年2月1日至2017年12月31日在中南大学湘雅三医院择期行剖宫产手术的产妇726例，采用爱丁堡产后抑郁量表(EdinburghPostnatal Depression Scale，EPDS)在产后第42天对产后抑郁(postpartum depression，PPD)的发生情况进行评估，≥13评定为PPD。测定并比较PPD组24例和对照组48例产妇血浆KYN，喹啉酸(quinolinic acid，QUIN)和犬尿喹啉酸(kynurenic acid，KYNA)的血浆浓度。结果：PPD发生率7.99%，PPD产妇相比非PPD产妇产前1 d血浆KYN浓度明显升高(P<0.05)，产后第3天血浆QUIN浓度明显升高(P<0.05)，KYNA浓度明显降低(P<0.05)，产后第3天KYNA/QUIN比值明显降低(P<0.01)。结论：产妇围产期血浆KYN，QUIN和KYNA浓度变化与PPD的发病密切相关，纠正血浆KYNA/QUIN比例失衡可能有利于防治PPD。

Correlation between kynurenine metabolites and postpartum depression

Objective: To explore the correlation between kynurenine (KYN) metabolites and postpartumdepression (PPD), and to provide new possible explanation for the pathogenesis of postpartumdepression (PPD).Methods: A total of 726 Chinese women, who received cesarean section, were enrolled in thisstudy. PPD was diagnosed with an Edinburgh Postnatal Depression Scale (EPDS) score ≥13.Twenty-four women with PPD and 48 matched women without PPD were randomly selected.Th e perinatal serum concentrations of KYN, quinolinic acid (QUIN) and kynurenic acid (KYNA)were measured. Subsequently, the puerperants were compared for the differences in the serumconcentrations of KYN, QUIN and KYNA at the end of term, day 1 and day 3 after cesarean section,respectively.Results: The incidence of PPD was 7.99%. Of clinical characteristics, pressure during pregnancywas significantly different between subjects with or without PPD (P<0.01). Patients with PPDshowed significantly increased serum KYN concentration (P<0.05) at the end of term, increasedserum QUIN concentration (P<0.05) and decreased KYNA concentration (P<0.05) on the thirdday after cesarean section as compared with the control women. Furthermore, the KYNA/QUINratio was significantly higher in patients with PPD as compared to the control women on the thirdday after cesarean section (P<0.01).Conclusion: The contribution of alterations in plasma levels of KYN, QUIN and KYNA is closelyrelated with the incidence of PPD, and correction of KYNA/QUIN ratio could be a new strategyfor the prevention and treatment of postpartum depressive symptoms.