LONGEVITY MAY DECREASE MEDICAL COSTS
LONGEVITY MAY DECREASE MEDICAL COSTS
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长寿可能会降低医疗费用
DOI：
10.1111/j.1532-5415.1999.tb05255.x
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发表时间：
1999
影响因子：
6.3
通讯作者：
H. Md
中科院分区：
文献类型：
--
作者：
K. Nakajoh;Takuma Satoh‐Nakagawa Md;H. Md;M. Md;M. Md;H. Md
致编者：Dentino等人发现炎症标志物白细胞介素-6 （1L-6）与社区生活老年人的抑郁有关。他们的发现支持了抑郁和炎症标志物之间的关系。低胆固醇血症被认为是另一种炎症。在猴子中，慢性注射IL-6可引起低胆固醇血症。Ettinger等1.3报告说，患有低胆固醇血症的老年人的慢性疾病和IL-6增加，死亡率也高于对照组。临床疾病（如结肠癌）、慢性疾病（如心力衰竭）或免疫失调（如HIV-1感染）通过产生促炎细胞因子和随后细胞因子对脂蛋白代谢的作用导致低胆固醇。McMurtry和Rosentha14报道了可溶性白介素-2受体（sIL-2R）和老年男性血清胆固醇之间的反比关系。此外，低胆固醇血症与老年人抑郁和自杀风险增加有关。这种关系主要集中在血清素代谢假说上。在小鼠中，低膜胆固醇减少了5 -羟色胺受体的数量，而脑突触体膜胆固醇的增加增加了5 -羟色胺受体的数量。“因此，由于膜胆固醇与血浆胆固醇处于平衡状态，低胆固醇血症可能导致血清素水平下降，而血清素水平下降又与抑制不良行为冲动、增加自杀和暴力死亡有关。”重要的是，丹蒂诺说。的研究还发现，女性患抑郁症的几率有所增加。初步数据显示IL-6与雌激素之间存在关系。在体外，雌二醇抑制IL-6的产生。雌激素和IL-6对骨骼的影响相反：雌激素抑制骨吸收，而IL-6促进骨吸收。雌激素抑制IL-6基因表达。“重要的是，抗雌激素治疗或更年期会增加抑郁症的患病率。相反，激素替代疗法与情绪改善有关。“这也表明了细胞因子、雌激素和抑郁症之间的联系。”Dentino等人的另一项发现是抑郁症与短便携式精神状态问卷得分之间的显著相关性。作为炎症标志物的低胆固醇血症可能部分解释了与抑郁症相关的认知能力下降。例如，Cattin等人9发现血清胆固醇水平与认知障碍明显呈负相关。在另一项研究中，Wada等。报道称，低胆固醇血症与健康老年人认知功能下降有关。因此，促炎细胞因子对胆固醇和血清素代谢的影响可能解释了晚年抑郁症免疫内分泌失调的一些特征。需要进一步研究炎症和抑郁症的成因。
To the Editor: Dentino et al.’ found that the inflammatory marker interleukin-6 (1L-6) was associated with depression in community-living older people. Their findings support the relationship between depression and inflammatory markers. Hypocholesterolemia is considered to be another inflammatory In monkeys, chronic IL-6 injections cause hypocholesterolemia? Ettinger et a1.3 reported that older persons with hypocholesterolemia had increased chronic illnesses and IL-6 as well as higher mortality rates than controls. Clinical disease (e.g., colon cancer), chronic disease (e.g., heart failure), or immune dysregulation (e.g., HIV-1 infection) leads to low cholesterol through the production of proinflammatory cytokines and the subsequent action of cytokines on lipoprotein metab~lism.~ McMurtry and Rosentha14 reported an inverse relationship between the soluble interleukin-2 receptor (sIL-2R) and serum cholesterol in older men. In addition, hypocholesterolemia is associated with increased depression and risk for suicide in older people. This relationship has focused on the hypothesis of serotonin metabolism.’* In mice, low membrane cholesterol decreases the number of serotonin receptors, whereas a rise in brain synaptosomal membrane cholesterol increases the number of serotonin receptors.‘ Thus, because membrane cholesterol is in balance with plasma cholesterol, hypocholesterolemia could contribute to decreased serotonin levels, which, in turn, are associated with poor suppression of harmful behavioral impulses, increasing suicides, and violent deaths.’ Importantly, Dentino et a].’ also found an increased incidence of depression in women. Preliminary data show a relationship between IL-6 and estrogens. In vitro, estradiol inhibits IL-6 production. Estrogens and IL-6 exert opposite influences on bone: estrogens inhibit bone resorption and IL-6 promotes it. Estrogen inhibits the IL-6 gene expression.’ Importantly, antiestrogen therapy or menopause increases prevalence of depression. Conversely, hormone replacement therapy is associated with improvements in mood.’ This also indicates a link among cytokines, estrogen, and depression. Another finding of Dentino et al.’ was a significant correlation between depression and Short Portable Mental Status Questionnaire scores. Hypocholesterolemia as an inflammatory marker might explain part of the cognitive decline related to depression. For example, Cattin et al.9 found that levels of serum cholesterol were clearly associated inversely with cognitive impairment. In another study, Wada et a].’’ reported that hypocholesterolemia was associated with decreased cognitive functions in healthy older subjects. Therefore, the effects of proinflammatory cytokines on cholesterol and serotonin metabolism might explain some traits of the immunoendocrine dysregulation in late life depression. Further studies on inflammation and the genesis of depression are needed.