Depressive symptoms are associated with reduced neutrophil function in hip fracture patients.
Depressive symptoms are associated with reduced neutrophil function in hip fracture patients.
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DOI：
10.1016/j.bbi.2013.07.004
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发表时间：
2013-10
影响因子：
15.1
通讯作者：
Lord, Janet M.
中科院分区：
文献类型：
--
作者：
Duggal, Niharika Arora;Upton, Jane;Phillips, Anna C.;Hampson, Peter;Lord, Janet M.
抑郁症状是髋部骨折后免疫力下降的主要驱动力。髋部骨折是老年人中常见的创伤，抑郁症的发病率很高，这与较差的预后有关，包括感染风险增加。衰老伴随着免疫力下降，称为免疫衰退，导致对感染的易感性增加。我们研究了身体创伤（髋骨骨折）和心理困扰（抑郁症状）是否对老年免疫系统产生叠加效应，这可能导致受伤后的不良结局。对101名髋部骨折患者（81名女性）在伤后6周和6个月以及43名年龄匹配的健康对照者（28名女性）的神经功能进行了评估。38例骨折患者在6周时有抑郁症状。对照组和髋部骨折患者之间中性粒细胞吞噬大肠杆菌的能力没有观察到差异，但与无症状患者（p = .001）或对照组（p = .004）相比，有抑郁症状的髋部骨折患者的超氧化物产生量显着减少。6周。骨折后6个月，超氧化物生成改善至对照组水平。我们检测到血清皮质醇升高，减少硫酸脱氢表雄酮（DHEAS）和增加皮质醇：DHEAS比率骨折患者与抑郁症状相比，无抑郁症状的患者或对照组在6周和6个月后受伤。6周时有抑郁症状的患者血清IL 6、TNFα和IL 10水平升高。皮质醇：DHEAS比值和IL 6水平与抑郁症状评分相关，但与中性粒细胞功能无关。总之，抑郁症状与髋部骨折后中性粒细胞功能较差有关，但这不是由应激激素或细胞因子水平的变化引起的。
Depressive symptoms are a major driver of reduced immunity after hip fracture. Hip fracture is a common trauma in older adults with a high incidence of depression, which relates to poorer prognosis including increased risk of infection. Ageing is accompanied by reduced immunity, termed immunesenescence, resulting in increased susceptibility to infection. We examined whether physical trauma (hip fracture) and psychological distress (depressive symptoms) had additive effects upon the aged immune system that might contribute to poor outcomes after injury. Neutrophil function was assessed in 101 hip fracture patients (81 female) 6 weeks and 6 months after injury and 43 healthy age-matched controls (28 female). Thirty eight fracture patients had depressive symptoms at 6 weeks. No difference in neutrophil phagocytosis of Escherichia coli was observed between controls and hip fracture patients, but superoxide production was significantly reduced in hip fracture patients with depressive symptoms compared with patients without symptoms (p = .001) or controls (p = .004) at 6 weeks. Superoxide production improved 6 months following fracture to the level seen in controls. We detected elevated serum cortisol, reduced dehydroepiandrosterone sulphate (DHEAS) and an increased cortisol:DHEAS ratio in fracture patients with depressive symptoms compared with patients without depressive symptoms or controls at 6 weeks and 6 months after injury. Serum IL6, TNFα and IL10 were higher among patients with depressive symptoms at 6 weeks. The cortisol:DHEAS ratio and IL6 levels related to depressive symptom scores but not to neutrophil function. In conclusion, depressive symptoms related to poorer neutrophil function after hip fracture, but this was not driven by changes in stress hormone or cytokine levels.
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