Bidirectional psychoneuroimmune interactions in the early postpartum period influence risk of postpartum depression.
Bidirectional psychoneuroimmune interactions in the early postpartum period influence risk of postpartum depression.
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DOI：
10.1016/j.bbi.2015.04.012
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发表时间：
2015-10
期刊：
影响因子：
--
通讯作者：
McCarthy DO
中科院分区：
文献类型：
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作者：
Corwin EJ;Pajer K;Paul S;Lowe N;Weber M;McCarthy DO
每年有超过 500,000 名美国女性患上产后抑郁症 (PPD)。尽管心理社会风险是已知的，但潜在的生物学风险仍不清楚。免疫炎症反应和下丘脑-垂体-肾上腺（HPA）轴的失调与其他人群的抑郁症有关。虽然已经对这些系统对 PPD 发展的贡献进行了重要研究，但结果尚无定论。部分原因是很少有研究关注炎症反应和 HPA 轴之间双向动态相互作用的破坏是否共同影响 PPD。在这项研究中，我们检验了炎症-HPA 轴双向关系的破坏会增加 PPD 风险的假设。在妊娠第 3 个月、第 7 天和第 14 天以及分娩后第 1、2、3 和 6 个月对女性血浆促炎和抗炎细胞因子进行了测量。抽血前一天收集 5 次唾液，以确定皮质醇曲线下面积 (AUC)，并使用爱丁堡产后抑郁调查 (EPDS) 测量抑郁症状。根据 EDPS 标准，在 152 名完成 EPDS 的女性中，18% 在产后 6 个月内患有抑郁症。第 14 天有症状女性的皮质醇 AUC 较高 (p=.017)。为了考虑细胞因子和皮质醇对预测 PPD 症状的综合影响，开发了一个多重逻辑回归模型，其中包括在双变量分析中确定的对抑郁症状有影响的预测因子。结果表明，抑郁症家族史、第 14 天皮质醇 AUC 和第 14 天 IL8/IL10 比值是 PPD 症状的显着预测因子。 IL8/IL10比值和皮质醇AUC各增加1个单位，导致PPD的发展分别增加1.50（P=0.06）和2.16（P=0.02）倍。总体而言，该模型正确地将 84.2% 的个体分类到各自的组中。研究结果表明，炎症反应和 HPA 轴之间复杂相互作用的变异性会影响 PPD 的风险。
More than 500,000 U.S. women develop postpartum depression (PPD) annually. Although psychosocial risks are known, the underlying biology remains unclear. Dysregulation of the immune inflammatory response and the hypothalamic-pituitary-adrenal (HPA) axis are associated with depression in other populations. While significant research on the contribution of these systems to the development of PPD has been conducted, results have been inconclusive. This is partly because few studies have focused on whether disruption in the bidirectional and dynamic interaction between the inflammatory response and the HPA axis together influence PPD. In this study, we tested the hypothesis that disruption in the inflammatory-HPA axis bidirectional relationship would increase the risk of PPD. Plasma pro- and anti-inflammatory cytokines were measured in women during the 3rd trimester of pregnancy and on Days 7 and 14, and Months 1, 2, 3, and 6 after childbirth. Saliva was collected 5 times the day preceding blood draws for determination of cortisol area under the curve (AUC) and depressive symptoms were measured using the Edinburgh Postpartum Depression Survey (EPDS). Of the 152 women who completed the EPDS, 18% were depressed according to EDPS criteria within the 6 months postpartum. Cortisol AUC was higher in symptomatic women on Day 14 (p=.017). To consider the combined effects of cytokines and cortisol on predicting symptoms of PPD, a multiple logistic regression model was developed that included predictors identified in bivariate analyses to have an effect on depressive symptoms. Results indicated that family history of depression, day 14 cortisol AUC, and the day 14 IL8/IL10 ratio were significant predictors of PPD symptoms. One unit increase each in the IL8/IL10 ratio and cortisol AUC resulted in 1.50 (P=0.06) and 2.16 (P=0.02) fold increases respectively in the development of PPD. Overall, this model correctly classified 84.2% of individuals in their respective groups. Findings suggest that variability in the complex interaction between the inflammatory response and the HPA axis influence the risk of PPD.