忧郁与血中锌浓度降低有关


  【24drs.com】一篇统合分析认为,忧郁患者的外围血液锌浓度比无忧郁者低。
  
  加拿大多伦多大学Sunnybrook研究院Walter Swardfager博士等人写道,锌浓度与忧郁之间的病理生理关系,以及忧郁患者补充锌的潜在好处,需要后续研究探讨。
  
  这些研究结果发表于12月15日的生物精神学期刊。
  
  作者们写道,越来越多证据显示,以实验方法让动物缺乏锌会诱发牠们的类忧郁行为,补充锌之后可以有效恢复;再者,初步临床试验认为,抗忧郁治疗时加入锌可以更迅速或更有效的改善忧郁症状。
  
  研究者指出,过去十年来,探讨忧郁和无忧郁者之外围血液锌浓度的研究,有许多认为,忧郁可能和某些人的锌浓度低有关。
  
  这篇统合分析的目标是确认临床证据是否支持忧郁患者的锌浓度比无忧郁者低。
  
  这篇分析包括了17篇测量外围血液锌浓度的研究,包括1,643名忧郁患者以及804名对照组;其中10篇研究对象是精神科住院病患,7篇是社区样本;34.4%研究对象是男性;平均年纪37.7岁。
  
  研究者发现,忧郁患者的平均外围血液锌浓度比对照组低了将近1.85 μmol/L(95%信心区间[CI],-2.51至-1.19;P < .00001);忧郁者和对照组的锌浓度差异越大时,其忧郁更严重(P = .026)。
  
  此外,作者们报告指出,住院病患的效应值(加权平均差[WMD],-2.543;95% CI,-3.522至 -1.564;P < .0001)比社区样本(WMD,-.943;95% CI,-1.563至-.323;P = .003)更大,在研究方法质量更佳的研究也是(WMD,-2.354;95% CI,-2.901至 -1.807;P < .0001)。
  
  作者们写道,虽然关联性研究无法确认因果关系,锌浓度和忧郁症在生物学方面之因果关系是肯定的。
  
  他们写道,锌有抗氧化性质,可帮助维持体内内分泌平衡以及免疫功能,在调节海马回和皮层麸胺酸回路有多种功能,这些有益于调控情感与认知功能。因此,锌平衡状态受影响时可能危及神经可塑性,并造成长期神经心理学和精神病学之衰退。
  
  作者们指出,锌对免疫功能也很重要。血清锌浓度低和影响脂肪酸代谢及血清脂质值有关,这可能会影响脑部功能和血管健康。锌浓度低也和心血管疾病有关,心血管疾病是重度忧郁异常(MDD)常见的共病症。
  
  研究者提到它们的研究限制。他们写道,像这篇统合分析之研究的质量和偏见风险是不平等的。
  
  作者们写道,并非所有研究的人口统计学资料都足以纳入探讨异质性,所用的抗忧郁剂和其它药物也未有一致报告,没有关于饮食和饮酒的资料。
  
  研究者结论表示,尽管有限制,研究结果认为忧郁和外围血液锌浓度降低有关。
  
  他们结论指出,研究结果认为需要进一步探讨:锌在忧郁症之病理生理学的可能角色,锌的可能用处,以及监测MDD的相关生物标记与其临床后遗症,还有MDD病患补充锌的潜在效益。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7042&x_classno=0&x_chkdelpoint=Y
  

Depression Linked to Low Zinc Levels in Blood

By Fran Lowry
Medscape Medical News

People who are depressed have lower concentrations of zinc in their peripheral blood compared with nondepressed individuals, a meta-analysis suggests.

"The pathophysiological relationships between zinc status and depression, and the potential benefits of zinc supplementation in depressed patients, warrant further investigation," write Walter Swardfager, PhD, from the Sunnybrook Research Institute, University of Toronto, Canada, and colleagues.

Their findings were published in the December 15 issue of Biological Psychiatry.

Link to Zinc Deficiency

"A growing body of evidence demonstrates that experimental zinc deficiency can induce depressive-like behavior in animals, which can be effectively reversed by zinc supplementation," the authors write. Furthermore, preliminary clinical trials have suggested that zinc added to antidepressant therapy may produce more rapid or more effective improvement in depressive symptoms.

Many, although not all, studies that have measured zinc concentrations of peripheral blood in depressed and nondepressed individuals during the past several decades have suggested that depression might be associated with lower zinc concentrations in various population samples, the researchers note.

The aim of this meta-analysis was to determine whether the clinical evidence collectively supports lower zinc concentrations in depressed patients compared with nondepressed individuals.

The analysis included 17 studies that measured peripheral blood–zinc concentrations in 1643 depressed patients and 804 control participants. Ten of these studies reported on psychiatric inpatients, and 7 reported on community samples. Of the participants, 34.4% were male; the mean age was 37.7 years.

The researchers found that mean peripheral blood–zinc concentrations were lower by approximately 1.85 μmol/L in depressed individuals compared with control participants (95% confidence interval [CI], -2.51 to -1.19; P < .00001).

More severe depression was associated with greater differences in zinc levels between depressed and control participants (P = .026).

Further, the authors report that effect sizes were larger in studies of inpatients (weighted mean difference [WMD], -2.543; 95% CI, -3.522 to -1.564; P < .0001) vs community samples (WMD, -.943; 95% CI, -1.563 to -.323; P = .003) and in studies with higher methodologic quality (WMD, -2.354; 95% CI, -2.901 to -1.807; P < .0001).

Biologically Plausible

"Although association studies cannot determine the direction of causation, a causal association between zinc status and depression is biologically plausible," the authors write.

"Zinc has antioxidant properties, helps to maintain endocrine homeostasis and immune function, and plays multiple roles in regulating the hippocampal and cortical glutamatergic circuits that subserve affective regulation and cognitive function. Thus, changes in zinc homeostasis might compromise neuroplasticity and contribute to long-term neuropsychological and psychiatric decline," they write.

Zinc also plays an important role in immune function. Lower serum levels of zinc have been associated with disturbances in fatty acid metabolism and in serum lipid levels, which might affect brain function and vascular health. Lower zinc levels have also been associated cardiovascular disease, a common comorbidity of major depressive disorder (MDD), the authors note.

The investigators point out limitations of their study. The quality and risk of bias "were uneven among studies included in this meta-analysis," they write.

Not all studies reported demographic data "sufficiently to be included in investigations of heterogeneity, the use of antidepressants and other concomitant medications were not consistently reported, and data on diet and alcohol use were often not reported," the authors write.

Limitations notwithstanding, the authors conclude that their results suggest that depression is associated with reduced concentrations of zinc in peripheral blood.

"The findings suggest the need to further investigate potential roles of zinc in the pathophysiology of depression, the potential utility of zinc and related biomarkers in monitoring MDD and its clinical sequelae, and potential benefits of zinc supplementation in MDD patients," they conclude.

The study was supported by the Ontario Mental Health Foundation. Dr. Swardfager was supported by fellowships from the Heart and Stroke Foundation Center for Stroke Recovery and the Toronto Rehabilitation Institute. Dr. Swardfager and the other authors report no relevant financial relationships.

Biol Psychiatry. 2013;74:872-878.

    
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