Murat ERDEM, Abdullah BOLU, Emin Özgür AKGÜL, Muzaffer ÖZTOSUN, Adem BALIKCI, Ali Emrah BİLGEN, Özcan UZUN

Majör Depresyon Hastalarında Atak Sayısı ile Serum Haptoglobulin ve Neopterin Düzeyleri Arasındaki İlişki

Amaç: Depresyon ile immün sistem arasındaki ilişkinin açıklanmasında pro–inflamatuar sitokinler ön plana çıkmakta ve özellikle hücresel immün yanıtta artma görülmektedir. Halen özgül işlevi tam olarak bilinmeyen neopterin ölçümleri hücresel immün yanıtının izlenmesini sağlar. Aynı şekilde pozitif bir akut faz proteini olan haptoglobulin (Hp) üzerinde de durulmaktadır. Bu çalışmada ilk atağında olan depresyon hastaları ile tekrarlayan ataklar geçiren depresyon hastalarının serum neopterin ve haptoglobulin seviyelerinin sağlıklı kontrol grubu ve birbirleri ile karşılaştırılması yoluyla depresif atakların neopterin ve Hp düzeyleri üzerine etkilerinin araştırılması amaçlanmıştır. Yöntem: Çalışmaya Ankara Gülhane Askeri Tıp Akademisi (GATA) Psikiyatri polikliniğine başvuran 80 hasta alındı. 44 hasta ilk atak depresyon tanısı ile takip edilmekteydi. Tekrarlayan ataklar geçiren grupta ise 36 hasta vardı. Sağlıklı kontrol grubu ise 41 kişiden oluşuyordu. Tekrarlayan majör depresyon (MD) grubunda 22 hasta ikinci, 16 hasta üçüncü atağında, 6 hasta ise dört ya da daha fazla atak geçirmiş durumdaydı. Depresyon şiddeti 17 maddelik Hamilton Depresyon Ölçeği (HDÖ) ile değerlendirildi. Tam kan, rutin biyokimya, serum neopterin ve haptoglobulin düzeylerinin saptanması için katılımcılardan periferik venöz kan örnekleri alındı. Serum neopterin and haptoglobin düzeyleri katılımcılar gece boyunca 12 saat aç kaldıktan sonra sabah 8:00 ve 11:00 saatleri arasında ölçüldü. Bulgular: Yaş, eğitim düzeyi, sigara kullanımı ve cinsiyet açısından her üç grup arasında anlamlı bir farklılık yoktu. İlk atak MD ve tekrarlayan MD grupları arasında da HDÖ skorları açısından anlamlı bir farklılık yoktu. İlk atak MD grubu ile kontrol grubu arasında serum Hp ve neopterin açısından fark saptanmadı. Tekrarlayan MD grubunda serum Hp ve neopterin seviyesi ilk atak MD grubuna ve kontrol grubuna göre yüksek bulundu. MD hastalarının (hem ilk atak MD hem de tekrarlayan MD grubunda) HDÖ skorları ile serum Hp seviyeleri arasında ilişki vardı, ancak HDÖ skorları ile serum neopterin seviyeleri arasında herhangi bir ilişki yoktu. Sonuç: MD hastalarının neopterin ve Hp seviyelerini etkileyen bağımsız etken depresyon atak sayısı olarak bulundu. Tekrarlayan ataklar ilk atak hastalarından farklı olarak her iki belirtecin düzeylerinin artması ile sonuçlanmıştır. Bu bulgunun önemli olduğunu düşünüyoruz. Bulgularımız MD’de hastalığın genellikle yaygın inflamatuvar reaksiyon ile ilişkili olduğu ve depresif belirtilerin şiddetinin inflamatuvar belirteçler ile pozitif bir şekilde ilişkili olduğu hipotezini desteklemektedir. Hem tek atak geçiren hem de birden fazla atak geçiren hastaların serum Hp seviyeleri depresyonun ciddiyeti ile ilişkili bulunmuştur. Aynı ilişki neopterin için bulunamamıştır. Her iki belirteç arasında gözlenen bu farklılığın öneminin saptanması ve bu belirteçlerin etyolojik öneminin kesin olarak saptanması için ileri çalışmalara gereksinim vardır.

Anahtar Kelimeler:

depresyon, neopterin, haptoglobinler

The relationship between serum levels of haptoglobin and neopterin and the number of episodes in patients with major depression

Objective: In explaining the association between depression and immune system pro-inflammatory cytokines have come to the fore and there appears to be an increase in particular at the cellular immune response. Neopterin measurements enable monitoring of the cellular immune response although its specific function is still not fully described. Similarly, haptoglobin (Hp), a positive acute phase protein, has been mentioned as well. In this study, we aimed to investigate the effects of depressive episodes on serum levels of neopterin and Hp by comparing serum haptoglobin and neopterin levels of the depressive patients in their first attack with those of depression patients suffering from recurrent attacks, and with the healthy control group. Method: Eighty patients who admitted to the outpatient psychiatry clinic of Ankara Gulhane Military Medical Academy (GMMF) were included in the study. Fourty-four individuals were being followed up with a diagnosis of first episode depression. There were 36 patients in the recurrent major depression (MD) group. The control group consisted of 41 healthy individuals. Of recurrent MD patients, 22 patients were in their second episode, 16 patients were in their third attack and 6 patients had four episodes or more. Severity of depression was evaluated with 17-item Hamilton Depression Rating Scale (HAM-D). Peripheral venous blood samples were collected from participants to determine complete blood count, routine biochemistry, serum neopterin, and haptoglobin measurements. The levels of serum neopterin and haptoglobin were measured by using the samples that were collected between the hours of 8:00 am and 11:00 am after 12 hour fasting during the previous night. Results: There was no significant difference between the three groups in terms of gender, age, educational level, and smoking. There was also not significant difference between the first episode MD and recurrent MD groups for HAM-D scores. No significance was detected between the first episode MD and control groups in terms of serum Hp and neopterin levels. In the recurrent MD group serum Hp and neopterin levels were higher than those of the first episode MD patients and the control subjects. HAM-D scores of MD patients (both first-episode MD and recurrent MD group) were correlated with serum levels of Hp, but there was no correlation between serum neopterin levels and HAM-D scores. Conclusion: The independent factor affecting the neopterin and Hp levels in patients with MD was found as the number of episodes of depression. Recurrent episodes have resulted with increased levels of both markers. We believe that this finding is important. Our findings support the hypothesis that major depressive disorder is generally associated with widespread inflammatory reaction and severity of depressive symptoms are positively correlated with the increase in inflammatory markers. Serum levels of Hp were associated with depression severity in patients who had a single episode as well as patients with multiple episodes. The same relationship was not found for neopterin. Further studies are needed to determine the importance of this difference observed between the two markers and also etiological significance of them.

Keywords:

depression, neopterin, haptoglobins,

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