| Functional Dyspepsia(FD)is a syndrome which behaves recurrent epigastric discomfort symptoms and has eliminated organic indigestion.The pathogenesis of FD is not fully clear at present.Previous research shows that the onset of FD is relevant with gastrointestinal dysfunction,visceral high sensitivity,a large number of gastric acid secretion,H.pylori infection and the receptive relaxation decline of proximal gastric to food.The regular treatment including the application of acid suppression,protecting gastric mucosa and regulating gastrointestinal doesn’t work effectively.The symptoms can easily break out over and over again.In recent years,world-wide studies have found that spirit and psychological factors is closely related to FD.Epidemiological investigation showed that the incidence of depression in patients with FD can be as high as 57% to 70%.Depression patients often go to see a doctor in the comprehensive department with a complaint ofsomatic symptoms,especially the gastrointestinal symptoms such as abdominal discomfort,nausea,belching.People began to recognize that FD is a psychosomatic disease,and constantly explore the related mechanism since then.Currently,the lack of biological detection index and abnormal scale using in comprehensive department have led to the deficiency of identification and treatment level about depression.The latest studies show that inflammatory reaction mediated by cytokines may be one of the pathogenesis of depression.Serum interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α)and other cytokines play an important role in the process of the pathogenesis of depression.The development of neural gastroenterology reveals that the spirit of psychological factors,brain gut axis disorders,gastrointestinal mucosa low-grade inflammation and cytokines play a role in FD.Domestic and overseas reports about the cytokine level change indepression patients combined with FD is relatively rare.In this research,we take Hamilton depression scale(HAMD)score for FD patients,divide into mild-to-moderate depression and no depression group according to the result of HAMD score,detect the IL-6 and TNF-α level in the serum,explore the role of the IL-6 and TNF-αand the possible mechanism in FD patients combined with mild-to-moderate depression disease and provide certain theoretical basis for clinical diagnosis and treatment about such patients.Objective:To explore the possible mechanism and clinical significance of serum IL-6 and TNF-α level change in FD patients combined with mild-to-moderate depression by researching the change of serum IL-6 and TNF-α level and the correlation with the depression in FD patients.Methods:1 Subjects: Select FD patients conforming to the Roman Ⅲ diagnostic criteria from digestive outpatient service and inpatient department in Hebei General Hospital between January 2016 and June 2016,dividing them into mild-to-moderate depression and no depression group according to the HAMD score.FD patients combined with mild-to-moderate depression is defined observational group which total number is 45 including 15 male cases and 30 female cases.FD patients without depression is defined control group which total number is 45 including 13 male cases and 32 female cases.Record the demographic information and clinical data of all patients that had been selected.There is comparability between the two groups about sex(c2=0.207,P>0.05)、age(t=0.401,P>0.05)and BMI(t=0.210,P>0.05).2 The HAMD score of FD patients is taken by two physicians trained with mental scale score independently.The average score of the two physicians is the patients’ final score.2.1 HAMD 24 assessment item: depressed mood,feeling of guilty,suicide,trouble falling asleep,shallow sleep,early awakening,work and interest,retardation,agitation,psychic anxiety,somatic anxiety,gastrointestinal symptoms,general symptoms,genital symptoms,hypochondriasis,loss of weight,insight,diurnal variation,depersonalization and derealizatin,paranoidsymptoms,obsessional symptoms,helplessness,hopelessness,worthlessness.2.2 HAMD scoring criteria: single project uses the evaluation method of five levels from 0 to 4 points:(0)normal;(1)the mild;(2)moderate;(3)severe;(4)very severely.A few project evaluation for three levels from 0 to 2 points:(0)no;(1)the mild to moderate;(2)severely.2.3 Results: the total score < 8 points: normal,no depression;Total 8 to 20points: mild depression;Total 21 to 35 points,moderate depression;Total score > 35 points: severe depression.3 FD score Taking indigestion symptom score for all groups of FD patients.The symptoms include:(1)epigastric pain;(2)postprandial fullness;(3)early satiety;(4)epigastric burning;(5)Anorexia.And scoring on the following standards: 0 point: asymptomatic;1 point: mild,need a little attention to feel symptoms,no affection to daily life;2 points: moderate,there is subjective symptom,but has no affection to daily life;3 points: serious,often happen,affect daily life and work.Each symptom integral sum for the patients with symptoms integral.4 5ml venous blood were extracted from the experimental group and control group patients in the morning after 8 to 10 hours empty stomach.Collect the blood using vacuum tubes,centrifugal in rate of 3000 rpm for 15 minutes,take the supernatant,repackage and save them to-80℃ refrigerator.ELASA method is used to detect the IL-6 and TNF-α level.5 Statistical processing SPSS13.0 statistical software is used to analysis statistical data.Chi-square test is used to analysis count data.T test or Wilcoxon rank testing to analysis measurement data comparison between the two groups.The pearson or spearman rank correlation test is used to analysis two parameters.Take P<0.05 as statistically significance.Results:1 The comparison of clinical data between the observation group and control group1.1 The observational group include 15 male cases and 30 female cases,control group include 13 male cases and 32 female cases.There is no significant difference in gender composition ratio between the two groups(c2 =0.207,P>0.05);1.2 The age of the observational group was(59.20±9.13),while the control group was(58.47±8.20).There is no statistical significance in age between the two groups(t = 0.401,P>0.05);1.3 The BMI of the observational group was(23.51±2.63)kg/m2,while the control group was(23.40±2.34)kg/m2.There is no statistical significance in BMI between the two groups(t = 0.210,P>0.05);2 The comparison of HAMD scores and indigestion symptom scores between the observational group and the control group2.1 The HAMD scores of the observational group[26(10)] is significantly higher than the control group[5(2)],there is statistically significant difference(Z=-8.203,P<0.05);2.2 The indigestion symptom scores of the observational group(10.47±1.66)is significantly higher than the control group(6.13±1.49),there is statistically significant difference(t=13.05,P<0.05);3 The comparison of the serum level of IL-6 and TNF-α between the observational group and the control group3.1 The serum level of IL-6 of the observational group(13.70±4.14)pg/ml is significantly higher than the control group(4.19±1.35)pg/ml,there is statistically significant difference(t=14.66,P<0.05);3.2 The serum level of TNF-α of the observational group(1.94±0.47)pg/ml issignificantly higher than the control group(1.26±0.42)pg/ml,there is statistically significant difference(t=7.295,P<0.05);4 The correlation analysis between indigestion symptom scores,IL-6,TNF-αand HAMD scores in the observational group4.1 The indigestion symptom scores and the HAMD scores were positively correlated(r=0.722,P<0.01);4.2 The serum level of IL-6 and the HAMD scores were positively correlated(r =0.690,P<0.01);4.3 The serum level of TNF-α and the HAMD scores have no obvious correlation(r=0.208,P>0.05);5 The correlation analysis between IL-6,TNF-α and indigestion symptom scores in the observational group5.1 The serum level of IL-6 and the indigestion symptom scores were positively correlated(r =0.605,P<0.01);5.2 The serum level of TNF-α and the indigestion symptom scores have no obvious correlation(r=0.090,P>0.05).Conclusions:1 The indigestion symptom scores in FD patients combined with mild-to-moderate depression is significantly higher than the control group,suggesting that depression may aggravate FD indigestion symptom scores.The indigestion symptom scores and the HAMD scores is positively correlated,suggesting that depression participated in the occurrence of FD.2 The serum level of IL-6 and TNF-α is higher in the FD patients combined with mild-to-moderate depression than in the control group,suggesting that there is neuroendocrine immune dysfunction in the FD patientswith depression.IL-6 and TNF-α play an important part in the occurrence of FD.3 The serum level of IL-6 is positively correlated with HAMD scores,indigestion symptom scores,speculating that IL-6 participates in the occurrence of FD and may be relevant with the condition change of FD.4 The serum level of TNF-α in the FD patients combined with mild-to-moderate depression have no obvious correlation with HAMD scores and indigestion symptom scores,but may be related to this study sample size and the less degree of depression which is just mild-to-moderate. |
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