| Objective:Depression is a mental disorder with depressing mood, lack of joy and loss of interest as main clinical feature, usually recurred with procrastinate course. In current society, as the pace of life speeds up, the social pressure increases, the prevalence of depression has an upward trend. It’ll affect people’s health and socio-economic development seriously.In Chinese traditional medicine, depression was considered from the view of holism. The ancient Chinese medicine practitioners thought that depression was a disease based on the inborn susceptibility of the human body, added with extreme emotion, stagnation of Qi, then it involved internal organs, affected the normal operation of Qi, blood and body fluid, resulted in lack of nourishment of spirit, deficiency and dysfunction of five Zang organs etc. Modern Chinese medicine physicians believed that depression was caused by long-term internal and external environmental stimuli and internal organs function disorder, emotional regulation disorder. It was deficiency in origin and enrichment in symptom, involved the heart, liver, spleen, lung, kidney and brain and many internal organs, characterized by disorder of functional acclivities of Qi and the function of Zang-Fu organs disorders. In modern medicine, several hypothesists has been raised on the etiology of depression, such as biochemical hypothesis, the hypothesis of neuro-endocrine and neural immunity, gene hypothesis, and so on.Yang-deficiency constitution represents mainly as weak Yang-Qi in physical state and become the physical basis of many diseases. Physical factors may determine the susceptibility of pathogenic factors and lesions of the body type preference. Increasing evidences suggest that depression is related with Yang-Qi deficiency. Some scholars have elaborated the relationship between depression and Yang deficiency from the onset age, season, clinical performances. Some Traditional Chinese medicine of warm and tonify kidney-Yang have antidepressant effects.The normal arterial blood pH values in adult range from 7.36 to 7.44. Acid-base imbalance will be occurred when too much acidic or alkaline substance produced exceed the body’s adjustment capacity, or kidney and lung disorders result in regulation ability of acid-base balance declined. In this condition, the bodies will iniate a series of mechanisms to resist their own body fluid pH value changes. The mechanisms involve three aspects:①the buffer effect of extracellular fluid, intracellular fluid and bone;②djustment of blood carbon dioxide pressure through change of pulmonary ventilation rate; ③ adjustment of renal secretion of acid and alkali.Metabolic acidosis can lead to decreases of bone mineral. The bone mineral such as sodium, potassium, carbonate and phosphate dissolve by physicochemical effects first, and later mediated by the changes of bone cell function. Acidosis inhibits Osteoblast activity, especially inhibits specific matrix proteins synthesis and activity of alkaline phosphatase. Osteogenic cells produce prostaglandins in manner of para-crine with acid stimulation, which will increase the synthesis of RANKL. Osteoclast activity is stimulated by RANKL following, recruiting more osteoclast to facilitate bone resorption to buffer excess hydrogen ions loads. The protective function of bone for keeping the system stable pH value will come at the expense of its mineral stores.Multiple studies at home and abroad have proved that the bone density is decreased in patients with depression, and there is close relationship between decreased bone density and metabolic acidosis. The performance of acidic constitution described by domestic Scholars is very similar with the clinical presentation of depression. But until now, the clear detecting index of acidic constitution is lacking, and the study among depression, bone mineral density and acidic Constitution is rarely reported.So the objective of this article is:1. To clarify the relationship between depression and Yang deficiency;2. To clarify whether the the bone density is abnormal in patients with depression?3. Whether there is a clear indicator of acid-base disturbance in patients with depression?4. Whether there are differences in acid-base indicators and bone mineral density between Yang deficiency and non Yang deficiency patients with depression?Method:This study was cross-sectional study with procedures as follows:1. Collecting outpatients with depression;2. Selecting normal control group paired with patients by sex, age, body mass index;3. Signing the informed consent form;4. Assessing Hamilton depression scale and Chinese medicine Questionnaire;5. Detecting venous blood gas analysis and bone mineral density;6. All data were analyzed in PASW Statistics 18.0 data statistical package. the statistic methods involved t-test, analysis of variance, correlation analysis and X2 testing.Results:There were 52 cases both in depression group and normal control group, with 15(28.8%) males and 37(71.2%) females. There had no significantly differences between two groups in age, height and weight, but existing differences in education years and weight index. In depression group, the proportion of administration personnel was less than control group (X2 =78.386, P=0.006), the proportion of jobless/unemployment is greater than control group (X2=7.792,P=.005).In depression group, according to constitution criteria, there were 10 cases of single constitution,4 of two-mixed constitution,7 of three-mixed constitution,10 of four-mixed constitution and 21 of more than five-mixed constitution. According to the maximum score of 9 constitutions, there were 16 cases of Qi deficiency,16 cases of Qi stagnation,12 cases of Yang deficiency,5 casas of Damp-heat,1 case of normal,1 case of Yin deficiency, 1 case of Special. In control group, there were 47 cases of single constitution, 2 of two-mixed constitution,0 of three-mixed constitution,2 of four-mixed constitution and 1 of five-mixed constitution. According to the maximum score of 9 constitutions, there were 3 cases of Qi deficiency,1 cases of Qi stagnation,11 cases of Yang deficiency,5 casas of Damp-heat,27 case of normal,3 case of Yin deficiency,2 case of phlegm-dampness.The values of PvO2, SvO2, CvO2, SB and venous pH in depression group were higher than that in control group(pH value:7.368±0.026vs7.341±0.024, t=5.132, P<0.001; PvO2:32.523±11.518vs22.646±5.383, t=5.516, P<0.001; Sv02:52.162±21.559vs29.552±12.748, t=6.483, P< 0.001; CvO2:4.679±2.277 vs2.625±1.109,t=5.784, P<0.001; SB:24.044±1.260vs23.425±1.335,t=2.942, P=0.005), the values of PvC02, CvC02, AB were lower than that of control group (PvC02:46.635±5.708vs51.117v5.410, t=-4.061, P< 0.001;CvC02:27.534±2.317 vs28.433±2.246, t=-2.240, P=0.030;AB:26.073±2.194vs26.860±2.105, t=-2.107, P=0.040). The two groups showed no statistically significant difference in lumbar spine bone mineral density and T values, Z value, but showed significant differences in femoral neck and proximal femoral bone mineral density, T, Z values, which was significantly lower in depression group than that of control group (femoral neck-BMD:0.735±0.104vs0.787±0.082, t=-2.654,p= 0.011; Femoral neck-T:-1.171±0.862vs-0.713±0.724,t=-2.526,p=0.015; Femoral neck-Z:-0.853±0.855vs-0.420±0.771,t=-2.493, P=0.016; Proximal femur-BMD:0.875±0.104vs0.916±0.091, t=-2.183, P=0.034; Proximal femur-T:-0.696±0.808vs-0.373±0.691, t=-2.054,p=0.046; Proximal femur-Z:-0.537± 0.809vs-0.224±0.772, t=-2.103,p=0.041). In hip structural analysis, the CSA of NN regional in depression group was lower than that of control group (2.65±0.46vs2.87±0.43, t=-2.915,P=0.005); and no statistical difference in other hip structural.The scores of cognitive impairment factor, retardation factor and total depression in Yang deficiency depression group were higher than those of non Yang deficiency depression Group (cognitive impairment factor:5.48± 2.01vs4.19±1.97, t=2.294, P=0.026;Retardationfactor:8.71±1.75vs7.29±1.65, t=2.942, P=0.005; Total depression score:29.26±4.47vs25.67±4.69, t=2.785, P=0.008). Variance analyses were implemented among Yang deficiency depression group, non Yang deficiency depression group and normal control group. Some indicators showed no difference between Yang deficiency and non Yang deficiency depression group, but all of them showed significant differences comparing with control group. These indicators included PvO2, PvCO2, SvO2 and CvO2. The venous blood pH value showed significant difference among 3 groups. It was minimum in control group, then the Yang deficiency depression group, it’s supreme in non Yang deficiency depression group. The value of femoral neck-BMD showed no difference not only between Yang deficiency and non Yang deficiency depression group, but also between non Yang deficiency depression group and control group. But it’s lower in Yang deficiency depression group than that in control group. The value of SB was higher in non Yang deficiency depression group than that in control group.In depression group, the score of anxiety factor in Hamilton Depression Scale showed positive correlation with scores of phlegm-dampness constitution. The score of cognitive impairment factor showed positive correlation with scores of Yin deficiency and Static-blood constitution. The score of retardation factor showed negative correlation with scores of normal constitution, and positive correlation with scores of Yang deficiency and Qi deficiency constitution. The total depression score showed negative correlation with scores of normal constitution, and positive correlation with scores of Yang deficiency and Qi deficiency constitution. The score of cognitive impairment factor was positive correlated with the value of PvO2, the score of weight factor was negative correlated with L1-BMD, L1-T, L1-Z and L2-BMD.In control group, the values of PO2, SvO2 and CvO2 were positive correlated with FS-DR, the values of PvCO2 and CvCO2 were positive correlated with HAL. Conclusion:1. Deficiency of acid excretion and tissue hypoxia exist in depression.2. Lower bone mineral density exists in depression, it may be associated with tissue acidosis and hypoxia.3. The higher venous pH values and PvO2/SvO2/CvO2, lower PvCO2, may be the characteristic indexes of acidosis/acidic constitution.4. Depression is closely related to Yang deficiency constitution, and Yang deficiency constitution is closely related to lower bone mineral density in depression.5. In depression, the score of anxiety factor in Hamilton Depression Scale showed positive correlation with scores of phlegm-dampness constitution. The score of cognitive impairment factor showed positive correlation with scores of Yin deficiency and Static-blood constitution. The total depression score, the score of retardation factor showed positive correlation with scores of Yang deficiency and Qi deficiency constitution, and negative correlation with scores of nomal constitution.6. The risk of fracture increases in patients with depression for its abnormality of hip bone structure; hip structure abnormal associated with hypoxia. |
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