Correlative Study On Depressive Symptoms And Regulatory T Cells In Patients With Acute Leukemia

BackgroundDepression disorde is one of the common mental disorders,the main symptoms of depression,somatic anxiety,mental anxiety,sleep disorders,fatigue and so on.Malignant tumor patients are often accompanied by different types of depressive disorders,such as depression and anxiety disorders,chronic depressive disorder,which can promote the development of tumors and affect the prognosis,and epidemiological investigation that such depressive disorder in cancer patients The incidence rate was increasing year by year.The results of the study at home and abroad that: with depression can further lead to tumor progression,and reduce the quality of life,shorten the survival time;chronic depressive disorder to promote immune function and tumor progression.As early as the last century 70 ~ 80 years there are foreign scholars noted that cancer patients prone to depression,and may be due to tumor-based protein(tumor hydrogens basic protein,TBP)produced by the corresponding antibodies,interference with 5-HT and receptor Combination,making its activity decreased,decreased immune function and suffering from depression.It has been reported that the incidence of tumor depression in foreign countries for the 3.7% to 58%,25% to 75% domestic.Some scholars even believe that almost 90% of cancer patients are suffering from long-term torture of depression symptoms,and even some cancer patients may be the direct cause of death is not a tumor but depression.WHO multicenter cooperation data show that: physicians on the recognition rate of depression was only 55.6% in 1999,Xiao Zhiping reported that Chinese physicians in Shanghai,the recognition rate of depressive symptoms was 21%.The reason may be(1)depressive symptoms are covered by somatic symptoms.(2)clinicians on the depressive symptoms of these patients is not enough attention.With the transformation of the current medical model,biomedical model to the biological one psychological-social model of medical transformation,malignant tumor treatment goals,from the simple pursuit of cure,cure,to focus on quality of life and prolong survival time,allowing "survival with tumor." Early detection of patients with depression tendency,and give appropriate intervention and treatment,and guide patients to mental health is particularly important.But due to the lack of psychological knowledge of cancer specialist and disease interference,clinically,often ignore the existence of tumor-related depression.So far,the mechanism of the relationship between tumor and depression has not been fully elucidated.However,some studies have shown that depressive disorder can lead to cellular immune dysfunction,CD3 + / CD4 +,CD3 + / CD8 +,NK cells and other T cell subsets reflect the level of cellular immune function.However,the CD3 + / CD4 +,CD3 + / CD8 +and NK cell levels were significantly decreased in the immune function test of the depressed animal model,and the quality of life of the experimental animals decreased.Clinical observation of anti-depression treatment of cancer patients after the immune function has improved its mechanism is not clear,may be through the hypothalamus-pituitary-adrenal axis(HPA)continued excitatory effect,inhibition of T cells,reduce immune function and disease resistance.On the other hand,chronic inflammation and malignant tumors promote the proliferation of MDSC and suppress the T cell immune response through MDSC.Depressive disorder aggravates the decline of immune function in malignant tumor and promotes the proliferation of MDSC by promoting inflammatory reaction.Increase the role of immune escape,and promote tumor progression.Regulatory T cells(Treg)and helper T cells 17(Th17)are two types of CD4 + T lymphocytes distinct from Th1 and Th2.Th17 cells play an important role in the development and progression of tumor,such as IL-17,which promote inflammatory reaction.Treg cells are an immune-balanced cell,which plays an important role in the development of autoimmune diseases,The Treg cells were significantly reduced,its function decreased significantly,resulting in inhibition of autoantibody production weakened,resulting in autoimmune antibodies,and thus the disease,but in the tumor,Treg cells showed a significant increase in function,secretion of IL-10(Inhibition of tumor immunity),leading to tumor proliferation,occurrence,development,metastasis and so on,and closely related with the prognosis of the tumor.Tumor cell differentiation was confirmed by TGF-? in the tumor animal model,but it was inhibited by IL-6 and induced Th17 differentiation.The two are related to each other in differentiation,functional antagonism.Animal experiments found that depression and regulatory T cells,but at home and abroad are not against Treg in the tumor-related depression clinical research.In view of this,this study intends to study the relationship between the degree of depression and the regulation of T cells in patients with acute leukemia or to help elucidate the relationship between the occurrence and development of acute leukemia depressive disorder and the regulation of T cells To explore.ObjectiveThis study will help to explore: 1)whether peripheral blood Treg can be used as an immune pathogenesis of tumor-related depression and possible intervention targets;2)whether peripheral blood Treg can be used as a sensitive marker for acute leukemia depressive symptoms Early identification and intervention index system;3)peripheral blood Treg can be used as acute leukemia depressive symptoms of individual treatment strategy choice.MethodsA total of 200 patients with acute leukemia were enrolled in this study from October 2014 to July 2016 in Guizhou Province people's hospital.At least 1 month follow-up,the patients were followed up for the first time course of chemotherapy.The Before the course of chemotherapy,according to the Hamilton Depression Scale,depression self-rating scale with depressive symptoms of acute leukemia patients into the case group;full-line acute leukemia patients with depressive symptoms,according to age,gender,education,chemotherapy And other factors 1: 1 matched into the control group.According to the National Comprehensive Cancer Network(NCCN)guidelines,the Hamilton Depression Scale and Depression Rating Scale were classified.Hamilton Depression Scale 24: total score <8 points: normal;total score in 8-20 points: may have depressive symptoms;total score in 20-35 points: certainly have depressive symptoms;total score> 35 points with severe symptoms of depression The Depression self-rating scale: the 20 items of each score added,that was coarse;standard points equal to the rough multiplied by 1.25 after the integer part of the total weight of the normal upper limit of 41 points,the total score of 53 points;0.5-0.59 mild to mild depressive symptoms;0.6-0.69 for moderate to severe depressive symptoms;0.7 above for severe depressive symptoms;Collection of patients with acute leukemia,diagnostic and treatment criteria refer to the NCCN guidelines.The patients were divided into two groups according to the Hamilton Depression Scale(24)and the Self-Rating Depression Scale.The patients were collected and the control group was collected according to the previous method.The following tests were collected:(1)Flow cytometry was used to detect the ratio of Treg and Th17 in peripheral blood.(2)The expression of IL-6,IL-17,IL-10 and TGF-?1 were detected by enzyme-linked immunosorbent assay(ELISA)Secretion level.Statistical analysis of Kruskal-Wallis H test,Spearman correlation analysis and other methods to explore the relationship between acute leukemia depressive symptoms and Treg cells.Results1.200 patients with acute leukemia were evaluated for depression.Forty-six patients were found to meet the diagnostic criteria for depression,19 of whom were mild,17 were moderate,10 were severe,and no leukemia was associated with depression 46 patients were 1: 1 matched into the control group.2.Compared with the control group,the percentage of Treg % a in the leukemia group was significantly higher than that in the control group.There was significant statistical difference between them and the control group.The percentages of Treg % and Th17% were increased in the mild,moderate and severe groups,Treg % ?Th17 %,were statistically significant;3.Compared with the control group,the IL-17,IL-10 concentrations in the leukemia patients were significantly higher than those in the control group.There was significant statistical difference between them and the control group.IL-10,IL-17 concentrations in the mild,moderate and severe groups were all higher than those in the mild and moderate groups.IL-17,IL-10 were all statistically significant.4.Th17(r = 0.295,P = 0.004),Treg(r = 0.398,p <0.001),and depression degree in the peripheral blood of depressive patients,There was a significant positive correlation.ConclusionThe quantity of Treg cells with acute leukemia were positively associated with the degree of depression.The percentage of Treg cells in the peripheral blood of patients with depression increased,the percentage of Treg cells increased,which may lead to the depression of the immune system.3.Th17 / Treg balance and the degree of depression were uncorrelated.