摘要

目的 探索慢性失眠、抑郁状态伴失眠患者中血清S100β、Dpp4水平的改变，并评估其作为判断失眠、抑郁状态伴失眠生物标志物的临床价值。

方法 纳入南华大学附属南华医院的患者及健康体检者238例，采取临床诊断和抑郁筛查自测量表（Patient Health Questionnare，PHQ-9)和失眠严重程度指数量表（Insomnia Severity Index，ISI）方式，将被试者分为正常组（n=64）、失眠组（n=64）和抑郁伴失眠组（n=110）。采用ELISA检测三组的血清S100β和Dpp4水平，比较三组在基线期的差异，并纵向比较患者组治疗前后指标变化；采用皮尔逊相关分析探索血清指标与抑郁和失眠症状的相关性；通过ROC曲线评估两种指标对失眠组、抑郁伴失眠组的诊断价值。

结果 三组间一般资料比较无统计学差异；三组的血清S100β和Dpp4水平存在明显差异，且呈现为正常值＜失眠组＜抑郁伴失眠组（P值均<0.05），且患者组的血清S100β和Dpp4水平与PHQ9和ISI评分呈正相关（r=0.209~0.479，P<0.05）；ROC曲线模型检验提示慢性失眠患者S100β曲线下面积为0.746，Dpp4的曲线下面积为0.785；抑郁状态伴失眠的患者中S100β曲线下面积为0.651，Dpp4的曲线下面积为0.636。患者组予以改善睡眠、抗抑郁等治疗后，两组PHQ9和/或ISI评分明显减低，S100β和Dpp4（P<0.001）水平明显降低。

结论 慢性失眠、抑郁状态伴失眠患者的血清S100β、Dpp4水平升高；血清S100β和Dpp4水平有望成为判断慢性失眠、抑郁状态伴失眠的潜在生物标志物。

关键词：慢性失眠；抑郁伴失眠；S100β；Dpp4

ABSTRACT

Objective This study aims to explore the correlation between these groups and serum Dpp4 and S100β levels, as well as the clinical value of serum Dpp4 and S100β levels in determining the chronic insomnia and chronic insomnia with depression in patients of insomnia disorder.

Methods Collecting 238 serum samples of volunteers and patients from Nanhua University Affiliated Nanhua Hospital, The subjects were divided into the normal group (n=64), the insomnia group (n=64), and the insomnia with depression group (n=110) by means of clinical diagnosis and Patient Health Questionnaire, PHQ-9 and Insomnia Severity Index, ISI. Serum levels of S100β and Dpp4 in the three groups were detected by ELISA. The differences among the three groups at the baseline period were compared, and the changes in the indicators before and after treatment in the patient group were longitudinally compared. Pearson correlation analysis was used to explore the correlation between serum indicators and depressive and insomnia symptoms. The diagnostic value of the two indicators for the insomnia group and the insomnia with depression group was evaluated by ROC curve..

Results There were no significant differences in general clinical data among the three groups. There were significant differences in the levels of serum S100β and Dpp4 among the three groups, and the levels were in the order of normal group < insomnia group < insomnia with depression group (all P values < 0.05). Moreover, the levels of serum S100β and Dpp4 in the patient groups were positively correlated with PHQ9 and ISI scores (r = 0.209 - 0.479, P < 0.05).. The ROC curve analysis in insomnia group showed that the area under the curve (AUC) for S100β was 0.746, and the AUC for Dpp4 was 0.785. In patients who has insomnia combined with depressive state, the AUC for S100β was 0.651, and the AUC for Dpp4 was 0.636 .After the treatment of improving sleep and anti-depression for the insomnia with depression group and the insomnia group, the PHQ9 and ISI scores were significantly reduced, and the levels of S100β and Dpp4 (P < 0.001) were significantly decreased.

Conclusion   patients who has insomnia or insomnia combined with depression state exhibit elevated serum S100β and Dpp4 levels. Serum S100β and Dpp4 levels is expecetd to be potential biomarkers to diagnose insomnia, as well as the depression state in insomnia patients .

Key words: Insomnia；Depressive state；S100β；Dpp4