Lupus：血清肿瘤坏死因子-α水平与系统性红斑狼疮患者的生活质量和抑郁症状相关

尽管系统性红斑狼疮（SLE）患者的健康相关的生活质量（HRQoL）比健康人更差，抑郁状态更严重，但是，重要促炎性细胞因子，比如，肿瘤坏死因子-α（TNF-α），对不良心理因素的重要性仍不清楚。针对这一情况，来自新加坡国立大学杨潞龄医学院风湿免疫科的A Mak等进行了一项研究。该研究的目的是探讨SLE患者抑郁症状，HRQoL和狼疮相关促炎性细胞因子有关。研究结果在线发布在2013年3月的《狼疮》（Lupus）杂志上，作者发现，SLE患者血清TNF-α水平升高与HRQoL评分更差和抑郁更严重有关。这一关系暗示，SLE患者炎性反应对抑郁症状和生活质量有潜在影响。

SLE患者和年龄匹配的健康对照受试者均接受HRQoL评估，并完成了关于抑郁和焦虑症状的简短健康状况问卷(SF-36)和医院焦虑抑郁量表的测试。采用多重免疫对SLE患者者对照者的血清促炎性细胞因子进行检测和对比，主要包括TNF-α，白介素（IL）-1 b, IL-6, IL-17, IL-23 和IL-33。采用回归模型对SF-36，血清促炎性细胞因子和HADS积分的独立关系进行分析。

研究结果如下，该研究共招募了54位SLE患者和54位健康对照。SLE患者的HRQoL明显比匹配的健康对照者差（p < 0.001），抑郁（p=0.006)和焦虑（p=0.022）症状更严重。所有研究的促炎性细胞因子中，SLE患者的血清TNF-α显著升高（ p < 0.001）。经多变量校准后，SLE患者升高的血清TNF-α（β=0.224，p=0.047）依然与SF-36评分低，吸烟（β=0.253，p=0.014)，严重抑郁症状态（β=0.433，p=0.002）有关。健康受试者中，血清TNF-α与抑郁状态有关，而与SF-36无关。

研究发现，SLE患者血清TNF-α水平升高与HRQoL评分更差和抑郁更严重有关。这一关系暗示，SLE患者炎性反应对抑郁症状和生活质量有潜在影响。
与红斑狼疮相关的拓展阅读：

• Blood：红斑狼疮治疗药不增加淋巴瘤风险
• 反应停联合羟氯喹治疗皮肤型红斑狼疮或更佳
• JAAD：反应停治疗皮肤型红斑狼疮需警惕卒中
• 补充维生素Ｄ有助治疗红斑狼疮
• 用抗疟药治疗皮肤型红斑狼疮需要耐心
• 专家视点—红斑狼疮患者妊娠的特殊挑战
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Serum tumour necrosis factor-alpha is associated with poor health-related quality of life and depressive symptoms in patients with systemic lupus erythematosus.
OBJECTIVES
While patients with systemic lupus erythematosus (SLE) have poorer health-related quality of life (HRQoL) and are more depressed than healthy people, the impact of proinflammatory cytokines, particularly tumour necrosis factor-alpha (TNFα), on these unfavourable psychosocial parameters is unclear. We aim to explore potential relationships between lupus-related proinflammatory cytokines, HRQoL and depressive symptoms in patients with SLE.
METHODS
Patients with SLE and age-matched healthy subjects were assessed for HRQoL and depressive and anxiety symptoms by the Short Form Health Survey-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) respectively. Using multiplex immunoassay, a panel of serum proinflammatory cytokines including TNFα, interleukin (IL)-1β, IL-6, IL-17, IL-23 and IL-33 were determined and compared between both groups. Independent associations between SF-36, serum proinflammatory cytokine levels and HADS scores were studied by regression models.
RESULTS
In total, 54 patients and 54 healthy controls were studied. Lupus patients had significantly poorer HRQoL (p < 0.001) and were significantly more depressed (p = 0.006) and anxious (p = 0.022) than their healthy counterparts. Amongst the proinflammatory cytokines studied, serum TNFα was significantly higher in lupus patients (p < 0.001). After multivariate adjustment, higher serum TNFα (β = -0.224, p = 0.047) remained significantly associated with lower SF-36, along with smoking (β = -0.253, p = 0.014) and more severe depressive symptoms (β = -0.433, p = 0.002). In healthy subjects, serum TNFα was associated with depressive symptoms but not with SF-36.
CONCLUSIONS
Higher serum TNFα level is independently associated with poorer HRQoL and more severe depressive symptoms in SLE patients. These associations suggest a potential impact of inflammatory response on depressive symptoms and the quality of life in patients with SLE.