BDNF与抑郁症的研究现状及进展

脑源性神经营养因子(brain-derived neurothrophic factor,BDNF)在中枢和外周均广泛存在,基于对其神经再生和修复功能的普遍认识,越来越多的研究开始关注BDNF在抑郁发生过程中对神经可塑性的影响以及BDNF在抗抑郁药物治疗中发挥的作用.本文综述了BDNF与抑郁症关系的基础性研究成果,以及近两年的相关研究趋势,更多的关于BDNF与其前体(precursor of brain derived neurothrophic factor,proBDNF)以及BDNF与其它神经递质在神经网络中的相互作用的研究需要被深入开展.     

BDNF及其受体在抗抑郁症中的作用及其机制研究

脑源性神经营养因子(brain-derived neurothrophic factor,BDNF)广泛存在于中枢和外周神经系统,具有神经再生和修复功能。近年来,研究发现BDNF在改善抑郁发生过程中神经可塑性以及抗抑郁药物治疗中发挥重要的作用。综述了BDNF及其受体在抗抑郁症中的作用及其机制研究。     

云南汉族人群5-羟色胺转运体基因启动子区多态性与酒精依赖的相关性

为了探讨云南汉族人群中5-羟色胺转运体基因启动子区多态性(5-HTTLPR)与酒精依赖的关联性, 文章采用PCR扩增和DNA测序技术, 对云南地区118例酒精依赖患者和214例健康对照个体进行了5-HTTLPR的基因多态性分析。结果表明: 酒精依赖患者组和正常对照组的5-HTTLPR的基因型分布存在显著性差异, L/L和L/S基因的携带者人群嗜酒发生率显著低于S/S基因型人群(OR: 0.581, P=0.026)。S和L等位基因频率在两组间无统计学差异(χ²=2.594, P=0.107), 但其分布存在种族差异性。因此, 云南地区人群中5-HTTLPR多态与酒精依赖存在相关性, L/L和L/S基因型可能是降低酒精依赖发病的影响因子之一。     

双相障碍抑郁发作及单相抑郁症患者血清T3、T4、TSH和BDNF水平的相关性分析

目的:分析双相障碍抑郁发作及单相抑郁症患者与血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、甲状腺激素(TSH)和脑源性神经营养因子(BDNF)水平的相关性。方法:选取2017年12月～2019年12月我院收治的120例抑郁症患者为研究对象,按照病情不同分为双相障碍抑郁发作组(n=50)、单相抑郁症组(n=70),同时选取同期于本院进行体检的30例健康者作为对照组,检测血清T3、T4、TSH和BDNF水平,并进行汉密尔顿抑郁(HAMD)量表评分,分析血清T3、T4、TSH和BDNF水平的相关性。结果:双相障碍抑郁发作组起病年龄低于单相抑郁症组(P0.05);治疗前双相障碍抑郁发作组和单相抑郁症组血清T3水平高于对照组,TSH、BDNF水平低于对照组(P0.05),双相障碍抑郁发作组血清T4水平高于对照组,单相抑郁症组和对照组血清T4水平比较差异无统计学意义(P0.05),双相障碍抑郁发作组血清T4水平高于单相抑郁症组,TSH、BDNF水平低于单相抑郁症组(P0.05);治疗后双相障碍抑郁发作组和单相抑郁症组血清T4水平低于对照组,双相障碍抑郁发作组血清T4水平低于单相抑郁症组(P0.05),且三组血清T3、TSH、BDNF水平比较差异无统计学意义(P0.05);治疗后双相障碍抑郁发作组认知障碍因子评分低于单相抑郁症组(P0.05);Spearman相关分析显示,血清T3、T4、TSH水平和HAMD评分与BDNF呈负相关,TSH水平与BDNF呈正相关(P0.05)。结论:抑郁症患者血清T3、T4、TSH和BDNF水平存在异常,可作为判断双相障碍抑郁发作及单相抑郁症的指标。     

节肢动物生殖器官进化的假说

节肢动物生殖器官的多样性及种间差异现象是动物学研究的热点.进化生物学家先后提出锁钥(lock-and-key)假说、基因多效性(pleiotropy)假说和性选择(sexual selection)假说解释节肢动物生殖器官演化规律,其中锁钥假说曾被广泛接受,但目前支持性选择假说的证据较多.     

重复经颅磁刺激联合盐酸帕罗西汀对抑郁症患者生活质量及血清NPY、BDNF与5-HT水平的影响

目的:探讨重复经颅磁刺激(r TMS)联合盐酸帕罗西汀治疗抑郁症患者的临床疗效及对患者生活质量和血清神经肽Y(NPY)、脑源性神经营养因子(BDNF)、5-羟色胺(5-HT)水平的影响。方法:选取2017年2月～2019年3月期间北京回龙观医院收治的91例抑郁症患者,按数表法将患者随机分为对照组(n=45)和研究组(n=46),对照组给予盐酸帕罗西汀治疗,研究组在对照组的基础上联合r TMS治疗,比较两组患者临床疗效、生活质量、汉密尔顿抑郁量表(HAMD)评分、血清相关指标及不良反应。结果:治疗4周后,研究组临床总有效率较对照组升高(P0.05)。两组治疗4周后HAMD量表评分均下降,且研究组低于对照组(P0.05)。两组治疗4周后躯体角色、社会功能、情感职能、精力、精神健康、一般健康、躯体疼痛、躯体机能评分均升高,且研究组高于对照组(P0.05)。两组治疗4周后血清NPY、BDNF、5-HT水平均升高,且研究组高于对照组(P0.05)。两组不良反应发生率比较无统计学差异(P0.05)。结论:r TMS联合盐酸帕罗西汀治疗抑郁症疗效显著,可改善患者的临床症状、生活质量以及血清NPY、BDNF、5-HT水平,安全性较好,具有一定的临床应用价值。     

TNF-α在抑郁症中的作用和机制研究

抑郁症是一种情感精神疾病,临床上以显著而持久的心境低落为主要特征。抑郁症严重危害人们身心健康,降低生活质量,增加社会负担。抑郁的产生原因比较复杂,发病机制存在多种假说。在过去的几十年,虽然对于抑郁症的研究取得了一定的进展,但其确切的病因及病理生理机制目前仍不明确。近期,研究显示,促炎性细胞因子,尤其是肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)在抑郁症的发生、发展及临床药理机制中扮演着重要角色。现通过对TNF-α的生物学特征、在抑郁症发病和抗抑郁治疗中的作用、基因多态性与抑郁症关联性以及未来的应用与展望等进行综述,以期从多方面阐明TNF-α在抑郁症中的作用。     

抗炎性细胞因子与抑郁症

细胞因子假说是关于抑郁症发病机理的重要假说,为探讨抑郁症的发病机理和临床治疗方法提供了新方向.细胞因子分为前炎性细胞因子和抗炎性细胞因子.前炎性细胞因子与抑郁症的发病密切相关,而抗炎性细胞因子可能具有抗抑郁的作用.本文着重综述抗炎性细胞因子与抑郁症的关系.抗炎性细胞因子如白介素10、白介素1受体拮抗剂、白介素4、白介素13、转化生长因子β和脂联素等,在抑郁症中表达下降;补充外源抗炎性细胞因子则具有一定的抗抑郁作用.抗炎性细胞因子可通过拮抗前炎性细胞因子的作用,并与MAPK信号通路、神经递质和糖皮质激素相互作用而参与到抑郁症中.抗抑郁药能使抗炎性细胞因子的表达上升,这可能是药物起效的机制之一.抗炎策略在抑郁症的治疗中有重要应用前景.     

新疆维、哈、蒙古族-HTT基因启动子区多态性的研究

采用聚合酶链反应(PCR)技术,对我国新疆维吾尔族、哈萨克族和蒙古族三个正常群体5-HTT基因启动子区(5-HTTLPR)的一个插入/缺失多态性进行了研究。结果显示:5-HTTLPR等位基因及基因型频率分布在三个民族中没有较大差异,短片段等位基因S有较高的分布频率。X2检验证明,三个民族群体的基因型分布均符合Hardy-Weinberg平衡(P>0.05)。经分析,维吾尔族的观测杂合度(Hobs)、期望杂合度(Hexp)、多态信息量(PIC)分别为0.4167、0.4845和0.3759;哈萨克族的Hobs、Hexp和PIC分别为0.4141、0.4338和0.3396;蒙古族的Hobs、Hexp和PIC分别为0.4639、0.4386和0.3425。结果可为人类学、法医学鉴定及疾病的关联研究提供遗传学数据。     

睡眠研究的科学前沿

关于睡眠机制的研究是一门历史悠久的学科.在过去的几十年中,运用细胞电生理学来研究睡眠取得了可喜的成果.由于种种技术上的困难,近年来该领域的研究多集中于临床和医学范围,例如嗜睡症、抑郁症等.虽说睡眠的节律性较易理解,但作为其本质———睡眠的基因和分子水平的自动平衡调节仍是一个谜.细胞因子(IL-1和TNFα)对睡眠的诱导作用已显示从分子水平上了解睡眠的可能性.到目前为止,关于睡眠的功能已有不少理论和假说,但人类对睡眠的生化机制的认识尚处于起步阶段.     

No effect of 5HTTLPR or BDNF Val66Met polymorphism on hippocampal morphology in major depression

Neuroimaging research implicates the hippocampus in the aetiology of major depressive disorder (MDD). Imaging genetics studies have investigated the influence of the serotonin transporter-linked polymorphic region (5HTTLPR) and brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on the hippocampus in healthy individuals and patients with depression (MDD). However, conflicting results have led to inconclusive evidence about the effect of 5HTTLPR or BDNF on hippocampal volume (HCV). We hypothesized that analysis methods based on three-dimensional (3D) hippocampal shape mapping could offer improved sensitivity to clarify these effects. Magnetic resonance imaging data were collected in parallel samples of 111 healthy individuals and 84 MDD patients. Manual hippocampal segmentation was conducted and the resulting data used to investigate the influence of 5HTTLPR and BDNF Val66Met genotypes on HCV and 3D shape within each sample. Hippocampal volume normalized by intracranial volume (ICV) showed no significant difference between 5HTTLPR S allele carriers and L/L homozygotes or between BDNF Met allele carriers and Val/Val homozygotes in the group of healthy individuals. Moreover, there was no significant difference in normalized HCV between 5HTTLPR diallelic and triallelic classifications or between the BDNF Val66Met genotypes in MDD patients, although there was a relationship between BDNF Val66Met and ICV. Shape analysis detected dispersed between-group differences, but these effects did not survive multiple testing correction. In this study, there was no evidence of a genetic effect for 5HTTLPR or BDNF Val66Met on hippocampal morphology in either healthy individuals or MDD patients despite the relatively large sample sizes and sensitive methodology.     

White matter microstructure in bipolar disorder is influenced by the serotonin transporter gene polymorphism 5‐HTTLPR

Bipolar disorder (BD) is associated with signs of widespread disruption of white matter (WM) integrity. A polymorphism in the promoter of the serotonin transporter (5‐HTTLPR) influenced functional cortico‐limbic connectivity in healthy subjects and course of illness in BD, with the short (s) allele being associated with lower functional connectivity, and with earlier onset of illness and poor response to treatment. We tested the effects of 5‐HTTLPR on diffusion tensor imaging (DTI) measures of WM microstructure in 140 inpatients, affected by a major depressive episode in course of BD, of Italian descent. We used whole brain tract‐based spatial statistics in the WM skeleton with threshold‐free cluster enhancement of DTI measures of WM microstructure: axial, radial and mean diffusivity and fractional anisotropy. Compared with l/l homozygotes, 5‐HTTLPR*s carriers showed significantly increased radial and mean diffusivity in several brain WM tracts, including corpus callosum, cingulum bundle, uncinate fasciculus, corona radiata, thalamic radiation, inferior and superior longitudinal fasciculus and inferior fronto‐occipital fasciculus. An increase of mean and radial diffusivity, perpendicular to the main axis of the WM tract, is thought to signify increased space between fibers, thus suggesting demyelination or dysmyelination, or loss of bundle coherence. The effects of 5‐HTTLPR on the anomalous emotional processing in BD might be mediated by changes of WM microstructure in key WM tracts contributing to the functional integrity of the brain.     

伴海马硬化的颞叶癫痫患者海马组织内BDNF表达变化

目的：研究伴海马硬化的难治性颞叶癫痫（TLE）患者海马组织内脑源性神经营养因子（brain derivedneurotrophic factor,BDNF）的表达变化,探讨其在难治性颞叶癫痫发病机制中的作用。方法：采集5例伴海马硬化的难治性TLE患者手术中切除的海马组织,用逆转录-聚合酶链反应（RT—PCR）法检测BDNFmRNA表达,并与3例非海马硬化TLE患者对照。结果：与非海马硬化组比较,伴海马硬化的难治性TLE患者海马组织中的BDNFmRNA表达明显增加（P〈0．01）。结论：伴海马硬化的难治性TLE患者海马组织中BDNFmRNA表达表达增高,可能在海马硬化和难治性颞叶癫痫发生、发展中具有重要作用。     

5‐HTTLPR genotype potentiates the effects of war zone stressors on the emergence of PTSD,depressive and anxiety symptoms in soldiers deployed to iraq

Exposure to war zone stressors is common, yet only a minority of soldiers experience clinically meaningful disturbance in psychological function. Identification of biomarkers that predict vulnerability to war zone stressors is critical for developing more effective treatment and prevention strategies not only in soldiers but also in civilians who are exposed to trauma. We investigated the role of the serotonin transporter linked polymorphic region (5‐HTTLPR) genotype in predicting the emergence of post‐traumatic stress disorder (PTSD), depressive and anxiety symptoms as a function of war zone stressors. A prospective cohort of 133 U.S. Army soldiers with no prior history of deployment to a war zone, who were scheduled to deploy to Iraq, was recruited. Multilevel regression models were used to investigate associations between 5‐HTTLPR genotype, level of war zone stressors, and reported symptoms of PTSD, depression and anxiety while deployed to Iraq. Level of war zone stressors was associated with symptoms of PTSD, depression and anxiety. Consistent with its effects on stress responsiveness, 5‐HTTLPR genotype moderated the relationship between level of war zone stressors and symptoms of emotional disturbance. Specifically, soldiers carrying one or two low functioning alleles (S or L_G) reported heightened symptoms of PTSD, depression and anxiety in response to increased levels of exposure to war zone stressors, relative to soldiers homozygous for the high functioning allele (L_A). These data suggest that 5‐HTTLPR genotype moderates individual sensitivity to war zone stressors and the expression of emotional disturbance including PTSD symptoms. Replication of this association along with identification of other genetic moderators of risk can inform the development of biomarkers that can predict relative resilience vs. vulnerability to stress.     

舍曲林辅助治疗对抑郁症合并冠心病患者血清炎症因子水平及预后的影响

目的：探讨舍曲林辅助治疗对抑郁症合并冠心病患者血清炎症因子水平及预后的影响。方法：选择2009年8月-2011年8月我院收治的86例抑郁症合并冠心病患者,将其随机分入对照组与观察组,40例对照组患者接受冠心病常规治疗,46例观察组患者在常规治疗基础上给予舍曲林口服,每次504100mg,每日1次,疗程24周。比较两组治疗期间心血管事件发生率、治疗前后汉密尔顿抑郁量表（HAMD）评分及血清炎症因子超敏c-反应蛋白（hs—CRP）、肿瘤坏死因子-α（TNF—α）及白介素-6（IL-6）的变化．结果：观察组心血管不良事件发生率显著低于对照组（13．0％VS32．5％,P〈0．05）;观察组治疗后HAMD评分、血清hs—CRP、TNF一双及IL-6水平显著均显著低于对照组（P〈0．05）。结论：舍曲林辅助治疗可显著改善抑郁症合并冠心病患者的抑郁状态,降低炎症因子水平并改善其预后．     

Evidence for plasticity genotypes in a gene–gene–environment interaction: the TRAILS study

The purpose was to study how functional polymorphisms in the brain derived neurotrophic factor gene (BDNF val66met) and the serotonin transporter gene linked promotor region (5‐HTTLPR) interact with childhood adversities in predicting Effortful Control. Effortful Control refers to the ability to regulate behavior in a goal‐directed manner and is an interesting endophenotype for psychopathology because of its heritability and the association of low Effortful Control with both internalizing and externalizing problems. In a longitudinal population‐based study Effortful Control was assessed with the parent version of the Early Adolescent Temperament Questionnaire at age 11. Pregnancy and delivery adversities and childhood events were assessed in a parent interview at age 11. Long‐term difficulties until age 11 were assessed with a parent questionnaire at age 13.5. Blood or buccal cells were collected at age 16 for genotyping the rs6265 and rs25531 SNPs and the 5‐HTTLPR length polymorphism. The study included 1032 complete data sets. Effortful Control was significantly predicted by the interaction between BDNF val66met, 5‐HTTLPR and childhood events. The BDNF val66met val/val–5‐HTTLPR l′/l′ genotype was unaffected by childhood events, while having either at least one BDNF val66met met or 5‐HTTLPR s′ allele (l′/l′‐met‐carrier; l′/s′‐val/val; s′/s′‐val/val) made children sensitive to childhood events. Predictions of Effortful Control by pregnancy and delivery adversities and long‐term difficulties were largely independent of genotype. We concluded that the l′/l′‐met‐carrier, l′/s′‐val/val and the s′/s′‐val/val genotypes showed greatest plasticity while the l′/l′‐val/val genotype was unaffected by childhood events.     

Plasma brain-derived neurotrophic factor levels predict the clinical outcome of depression treatment in a naturalistic study

Remission is the primary goal of treatment for major depressive disorder (MDD). However, some patients do not respond to treatment. The main purpose of this study was to determine whether brain-derived neurotrophic factor (BDNF) levels are correlated with treatment outcomes. In a naturalistic study, we assessed whether plasma BDNF levels were correlated with clinical outcomes by measuring plasma BDNF in patients with depressive syndrome (MADRS score ≥ 18), and subsequently comparing levels between the subgroup of patients who underwent remission (MADRS score ≤ 8) and the subgroup who were refractory to treatment (non-responders). Patients with depressive syndrome who underwent remission had significantly higher plasma BDNF levels (p<0.001), regardless of age or sex. We also found a significant negative correlation between MADRS scores and plasma BDNF levels within this group (ρ = -0.287, p = 0.003). In contrast, non-responders had significantly lower plasma BDNF levels (p = 0.029). Interestingly, plasma BDNF levels in the non-responder group were significantly higher than those in the remission group in the initial stage of depressive syndrome (p = 0.002). Our results show that plasma BDNF levels are associated with clinical outcomes during the treatment of depression. We suggest that plasma BDNF could potentially serve as a prognostic biomarker for depression, predicting clinical outcome. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000006264.     

脑源性神经营养因子基因多态性与注意缺陷多动障碍的关联性研究

目的：探讨脑源性神经营养因子（Brain-derivedneurotrophicfactor,BDNF）G196A、C270T及Val66Met3个单核苷酸多态性（SNP）位点与注意缺陷多动障碍（ADHD）的关系。方法：选取无亲缘关系的ADHD患者共114例,健康对照共96例。采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）技术检测G196A、C270T和Val66Met3个多态性位点的多态性,采用HaploView4.0及SPSS13.0软件进行连锁不平衡分析并比较两组基因型分布和等位基因频率。结果：BDNF三个多态性位点基因型及等位基因频率分布均符合Hardy-Weinberg定律。ADHD组G196A和C270T多态性位点分布与正常对照组比较差异无统计学意义,而BDNF基因Val66Met位点的基因型及等位基因频率分布在ADHD组与对照组存在显著性差异（p〈0.05）,ADHD组Val66Met位点的等位基因G（Val）频率显著高于正常对照组。结论：BDNF基因Val66Met多态性可能与ADHD发病有关,携带有Val66Met多态性位点G等位基因的个体可能更容易产生ADHD。     

BDNF RNA干扰在多巴胺能PC12细胞凋亡中的作用研究

目的：探讨脑源性神经营养因子（brain derived neurotrophic factor,BDNF）在PC12细胞凋亡中的作用。方法：设计并合成针对BDNF mRNA序列的小片段干扰RNA（siRNA）,利用lipofectamine 2000将siRNA转染入PC12细胞中或给与6-OHDA损伤,给与/不给予BDNF蛋白保护,采用定量PCR和免疫荧光法检测BDNF mRNA和蛋白表达水平;采用上清液乳酸脱氢酶（LDH）释放量测定和流式细胞仪法检测siRNA对细胞凋亡的影响。结果：转染siRNA的细胞的BDNF mRNA的表达量比正常组细胞减少73%,而转染作为对照的scrambled siRNA的细胞的BDNF mRNA的表达没有明显变化。BDNF RNA干扰与6-OHDA神经毒性一样可诱导PC12细胞的LDH释放和细胞凋亡。给予BDNF蛋白保护后细胞毒性减轻。结论：BDNF基因下调可以导致PC12细胞的凋亡,BDNF蛋白对PC12细胞有保护作用,为进一步进行动物体内研究奠定了基础。