【摘要】 目的 探讨抑郁症患者维生素D水平与睡眠效率及临床症状的关系进一步分析季节性差异。方法 选择2018年11月至2022年5月在我院住院治疗的369例抑郁症患者，使用汉密尔顿抑郁量表及汉密尔顿焦虑量表评价抑郁及焦虑评分，匹兹堡睡眠质量指数问卷评价睡眠质效率，静脉血测定血清25(OH)D水平。结果 抑郁症患者的25(OH)D和焦虑评分呈显著的季节性波动，25(OH)D在冬春季呈较低水平，焦虑评分在冬春季呈较高水平。控制混杂因素后，多因素线性回归模型显示，相比于维生素D非缺乏组，维生素D缺乏组患者的睡眠效率更低(β=-0.046,95%CI-0.089～-0.003),精神焦虑评分更高(β=1.240, 95%CI 0.501～1.980),未发现维生素D水平与躯体焦虑(R=0.006,P=0.902)及抑郁总得分(R=-0.025,P=0.632)差异有统计学意义。按季节分层后发现，维生素D状态与睡眠效率(P=0.001)、精神焦虑评分(P=0.018)仅在冬春季差异有统计学意义。有更高睡眠效率的抑郁症患者，其精神焦虑评分更低，差异有统计学意义(β=-1.877,95%CI-3.634～-0.119)。按季节分层后的中介效应模型显示，在冬春季调查人群中，维生素D可能通过改变睡眠效率来影响精神焦虑症状(直接效应为0.999,P=0.081;中介效应为0.401,P=0.013)。结论 抑郁症患者维生素D缺乏状态可能通过降低睡眠效率，加重精神焦虑症状，并且这种关联可能存在季节性差异。更多还原

【Abstract】 Objective To investigate the relationship between vitamin D levels and sleep efficiency and clinical symptoms in patients with depression, and to further analyze the seasonal differences.Methods A total of 369 patients with depression who were hospitalized in the P sychological Hospital from November 2018 to May 2022 were selected. The 25( OH) D level was detected by questionnaire,and the anxiety,depression scores and sleep efficiency were evaluated. Results The 25( OH) D and anxiety scores of depressed patients showed significant seasonal fluctuations,25( OH) D was lower in winter and spring,and anxiety scores were higher in winter and spring. After controlling for confounding factors,the multivariate linear regression model showed that patients in the vitamin D deficiency group had lower sleep efficiency( β =-0. 046,95% CI-0. 089 ～-0. 003) and higher scores for mental anxiety( β = 1. 240,95% CI 0. 501 ～ 1. 980) compared with those in the vitamin D non-deficiency group. No statistical association was found between vitamin D status and omatic sanxiety( R = 0. 006,P = 0. 902) or depression scores( R =-0. 025,P= 0. 632). Statistically significant associations between vitamin D status and sleep efficiency( P = 0. 001) and mental anxiety scores( P = 0. 018) were observed only in winter and spring after stratification by season. Depression patients with higher sleep efficiency had a significantly lower anxiety score( β =-1. 877,95% CI-3. 634 ～-0. 119). The seasonally stratified mediating effect model showed that vitamin D might affect the symptoms of mental anxiety by changing the sleep efficiency in the winter and spring survey population( direct effect was 0. 999,P = 0. 081; The mediating effect was 0. 401,P = 0. 013). Conclusion Vitamin D deficiency in patients with depression may aggravate symptoms of mental anxiety by reducing sleep efficiency,and there may be seasonal differences in this association.更多还原