【摘要】 目的 探讨重性抑郁障碍（MDD）患者炎性因子在失眠症状和认知功能间的中介作用。方法 选择2022年7月—2023年12月山西医科大学第一医院精神科门诊及病房中101例MDD患者，并在社区中纳入36名健康志愿者为健康对照组。将MDD患者依据匹兹堡睡眠质量指数（PSQI）评分分组，其中PSQI总分>7分为失眠组（71例）、PSQI总分≤7分为不伴失眠组（30例）。采用单因素ANOVA或Kruskal-Wallis H检验比较3组受试者的PSQI评分、重复性神经心理状态测验（RBANS）各维度评分、炎性因子[C反应蛋白（CRP）、白细胞介素6(IL-6)、IL-10及肿瘤坏死因子（TNF-α）]水平的差异，采用Spearman相关性检验分析三者之间相关性，并通过Bootstrap法验证分析炎性因子的中介作用。结果 失眠组的注意力维度评分低于不伴失眠组及健康对照组[（97.8±12.4）分比（105.9±14.8）分、（113.9±11.6）分]，差异有统计学意义（F=19.463,P<0.05）；失眠组的IL-6水平高于不伴失眠组及健康对照组[2.0(1.6,2.7)pg/mL比1.6(0.4,1.8)pg/mL、0.4(0.4,0.6)pg/mL]，差异有统计学意义（H=48.505,P<0.05）；失眠组的TNF-α水平高于不伴失眠组及健康对照组[17.9(14.0,20.7)pg/mL比13.7(13.0,19.0)pg/mL、13.0(12.7,13.1)pg/mL]，差异有统计学意义（H=60.906,P<0.01）。Spearman相关分析显示，失眠组PSQI中使用睡眠药物维度评分与视觉广度维度呈负相关（r=-0.368,P<0.01），与TNF-α水平呈正相关（r=0.296,P<0.05）;TNF-α水平与视觉广度维度分呈负相关（r=-0.782,P<0.01）。中介效应分析显示，失眠组使用睡眠药物维度通过炎性因子TNF-α对视觉广度维度起的中介效应作用（-2.279）占总效应的39.1%。结论 MDD患者炎性因子TNF-α水平可能在失眠症状和认知功能间起中介调节作用，反映睡眠状况的使用睡眠药物因子可直接影响视觉广度，也可能通过提高TNF-α水平间接影响视觉广度。更多还原

【Abstract】 Objective To investigate the mediating role of inflammatory factors between insomnia symptoms and cognitive function in patients with major depressive disorder(MDD). Methods A total of 101 patients with MDD in the psychiatric outpatient clinic and ward of the First Hospital of Shanxi Medical University from July 2022 to December 2023 were selected, and 36 healthy volunteers were included in the community as a healthy control group. Patients with MDD were grouped according to the Pittsburgh Sleep Quality Index(PSQI) scores, with a total PSQI score of > 7 as 71 cases in insomnia group and a total PSQI score of ≤ 7 as 30 cases in non-insomnia group. Differences in PSQI scores, Repeated Battery for Assessment of Neuropsychological Status(RBANS) factor scores, and levels of inflammatory factors [C-reactive protein(CRP), interleukin-6(IL-6), IL-10, and tumor necrosis factor(TNF-α)] were compared among the three groups of subjects by using the ANOVA or Kruskal-Wallis H-test. Spearman correlation was used to analyze the correlation between the three and the mediating role of inflammatory factors was verified by Bootstrap method. Results Attention factor scores in insomnia group were lower than those in non-insomnia group and healthy control group [(97.8±12.4) compared to(105.9±14.8) and(113.9±11.6)], and the difference was statistically significant(F=19.463, P<0.05). IL-6 levels in insomnia group were higher than those in non-insomnia group and healthy control group [2.0(1.6, 2.7) pg/mL compared to 1.6(0.4, 1.8) pg/mL and 0.4(0.4, 0.6) pg/mL], and the difference was statistically significant( H=48.505, P < 0.05). TNF-α levels in insomnia group were higher than those in non-insomnia group and healthy control group [17.9(14.0, 20.7) pg/mL compared to 13.7(13.0, 19.0) pg/mL, 13.0(12.7, 13.1) pg/mL], and the difference was statistically significant(H=60.906,P< 0.01). Spearman correlation analysis showed that the use of sleeping medication factor score in the PSQI in insomnia group was negatively correlated with the visual breadth factor score(r=-0.368, P<0.01), positively correlated with the TNF-α level( r=0.296,P<0.05), and the TNF-α level was negatively correlated with the visual breadth factor score(r=-0.782,P<0.01). The mediating effect analysis showed that the use of sleeping medication factor in insomnia group contributed 39.1% of the total effect through the mediating effect role(-2.279) of the inflammatory factor TNF-α on the visual breadth factor. Conclusions Levels of the inflammatory factor TNF-α in patients with MDD may play a mediating regulatory role between insomnia symptoms and cognitive function, and the use of sleeping medication factor, which reflects sleep conditions, may affect visual breadth directly or indirectly by increasing TNF-α levels.更多还原