憂鬱與血中鋅濃度降低有關


  【24drs.com】一篇統合分析認為,憂鬱患者的週邊血液鋅濃度比無憂鬱者低。
  
  加拿大多倫多大學Sunnybrook研究院Walter Swardfager博士等人寫道,鋅濃度與憂鬱之間的病理生理關係,以及憂鬱患者補充鋅的潛在好處,需要後續研究探討。
  
  這些研究結果發表於12月15日的生物精神學期刊。
  
  作者們寫道,越來越多證據顯示,以實驗方法讓動物缺乏鋅會誘發牠們的類憂鬱行為,補充鋅之後可以有效恢復;再者,初步臨床試驗認為,抗憂鬱治療時加入鋅可以更迅速或更有效的改善憂鬱症狀。
  
  研究者指出,過去十年來,探討憂鬱和無憂鬱者之週邊血液鋅濃度的研究,有許多認為,憂鬱可能和某些人的鋅濃度低有關。
  
  這篇統合分析的目標是確認臨床證據是否支持憂鬱患者的鋅濃度比無憂鬱者低。
  
  這篇分析包括了17篇測量週邊血液鋅濃度的研究,包括1,643名憂鬱患者以及804名對照組;其中10篇研究對象是精神科住院病患,7篇是社區樣本;34.4%研究對象是男性;平均年紀37.7歲。
  
  研究者發現,憂鬱患者的平均週邊血液鋅濃度比對照組低了將近1.85 μmol/L(95%信心區間[CI],-2.51至-1.19;P < .00001);憂鬱者和對照組的鋅濃度差異越大時,其憂鬱更嚴重(P = .026)。
  
  此外,作者們報告指出,住院病患的效應值(加權平均差[WMD],-2.543;95% CI,-3.522至 -1.564;P < .0001)比社區樣本(WMD,-.943;95% CI,-1.563至-.323;P = .003)更大,在研究方法品質更佳的研究也是(WMD,-2.354;95% CI,-2.901至 -1.807;P < .0001)。
  
  作者們寫道,雖然關聯性研究無法確認因果關係,鋅濃度和憂鬱症在生物學方面之因果關係是肯定的。
  
  他們寫道,鋅有抗氧化性質,可幫助維持體內內分泌平衡以及免疫功能,在調節海馬回和皮層麩胺酸迴路有多種功能,這些有益於調控情感與認知功能。因此,鋅平衡狀態受影響時可能危及神經可塑性,並造成長期神經心理學和精神病學之衰退。
  
  作者們指出,鋅對免疫功能也很重要。血清鋅濃度低和影響脂肪酸代謝及血清脂質值有關,這可能會影響腦部功能和血管健康。鋅濃度低也和心血管疾病有關,心血管疾病是重度憂鬱異常(MDD)常見的共病症。
  
  研究者提到它們的研究限制。他們寫道,像這篇統合分析之研究的品質和偏見風險是不平等的。
  
  作者們寫道,並非所有研究的人口統計學資料都足以納入探討異質性,所用的抗憂鬱劑和其他藥物也未有一致報告,沒有關於飲食和飲酒的資料。
  
  研究者結論表示,儘管有限制,研究結果認為憂鬱和週邊血液鋅濃度降低有關。
  
  他們結論指出,研究結果認為需要進一步探討:鋅在憂鬱症之病理生理學的可能角色,鋅的可能用處,以及監測MDD的相關生物標記與其臨床後遺症,還有MDD病患補充鋅的潛在效益。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7042&x_classno=0&x_chkdelpoint=Y
  

Depression Linked to Low Zinc Levels in Blood

By Fran Lowry
Medscape Medical News

People who are depressed have lower concentrations of zinc in their peripheral blood compared with nondepressed individuals, a meta-analysis suggests.

"The pathophysiological relationships between zinc status and depression, and the potential benefits of zinc supplementation in depressed patients, warrant further investigation," write Walter Swardfager, PhD, from the Sunnybrook Research Institute, University of Toronto, Canada, and colleagues.

Their findings were published in the December 15 issue of Biological Psychiatry.

Link to Zinc Deficiency

"A growing body of evidence demonstrates that experimental zinc deficiency can induce depressive-like behavior in animals, which can be effectively reversed by zinc supplementation," the authors write. Furthermore, preliminary clinical trials have suggested that zinc added to antidepressant therapy may produce more rapid or more effective improvement in depressive symptoms.

Many, although not all, studies that have measured zinc concentrations of peripheral blood in depressed and nondepressed individuals during the past several decades have suggested that depression might be associated with lower zinc concentrations in various population samples, the researchers note.

The aim of this meta-analysis was to determine whether the clinical evidence collectively supports lower zinc concentrations in depressed patients compared with nondepressed individuals.

The analysis included 17 studies that measured peripheral blood–zinc concentrations in 1643 depressed patients and 804 control participants. Ten of these studies reported on psychiatric inpatients, and 7 reported on community samples. Of the participants, 34.4% were male; the mean age was 37.7 years.

The researchers found that mean peripheral blood–zinc concentrations were lower by approximately 1.85 μmol/L in depressed individuals compared with control participants (95% confidence interval [CI], -2.51 to -1.19; P < .00001).

More severe depression was associated with greater differences in zinc levels between depressed and control participants (P = .026).

Further, the authors report that effect sizes were larger in studies of inpatients (weighted mean difference [WMD], -2.543; 95% CI, -3.522 to -1.564; P < .0001) vs community samples (WMD, -.943; 95% CI, -1.563 to -.323; P = .003) and in studies with higher methodologic quality (WMD, -2.354; 95% CI, -2.901 to -1.807; P < .0001).

Biologically Plausible

"Although association studies cannot determine the direction of causation, a causal association between zinc status and depression is biologically plausible," the authors write.

"Zinc has antioxidant properties, helps to maintain endocrine homeostasis and immune function, and plays multiple roles in regulating the hippocampal and cortical glutamatergic circuits that subserve affective regulation and cognitive function. Thus, changes in zinc homeostasis might compromise neuroplasticity and contribute to long-term neuropsychological and psychiatric decline," they write.

Zinc also plays an important role in immune function. Lower serum levels of zinc have been associated with disturbances in fatty acid metabolism and in serum lipid levels, which might affect brain function and vascular health. Lower zinc levels have also been associated cardiovascular disease, a common comorbidity of major depressive disorder (MDD), the authors note.

The investigators point out limitations of their study. The quality and risk of bias "were uneven among studies included in this meta-analysis," they write.

Not all studies reported demographic data "sufficiently to be included in investigations of heterogeneity, the use of antidepressants and other concomitant medications were not consistently reported, and data on diet and alcohol use were often not reported," the authors write.

Limitations notwithstanding, the authors conclude that their results suggest that depression is associated with reduced concentrations of zinc in peripheral blood.

"The findings suggest the need to further investigate potential roles of zinc in the pathophysiology of depression, the potential utility of zinc and related biomarkers in monitoring MDD and its clinical sequelae, and potential benefits of zinc supplementation in MDD patients," they conclude.

The study was supported by the Ontario Mental Health Foundation. Dr. Swardfager was supported by fellowships from the Heart and Stroke Foundation Center for Stroke Recovery and the Toronto Rehabilitation Institute. Dr. Swardfager and the other authors report no relevant financial relationships.

Biol Psychiatry. 2013;74:872-878.

    
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