全身炎症综合指数在儿童情绪忽视和重度抑郁症抑郁严重程度之间的中介作用：一项横断面研究

摘要(中文译文)

本研究为横断面研究，旨在探讨童年创伤、炎症与抑郁严重程度之间的关联，并特别关注外周血炎症标志物（全身免疫炎症指数，AISI）在童年情感忽视与抑郁严重程度关系中的中介作用。共纳入236例重性抑郁障碍（MDD）患者。所有参与者均完成童年创伤问卷（CTQ）和24项汉密尔顿抑郁量表（HAMD-24），并接受血常规检查。采用分层回归分析，在控制固定协变量（年龄、性别、教育程度等）后，为各指标分别建立模型，比较其对HAMD-24评分的预测能力。采用PROCESS中介模型检验AISI在童年情感忽视与抑郁严重程度关系中的中介作用。有童年创伤史的MDD患者其炎症标志物水平和抑郁严重程度均显著高于无童年创伤史者。在童年创伤各维度中，情感忽视对HAMD-24评分的预测能力最强（ΔR² = 0.111，ΔP < 0.001，AIC = 1691.663）；在炎症标志物中，AISI对HAMD-24评分的预测能力最强（ΔR² = 0.230，ΔP < 0.001，AIC = 1654.19）。情感忽视与AISI呈正相关（r = 0.213，p < 0.001），与HAMD-24评分亦呈正相关（r = 0.280，p < 0.001）。此外，炎症标志物AISI部分中介了童年情感忽视与抑郁严重程度之间的关系，中介效应为28.07%。童年情感忽视可能通过改变全身炎症反应而与抑郁严重程度相关，支持炎症是该通路中一个合理的中介机制。尽管无法确立因果关系，但这些结果凸显了在未来前瞻性研究中探讨抗炎策略作为MDD辅助治疗方案的潜在价值。

Abstract

This cross-sectional study aimed to explore the associations among childhood trauma, inflammation and depressive severity, with a particular focus on the mediating role of a peripheral blood inflammatory marker (the Aggregate Index of Systemic Inflammation, AISI) in the relationship between childhood emotional neglect and depressive severity. A total of 236 patients with major depressive disorder (MDD) were enrolled in this study. All participants completed the Childhood Trauma Questionnaire (CTQ) and the 24-item Hamilton Depression Rating Scale (HAMD-24), and underwent routine blood tests. Using Hierarchical regression analysis, after controlling for fixed covariates (age, sex, education level, etc.), separate models were built for each indicator to compare their predictive ability for HAMD-24 scores. The PROCESS mediation model was employed to examine the mediating role of AISI in the relationship between childhood emotional neglect and depressive severity. MDD patients with a history of childhood trauma exhibited significantly higher levels of inflammatory markers and depressive severity than those without such a history. Among the dimensions of childhood trauma, emotional neglect exhibited the strongest predictive power for HAMD-24 scores (ΔR² = 0.111, ΔP < 0.001, AIC = 1691.663), and among inflammatory markers, AISI demonstrated the strongest predictive power for HAMD-24 scores (ΔR² = 0.230, ΔP < 0.001, AIC = 1654.19). Emotional neglect was positively correlated with AISI (r = 0.213, p < 0.001) and with HAMD-24 scores (r = 0.280, p < 0.001). Furthermore, the inflammatory marker AISI partially mediated the relationship between childhood emotional neglect and depressive severity, with a mediation effect of 28.07%. Childhood emotional neglect may be associated with depression severity through alterations in systemic inflammatory responses, supporting inflammation as a plausible mediating mechanism in this pathway. While causal relationships cannot be established, these results highlight the potential value of investigating anti-inflammatory strategies as adjunctive treatments for MDD in future prospective studies.

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