Objective:To explore the relationship between Th17 immunoregulatory system and depression and reveal the mechanism of depression from the perspective of neuroimmunity, as well to look for biomarkers that can be used to diagnose, evaluate and predict recurrence of depression.Methods:A total of 91 patients with depression including 45 first-episode patients (FED group) and 46 recurrent episodes patients (RMDD group) were collected who were admitted to Psychiatry Department of the First Affiliated Hospital of Zhengzhou University from March 2019 to May 2020. And 40 healthy controls matched with depression patients in age, gender and education level were collected as control group (HC group). The levels of eight inflammatory cytokines in Th17 immunoregulatory system (five pro-inflammatory cytokines: IL-1β, IL-6, IL-17A, IL-21, IL-23; three anti-inflammatory cytokines: TGF-β1, IL-10, and IL-27) were measured by enzyme-linked immunosorbent assay (ELISA). Hamilton depression scale-24 (HAMD-24) was used to evaluate the severity of depressive symptoms. Data analyses were performed with SPSS 23.0.Two independent samples t-test, one-way ANOVA, Mann Whitney U test and Kruskal Wallis H test were used for comparison between groups. Results:(1) Comparison of FED group, RMDD group and HC group showed that the levels of pro-inflammatory cytokines IL-1β (5.321(1.317, 21.287)ng/L, 11.277(4.315, 26.167) ng/L, 8.126(1.179, 9.287) ng/L), IL-6(7.787(2.077, 16.778) ng/L, 5.290(2.364.14.475) ng/L, 4.389(1.453, 4.491) ng/L), IL-21 (6.777(6.293, 9.198) ng/L, 7.261(6.293, 25.058)ng/L, 5.097(3.033, 6.507) ng/L) and anti-inflammatory cytokines TGF-β1 (59.098(13.491, 125.368) ng/L, 46.230(18.852, 122.559) ng/L, 25.292(2.716, 31.874) ng/L), IL-10 (226.930(105.117, 449.444) ng/L, 193.929(109.014, 468.269) ng/L, 131.429(77.587, 157.497) ng/L) and IL-27 (0.968(0.651, 1.879)ng/L, 1.859(0.690, 6.221) ng/L, 0.865(0.679, 1.287)ng/L) in plasma were statistically different( H=7.219, 9.482, 18.989, 16.166, 11.511, 6.262, all P<0.05), while the levels of pro-inflammatory cytokines IL-17A (2.175(1.031, 7.975)ng/L, 3.576(1.896, 11.611)ng/L, 3.807(1.301, 4.710)ng/L)and IL-23 (15.708(2.898, 114.175) ng/L, 26.893(9.282, 58.592) ng/L, 17.041(5.027, 23.613)ng/L) were not statistically significant ( H=2.179, 4.305, both P>0.05). Further pairwise comparisons showed that the levels of pro-inflammatory cytokines IL-6, IL-21 and anti-inflammatory cytokines TGF-β1 and IL-10 in plasma of FED group were higher than those of HC group, and the differences were statistically significant (all P<0.05). The levels of pro-inflammatory cytokines IL-1β, IL-6, IL-21 and anti-inflammatory cytokines TGF-β1, IL-10, IL-27 in RMDD group were higher than those in HC group, and the differences were statistically significant (all P<0.05). There were no significant differences in the eight inflammatory cytokines between FED group and RMDD group (all P>0.05). (2) Spearman correlation analysis showed that IL-1β was positively correlated with total score of HAMD-24 ( r=0.286, P<0.05). IL-6 was positively correlated with total score of HAMD-24 and factor score of anxiety or somatization ( r=0.390, 0.291, both P<0.05). TGF-β1 was negatively correlated with total score of HAMD-24 and factor scores of anxiety or somatization and cognitive impairment ( r=-4.200, -0.321, - 0.361, all P<0.05). IL-21 was positively correlated with factor score of sleep ( r=0.319, P<0.05); IL-10 was negatively correlated with total score of HAMD-24 and factor score of cognitive impairment ( r=-0.306, - 0.270, both P<0.05). There was no significant correlation between other inflammatory cytokines and total score of HAMD-24 and seven factor scores (all P>0.05). Conclusion:There is an imbalance in pro-and anti-inflammatory cytokines of Th17 immunoregulatory system in patients with depression, which is more obvious in recurrent episodes patients.The level of immune activation of Th17 immunoregulatory system may be associated with the severity of clinical symptoms, in which the inflammatory cytokine IL-6 may be a biomarker of major depressive disorder; TGF-β1 and IL-21 may be associated with depressive cognitive impairment and sleep.

Objective:To explore the relationship between somatic symptoms of major depressive disorder(MDD)and cortisol(COR) rhythm, C-reactive protein(CRP) and other immune-metabolism-related indicators, and understand its mechanism from the perspective of endocrine and immune regulation.Methods:A case-control study was conducted in hospitalized patients with MDD who met DSM-5 diagnostic criteria.According to the Patient Health Questionnaire (PHQ-15), PHQ-15 ≥10 were classified as the somatic major depressive disorder group(S-MDD group) and 73 patients were enrolled.PHQ-15 <5 was classified as the non-somatic depressive disorder group (NS-MDD group) and 70 patients were enrolled.Plasma cortisol (COR8, COR16 and COR24) levels were measured at 8∶00, 16∶00 and 24∶00 on the same day, plasma CRP and interleukin-6 (IL-6) level, serum uric acid (UA), blood glucose (GLU), blood lipid (TC, TG, HDL, LDL) level were detected at 8∶00.Independent sample t test, non-parametric test, chi-square test, repeated ANOVA, covariance analysis, and multivariate Logistic regression were used for statistical analysis. Results:①Time effect, grouping effect and the interaction effect of the time and grouping in the level of COR were statistically significant ( P<0.05). Covariance analysis excluded age as an influential factor, COR16, AUC(total cortisol output/area under the curve, AUC) and COR8-16 in S-MDD group ((90.50±40.57)μg/L, (1 425.12±564.78), (-6.43±5.76))were higher than those in NS-MDD group((68.74±31.51)μg/L, (1 251.57±456.61), (-8.77±5.48)), and the difference was statistically significant ( F=8.971, 4.320, 8.731, P<0.05). ②CRP in S-MDD group ((1.41±1.06)mg/L) were higher than that in NS-MDD group((0.61±0.53)mg/L), and the difference was statistically significant ( F=25.436, P<0.05). The proportion of patients with higher CRP level(CRP≥1 mg/L) in S-MDD group(58%) was higher than that in NS-MDD group(23%), and the difference was statistically significant(χ 2=17.824, P<0.01). ③Multivariate logistic regression analysis found that CRP ( OR=4.953, 95% CI: 2.407-10.193), COR8-16 ( OR=3.451, 95% CI: 1.380-8.633) were main risk factors of somatic symptoms of MDD ( P<0.05). Conclusion:Cortisol rhythm disturbance and high CRP level may be the biological basis of somatic symptoms in patients with MDD.

Objective To investigate the effects of graphic health education pathway in patients with osteoporosis after postmenopausal.Methods Totals of 120 cases of perimenopausal patients with osteoporosis were divided into the observation group (n=60) and the control group (n=60) from January 2011 to December 2013.The control group patients were given the routine sexual health education.The observation group was taught with graphic health education for three months.The Osteoporosis Health Belief Scale ( OHBS ) , the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and bone mineral density of the two groups were observed and compared before and after the health education.Results In the observation group, the total score of KAP and the score of heath belief, the knowledge of osteoporosis, the prevention healthcare were (139.62 ±32.12), (65.32 ±12.48), (43.69 ±5.78) and (32.12 ±4.56), respectively, which were significantly higher than (105.63 ±28.69), (51.21 ±11.45), (31.25 ±4.96) and (22.62 ±5.12) in the control group after the intervention (t =3.456, 4.362, 5.126, 5.623, respectively;P <0.05).In the observation group, the score of ODI and VAS were ( 23.25 ±5.12 ) and ( 3.86 ±0.75 ) , which were significantly higher than (36.12 ±6.78) and (5.29 ±0.92) in the control group after the intervention (t=4.985, 5.122, respectively;P<0.05).The bone mineral density of lumbar L1 to L4, femoral neck and hip trochanter area and Wards area of the observation group were significantly higher than the control group ( t=4.252, 4.825, 4.312, 4.985, respectively;P<0.05).Conclusions The graphic health education pathway can effectively improve the KAP of osteoporosis patients and the bone mineral density.It can relieve the pain and dysfunction, so as to promote the rehabilitation of patients.

Objective To explore the relationship between anxious depression and cortisol rhythm disorder and influencing factors of immune metabolism. And to look for biological markers that can be used for clinical diagnosis and treatment of anxious depression. Methods Totally 43 patients with anxious depres-sion(A-MDD group) and 44 patients with non-anxious depression matched by sex,age and years of education (NA-MDD group)were recruited. Electrochemiluminescence was used to detect the plasma levels of adreno-corticotropic hormone(ACTH),cortisol(COR),c-reactive protein(CRP) and IL-6. Automatic biochemical a-nalysis was used to detect plasma total TC,TG,HDL and LDL. Using logistic regression analysis to discuss the influencing factors of anxiety depression. Results The comparison between the two group showed that the age of first onset,BMI and SBP in the A-MDD group((35. 15±11. 56),(24. 11±3. 03)kg/m2,(130. 09 ±13. 33)mmHg) were significantly higher than those in the NA-MDD group((31. 34± 14. 08),( 22. 70± 3. 19)kg/m2,( 121. 89±12. 49)mmHg)(t=2. 631,2. 009,2. 964,all P<0. 05). The HAMD score and the factor scores of cognitive impairment,change of day and night,delay,sleep disorder and feeling of despair in the A-MDD group((31. 81±5. 39),(8. 03±3. 00),(1. 17±0. 70),(6. 88±1. 93),(4. 44±1. 44),(4. 67± 2. 37)) were significantly higher than those in the NA-MDD group((25. 25±5. 017),(3. 87±3. 12),(0. 79 ±0. 78),(4. 64±2. 22),(3. 34±1. 54),(3. 61±2. 02))(t=2. 297,6. 524,2. 505,5. 210,3. 452,2. 421,all P<0. 05). The plasma TG,CRP and IL-6 levels in the A-MDD group((1. 63±1. 11)mmol/L,(1. 20±0. 77) mg/L,(3. 54±1. 90) pg/L) were significantly higher than those in the NA-MDD group (( 1. 19 ± 0. 66) mmol/L,(0. 933±0. 89)mg/L,(2. 65±1. 34)pg/L) (t=2. 254,2. 250,2. 352,all P<0. 05). The incidence of cortisol disturbance was 72% in the A-MDD group,and 48% in the NA-MDD group,and the difference was statistically significant (χ2=5. 369 P=0. 020). Multivariate Logistic regression found that sleep disorder (β=0. 729,OR=2. 072,95%CI=1. 018-3. 119),IL-6(β=0. 583,OR=1. 792,95%CI=1. 168-2. 748),cog-nitive impairment (β=0. 099,OR=1. 104,95% CI=1. 022-1. 193),cortisol rhythm disorders(β=0. 075, OR=1. 078,95%CI=1. 014-1. 146) were the risk factors for anxious depression. Conclusion Anxious de-pression has a high incidence of cortisol rhythm disorder. The COR and IL-6 may be mediators of cortisol rhythm disorder. IL-6 and cortisol rhythm disorder together with sleep disorder and negative cognition consti-tute maybe high risk factors for anxious depression.