Tulburarea metabolismului serotoninei ca substrat biologic al depresiei în hepatitele cronice virale

Abstract

Rezumat Ficatul participă în metabolismul serotoninei, care este un neurotransmițător responsabil de statutul emoțional. Scopul studiului a fost aprecierea la bolnavii cu hepatite cronice virale a nivelului de serotonină și triptofan (precursorul serotoninei) în sânge și a excreției urinare de acid 5-oxiindolacetic (metabolitul serotoninei) în funcție de prezența și de gradul depresiei și de expresivitatea sindromului citolitic. Au fost examinați 147 pacienți cu hepatite cronice virale și 29 persoane practic sănătoase (lotul-martor). Depresia a fost apreciată cu ajutorul testului Hamilton-21. Rezultatele au arătat valori de serotonină, triptofan și acid 5-oxiindolacetic mai scăzute în hepatitele virale versus persoanele sănătoase, din contul pacienților depresivi. Cele mai scăzute valori s-au determinat la pacienții cu depresie moderată-severă. În hepatitele cronice virale cu activitate minimală a procesului hepatic concentrațiile de serotonină și triptofan au fost mai favorabile decât în prezența proceselor hepatice cu activitate citolitică înaltă. Concluzie. Scăderea parametrilor metabolismului serotoninei, apreciată la pacienții cu hepatite cronice virale, refl ectă simptomatologia depresivă a acestor bolnavi. Este sugestivă implicarea nemijlocită a disfuncției hepatice în perturbarea mecanismelor biologice de reglare a statutului emoțional.

Disturbances of serotonin metabolism as a biological substrate of depression in chronic viral hepatitis The liver is involved in the metabolism of serotonin due to a variety of enzyme systems. Serotonin is an important neurotransmitter responsible for the emotions. The aim of the study was to investigate in patients with chronic viral hepatitis (CVH) blood levels of serotonin and its precursor tryptophan, as well as the daily urinary excretion of its metabolite 5-oxyindolacetic acid (5-OIA), to identify possible links to liver process and the availability and degree of depression. The study involved 147 patients with chronic viral hepatitis and 29 healthy individuals. The presence and degree of depression was determined using Hamilton-21 test. The results showed a decrease, compared with the control group, of serotonin, tryptophan, and 5-OIA in patients with CVH due to depressed patients. The decline in these indicators was the most signifi cant in the moderate to severe depression. In patients with minimal hepatic cytolytic activity of the process, the values of serotonin and tryptophan were somewhat more favorable in comparison with the group of patients with severe cytolysis. Conclusion. The decline in the exchange of serotonin, identified during the CVH refl ects the depressive symptoms of these patients. We do not exclude the dependence of the serotonin and tryptophan depletion to the liver pathology.

Нарушения обмена серотонина как биологический субстрат депрессии при хронических вирусных гепатитах Печень участвует в обмене серотонина благодаря множеству ферментных систем. Серотонин является важным нейротрансмиттером, отвечающим за эмоциональный статус человека. Целью исследования было изучить у больных хроническими вирусными гепатитами (ХВГ) содержание в крови серотонина и его предшественника триптофана, а также суточное выделение с мочой его метаболита 5-оксииндолуксусной кислоты (5-ОИК), выявить возможные связи с активностью печеночного процесса и с наличием и степенью депрессии. Обследовано 147 больных ХВГ и 29 практически здоровых лиц. Наличие и степень депрессии определяли с помощью теста Гамильтона-21. Результаты выявили снижение, по сравнению с контрольной группой средних показателей серотонина, триптофана и 5-ОИК у больных с ХВГ за счет пациентов с депрессией. Снижение данных показателей было наиболее значимо при умеренной и выраженной депрессии. У больных с минимальной цитолитической активностью печеночного процесса значения серотонина и триптофана несколько благоприятнее по сравнению с группой больных с выраженным цитолизом. Вывод. Снижение показателей обмена серотонина, выявленное при ХВГ, отражает депрессивную симптоматику данных больных.

Disturbances of serotonin metabolism as a biological substrate of depression in chronic viral hepatitis The liver is involved in the metabolism of serotonin due to a variety of enzyme systems. Serotonin is an important neurotransmitter responsible for the emotions. The aim of the study was to investigate in patients with chronic viral hepatitis (CVH) blood levels of serotonin and its precursor tryptophan, as well as the daily urinary excretion of its metabolite 5-oxyindolacetic acid (5-OIA), to identify possible links to liver process and the availability and degree of depression. The study involved 147 patients with chronic viral hepatitis and 29 healthy individuals. The presence and degree of depression was determined using Hamilton-21 test. The results showed a decrease, compared with the control group, of serotonin, tryptophan, and 5-OIA in patients with CVH due to depressed patients. The decline in these indicators was the most signifi cant in the moderate to severe depression. In patients with minimal hepatic cytolytic activity of the process, the values of serotonin and tryptophan were somewhat more favorable in comparison with the group of patients with severe cytolysis. Conclusion. The decline in the exchange of serotonin, identified during the CVH refl ects the depressive symptoms of these patients. We do not exclude the dependence of the serotonin and tryptophan depletion to the liver pathology.