Association between Niacin Skin Flushing Response and Non-Enzymatic Antioxidants/Thyroid Hormones in Depressive Episode Patients

目的：探讨抑郁发作患者在非酶类抗氧化物、甲状腺激素以及烟酸皮肤潮红反应(Niacin skin flushing response, NSFR)等方面的异常表现，并分析这些生物标志物之间的相关性及其与患者临床症状改善的关系。方法：纳入2023年6月至2024年6月在青岛市精神卫生中心住院治疗的100例抑郁发作患者(患者组)，同期于周围社区招募了50名健康志愿者(对照组)，其中52名患者完成了8周的随访。采用汉密尔顿抑郁量表17项(Hamilton depression scale-17, HAMD-17)、汉密尔顿焦虑量表(Hamilton anxiety scale, HAMA)评估临床症状；采用烟酸潮红皮肤反应分析仪对受试者进行NSFR测试并分析评分；同时测定非酶类抗氧化物包括尿酸(Uric Acid, UA)、白蛋白(Albumin, ALB)和胆红素(Bilirubin, BIL)水平，甲状腺激素包括促甲状腺激素(Thyroid-Stimulating Hormone, TSH)和甲状腺激素，如游离三碘甲状腺原氨酸(Free Triiodothyronine, FT3)和游离四碘甲状腺原氨酸(Free Thyroxine, FT4)水平。结果：患者组相较于对照组，FT4、TSH水平显著升高，FT3水平明显降低；UA水平显著升高；NSFR得分显著降低。患者组非酶类抗氧化物与甲状腺激素之间存在显著关联，如ALB与UA、FT3及FT4呈正相关，BIL与FT4和TSH正相关；FT3与TSH呈负相关，FT4与TSH呈正相关。患者组基线NSFR、非酶类抗氧化物及甲状腺激素与临床症状改善之间无显著相关。结论：本研究发现抑郁症患者在非酶类抗氧化物、甲状腺激素以及NSFR等方面存在显著异常，且这些生物标志物之间存在复杂关联，提示抑郁发作患者存在氧化应激水平及甲状腺功能的异常。基线生物标志物与临床症状改善之间未能得到阳性相关性，提示抑郁症的病理生理机制可能涉及多种因素。Objective: To explore the abnormal manifestations of non-enzymatic antioxidants, thyroid hormones, and niacin skin flushing response (NSFR) in patients with depressive episodes, and to analyze the correlations among these biomarkers and their relationship with the improvement of clinical symptoms. Methods: A total of 100 patients with depressive episodes hospitalized at Qingdao Mental Health Center from June 2023 to June 2024 were enrolled as the patient group, and 50 healthy volunteers were recruited from the surrounding community during the same period as the control group. Among them, 52 patients completed an 8-week follow-up. Clinical symptoms were assessed using the Hamilton Depression Scale-17 (HAMD-17) and the Hamilton Anxiety Scale (HAMA). The NSFR test was conducted on participants using a niacin skin flushing response analyzer and scored accordingly. Simultaneously, levels of non-enzymatic antioxidants, including uric acid (UA), albumin (ALB), and bilirubin (BIL), as well as thyroid hormones, including thyroid-stimulating hormone (TSH) and thyroid hormones such as free triiodothyronine (FT3) and free thyroxine (FT4), were measured. Results: Compared with the control group, the patient group exhibited significantly higher levels of FT4 and TSH, but significantly lower levels of FT3; UA levels were significantly elevated; and NSFR scores were significantly reduced. Significant correlations were observed between non-enzymatic antioxidants and thyroid hormones in the patient group, such as positive correlations of ALB with UA, FT3, and FT4, and of BIL with FT4 and TSH; FT3 was negatively correlated with TSH, while FT4 was positively correlated with TSH. No significant correlations were found between baseline NSFR, non-enzymatic antioxidants, thyroid hormones, and the improvement of clinical symptoms in the patient group. Conclusion: This study found significant abnormalities in non-enzymatic antioxidants, thyroid hormones, and NSFR in patients with depression, with complex correlations among these biomarkers, suggesting abnormalities in oxidative stress levels and thyroid function in patients with depressive episodes. The lack of a positive correlation between baseline biomarkers and the improvement of clinical symptoms suggests that the pathophysiological mechanisms of depression may involve multiple factors.