アブストラクト
Japanese
| Title | COVID-19感染症とうつ病 : 免疫学的見地から |
|---|---|
| Subtitle | 特集 新型コロナウイルス感染症・ウェルビーイング [総説] |
| Authors | 齋藤紀先 |
| Authors (kana) | |
| Organization | 弘前大学大学院医学研究科 臨床検査医学講座, 弘前大学医学部附属病院 感染制御センター |
| Journal | 日本心療内科学会誌 |
| Volume | 25 |
| Number | 2 |
| Page | 74-80 |
| Year/Month | 2021 / |
| Article | 報告 |
| Publisher | 日本心療内科学会 |
| Abstract | 「要旨:」米国において抑うつ症状を呈する患者は, 新型コロナウイルス感染症(以下, COVID-19)の流行前と比較し, 3倍以上に増加していると報告されている. 日本においても同様に, (うつ病を伴っていたであろう)自殺者がCOVID-19流行の遷延とともに増加している. ストレスは免疫に影響し, IL-1β, IL-6, TNFα等, 多くの炎症性サイトカインがうつ病患者にて増加していることが報告されている. これらのサイトカインはTh17細胞の分化・増殖を促進する. いくつかの研究では, うつ病患者における血液中のTh17細胞の増加や, Th17細胞が産生するIL-17Aの上昇が報告されている. 興味深いことに, COVID-19患者においてもIL-1β, IL-6, TNFαおよびIL-17Aの上昇が報告されており, とくにIL-17AはARDS(急性呼吸窮迫症候群)を惹起させる大きな要因であることが報告されている. 一方, 30代以下のCOVID-19陽性者が呼吸不全を起こすほど重症化し, ARDSに進行することは極めて稀であり, 年齢が高くなるにつれ(特に70歳以上で)ARDSを発症する頻度が高くなるが, まだその理由は解明されていない. 一般に高齢者は環境ストレスに対するレジリエンスが低く, うつになる傾向も多いことから, ストレスによる炎症性サイトカインの上昇のしやすさがCOVID-19感染の重症化にも影響を与える可能性が考えられる. ある報告では, COVID-19感染で呼吸不全となった患者2名(42歳と75歳)においてIL-6の上昇がみられ, 入院から約1カ月後にうつ病を発症したが, 2名とも抗うつ薬(SSRI+SNRIの併用)による治療に伴い抑うつの改善とIL-6の正常化を観察している. しかし75歳の症例ではその後呼吸不全が再発し死亡している. 今後の報告や研究が期待される. |
| Practice | 臨床医学：内科系 |
| Keywords | COVID-19, 炎症性サイトカイン, IL-17A, うつ, Covid-19, Inflammatory cytokine, Depression |
English
| Title | Depression in COVID-19 shock : From an immunological point of view |
|---|---|
| Subtitle | |
| Authors | Norihiro Saito |
| Authors (kana) | |
| Organization | Hirosaki University Graduate School of Medicine, Division of Infection Control and Prevention, Hirsosaki University Hospital |
| Journal | Japanese Journal of Psychosomatic Internal Medicine |
| Volume | 25 |
| Number | 2 |
| Page | 74-80 |
| Year/Month | 2021 / |
| Article | Report |
| Publisher | Japanese Society of Psychosomatic Internal Medicine |
| Abstract | [Abstract:] Prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Similarly in Japan, the increase of patients with depression and the suicide during COVID-19 pandemic becomes a hot topic. The stress influences immune system and it has been reported that many (pro-) inflammatory cytokines, including IL-1β, IL-6 and TNFα (called pro-inflammatory cytokines), are elevated in the blood of depressed patients. These cytokines are known to promote Th17 cell differentiation. One study found that Th17 cells were increased in the blood of depressed patients and two studies found IL-17A to be elevated in the blood of depressed patients. Interestingly, severe COVID-19 also presents cytokine storm such as IL-1β, IL-6, TNFα and IL-17A, leading to acute respiratory distress syndrome (ARDS). It is extremely rare that COVID-19 infected person younger than 30 years is aggravated and is easy to be aggravated with ARDS so that the patient becomes old. Since the elderly person has generally less resilience for stress and often becomes depressive, it may have some influence to aggravation in the COVID-19 infection. It has been reported that two patients (42- and 75-year-old) with a respiratory failure by COVID-19 infection experienced the elevated serum IL-6 and depression after about one month from the admission, and observed a resolution of the depression with the decline of IL-6 with antidepressant (SSRI+SNRI) treatment. However, the 75-year-old patient died with a recurrence of respiratory failure. Further reports and investigations are expected. |
| Practice | Clinical internal medicine |
| Keywords | Covid-19, Inflammatory cytokine, IL-17A, Depression |
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残りの15件を表示する
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