Abstract: Background　Serum folic acid level is associated with the incidence of depression to some extent.Folic acid，as an additive treatment for depression，can significantly improve the clinical depressive symptoms，but the mechanism is unknown.Objective　To investigate the effects of sertraline plus an additive treatment with folic acid on serum levels of brain-derived neurotrophic factor（BDNF） and homocysteine （Hcy） in depressive patients.Methods　According to the inclusion criteria of this study，we enrolled 100 patients with depressive disorder from Department of Psychiatry，Wuhan Second Mental Hospital from January 2017 to January 2018，and assigned 50 of them to the control group and other 50 to the intervention group，respectively，by use of a random number table.Both groups received routine sertraline therapy，the intervention group additionally received folic acid.All the cases were treated for 8 weeks.Intragroup and intergroup comparisons were made at baseline and at the end of the treatment in terms of serum levels of folic acid，BDNF，Hcy，neural function related factors〔astrocyte-derived protein S100B，myelin basic protein （MBP），neuron specific enolase （NSE），and insulin growth factor-1
（IGF-1）〕，Hamilton Depression Rating Scale （HAMD） and Hamilton Anxiety Rating Scale （HAMA） scores and clinical response.Adverse reactions were assessed by the Treatment Emergent Symptoms Scale （TESS）．Results　After treatment，the intervention group showed significantly increased serum folic acid level compared to the baseline（P<0.05），and demonstrated much higher average serum folic acid and BDNF levels but significantly lower average Hcy level compared with the control group （P<0.05）．After treatment，serum levels of S100B and NSE decreased significantly in the two groups compared to the baseline（P<0.05）；intervention group showed much lower average serum levels of S100B and NSE（P<0.05），but similar average MBP and IGF-1 levels （P>0.05） compared with the control group.HAMD and HAMA scores declined significantly in both groups after treatment（P<0.05）．But the intervention group had much lower post-treatment HAMD and HAMA scores than the control group（P<0.05）．The overall response rate of the intervention group was much higher than that of the control group〔96.0%（48/50）vs 82.0%（41/50）〕 （χ2=5.005，P<0.05）．The intervention group and the control group showed no significant difference in the incidence of adverse reactions〔16.0%（8/50）vs 14.0%（7/50）〕 （χ2=0.078，P>0.05）．Conclusion　Sertraline plus an additive treatment with folic acid can effectively increase serum folic acid and BDNF levels in depressive patients，and reduce the serum levels of Hcy，S100B and NSE.

Key words: Depressive disorder, Folic acid, Brain-derived neurotrophic factor, Cysteine, Neural function related factors

摘要： 背景　抑郁症患者体内血清叶酸水平与其发病程度存在一定关系。叶酸作为增效剂能够明显改善抑郁症患者的临床症状，但其机制未明。目的　探讨叶酸辅助舍曲林对抑郁症患者血清脑源性神经营养因子（BDNF）、同型半胱氨酸（Hcy）的影响。方法　选取2017年1月—2018年1月在湖北省武汉市第二精神病医院精神科接受治疗的100名符合研究标准的抑郁症住院患者为研究对象，依据随机数字表法将其分为对照组（50例）和研究组（50例）。对照组患者采用常规舍曲林治疗，研究组患者在常规舍曲林治疗基础上增服叶酸。两组患者均治疗8周。比较治疗前及治疗后两组患者血清叶酸、BDNF、Hcy、星型胶质源性蛋白（S100B）、髓鞘碱性蛋白（MBP）、特异性烯醇化酶（NSE）、胰岛素生长因子-1（IGF-1）水平，汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评分，临床疗效。并采用副反应量表（TESS）评定不良反应发生情况。结果　治疗后研究组患者血清叶酸、BDNF水平高于对照组，血清Hcy水平低于对照组（P<0.05）。研究组患者治疗后血清叶酸水平高于治疗前（P<0.05）。治疗后研究组患者血清S100B、NSE水平低于对照组（P<0.05）；治疗后两组患者血清MBP、IGF-1水平比较，差异无统计学意义（P>0.05）。两组患者治疗后血清S100B、NSE水平低于治疗前（P<0.05）。治疗后研究组患者HAMD、HAMA评分低于对照组（P<0.05）。两组患者治疗后HAMD、HAMA评分均低于治疗前（P<0.05）。研究组患者有效率为96.0%（48/50），高于对照组的82.0%（41/50）（χ2=5.005，P<0.05）。研究组患者不良反应发生率为16.0%（8/50），对照组患者不良反应发生率为14.0%（7/50），两组患者不良反应发生率比较，差异无统计学意义（χ2=0.078，P>0.05）。结论　叶酸辅助舍曲林能够有效提高抑郁症患者血清叶酸、BDNF水平，降低血清Hcy、S100B、NSE水平。

关键词: 抑郁症, 叶酸, 脑源性神经营养因子, 半胱氨酸, 神经功能相关因子