Correlation of Non-suicidal Self-injury with 25-Hydroxyvitamin D3 and Blood Lipid Levels in Adolescents with Major Depressive Disorder

doi:10.12114/j.issn.1007-9572.2024.0127

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (05): 612-618.DOI: 10.12114/j.issn.1007-9572.2024.0127

Special Issue: 儿科最新文章合辑；心理健康最新文章合辑

• Original Research·Research of Specific Population·Adolescents Health • Previous Articles Next Articles

Correlation of Non-suicidal Self-injury with 25-Hydroxyvitamin D₃ and Blood Lipid Levels in Adolescents with Major Depressive Disorder

1. Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 238000, China
2. Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China
3. Anhui Psychiatric Center, Hefei 238000, China
4. The Fourth People's Hospital of Hefei, Hefei 238000, China
5. Department of Psychology and Sleep Medicine, the Second Hospital of Anhui Medical University, Hefei 238000, China
6. Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 238000, China

Received:2024-04-10 Revised:2024-06-30 Published:2025-02-15 Online:2024-11-25
Contact: LIU Huanzhong

青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D₃和血脂水平的相关性研究

1．238000　安徽省合肥市，安徽医科大学精神卫生与心理科学学院
2．238000　安徽省合肥市，安徽医科大学附属巢湖医院精神科
3．238000　安徽省合肥市，安徽省精神医学中心
4．238000　安徽省合肥市第四人民医院
5．238000　安徽省合肥市，安徽医科大学第二附属医院心理与睡眠医学科
6．238000　安徽省合肥市，脑库构建及资源利用安徽省重点实验室

通讯作者: 刘寰忠
作者简介:
作者贡献：
凡豪杰提出主要研究目标，负责研究的构思与设计，研究的实施，撰写论文；刘乐伟、夏磊进行论文的修订及统计学处理；田英汉、杨铖、郝明茹、赵鑫、申晴晴、莫大明、耿峰进行数据的收集与整理；刘寰忠负责文章的质量控制与审查，对文章整体负责，监督管理。
基金资助:
2022年安徽省转化医学研究院科研基金(2022zhyx-B01); 安徽省高等学校科学研究项目(2022AH050671); 2019年度国家临床重点专科能力建设项目(皖卫医秘[2019]267号)

Abstract

Abstract:

Background

The incidence of major depressive disorder (MDD) in adolescents is annually elevated. Non-suicidal self-injury (NSSI) is a common clinical manifestation of MDD. Evidence suggested that vitamin D and lipid levels are associated with MDD, but whether they are related to NSSI is unclear.

Objective

To compare the levels of 25 (OH) D₃ and blood lipids in MDD adolescents with or without NSSI behavior, and to explore their diagnostic value for NSSI.

Methods

A total of 129 MDD adolescents who received treatment in the Department of Psychiatry, Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei from October 2020 to March 2022 were recruited. They were assigned into NSSI group (n=77) and non-NSSI group (n=52) based on the diagnostic criteria of NSSI in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) . The Positive and Negative Suicide Ideation (PANSI) , Insomnia Severity Index (ISI) , and Center for Epidemiological Survey, Depression Scale (CES-D) were used to evaluate the clinical symptoms. Fasting venous blood samples were collected to measure the levels of 25 (OH) D₃ and blood lipids, and compared between groups. In addition, multivariate Logistic regression analysis was performed to identify influencing factors for NSSI behavior in MDD adolescents. The diagnostic value of 25 (OH) D₃ and lipid levels in NSSI behaviors was assessed by plotting the receiver operating characteristic (ROC) curves.

Results

The age of the NSSI group was significantly lower than that of the non-NSSI group, whereas the total scores of PANSI, ISI, and CES-D were significantly higher than those of the non-NSSI group (P<0.05) . The level of 25 (OH) D₃ in the NSSI group was significantly lower than that in the non-NSSI group, whereas the levels of total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , and low-density lipoprotein cholesterol (LDL-C) were significantly higher than those in the non-NSSI group (P<0.05) . Multivariate Logistic regression analysis showed that both LDL-C (OR=5.695, 95%CI=2.422-13.388, P<0.001) and 25 (OH) D₃ (OR=0.871, 95%CI=0.768-0.987, P<0.05) were the influencing factors of MDD adolescents with NSSI. The area under curve (AUC) of LDL-C and 25 (OH) D₃ levels in assessing the risk of developing NSSI behavior in MDD adolescents was 0.73 (95%CI=0.65-0.82, P<0.001) and 0.62 (95%CI=0.52-0.72, P=0.023) , respectively. Their optimal cut-off value was 1.89 mmol/L and 19.15 μg/L, respectively. The AUC of 25 (OH) D₃ combined with LDL-C levels [ln (p/1-p) =1.364X1-0.143X2-0.161, where X1 and X2 was LDL-C and 25 (OH) D₃, respectively] in diagnosing NSSI behavior in MDD adolescents was 0.77 (95%CI=0.69-0.85, P<0.001) , with 77.92% of sensitivity and 67.31% of specificity.

Conclusion

25 (OH) D₃ and lipid levels are out of normal ranges in MDD adolescents with NSSI. Measurement of LDL-C combined with 25 (OH) D₃ levels may provide information to predict the occurrence of NSSI behaviors in MDD adolescents. A regular measurement of LDL-C and 25 (OH) D₃ and a dynamic monitor is valuable to provide symptomatic supports.

Key words: Depression, Major depressive disorder, Adolescent, Non-suicidal self-injury, 25 (OH) D₃, Dyslipidemias

摘要： 背景抑郁障碍（MDD）在青少年人群中的发病率逐年增高，非自杀性自伤（NSSI）行为也是其常见的临床表现。有研究结果显示维生素D和血脂水平与MDD有关，但是其是否与NSSI有关尚不明确。目的比较伴或不伴有NSSI行为青少年MDD患者的25羟维生素D₃[25（OH）D₃]和血脂水平，并探索其对NSSI的诊断价值。方法选取2020年10月—2022年3月在安徽医科大学附属巢湖医院精神科和合肥市第四人民医院就诊的青少年MDD患者129例，参考《精神障碍诊断与统计手册》第5版（DSM-5）中NSSI的诊断标准将其分为NSSI组（77例）和非NSSI组（52例）。采用青少年自杀意念量表（PANSI）、失眠严重指数（ISI）、流调用抑郁量表（CES-D）评估患者的临床症状。采集空腹静脉血，检测样本中25（OH）D₃和血脂水平，并进行两两比较。进一步采用多因素Logistic回归分析探究青少年MDD患者发生NSSI行为的影响因素，并绘制受试者工作特征（ROC）曲线评估25（OH）D₃和血脂水平对NSSI行为的诊断价值。结果 NSSI组的年龄低于非NSSI组，而PANSI总分、ISI总分、CES-D总分高于非NSSI组（P<0.05）。NSSI组25（OH）D₃水平低于非NSSI组，而总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平高于非NSSI组（P<0.05）。多因素Logistic回归分析显示，LDL-C（OR=5.695，95%CI=2.422~13.388，P<0.001）和25（OH）D₃（OR=0.871，95%CI=0.768~0.987，P<0.05）是青少年MDD患者伴有NSSI行为的影响因素。LDL-C和25（OH）D₃评估青少年MDD患者NSSI行为发生风险的ROC曲线下面积（AUC）分别为0.73（95%CI=0.65~0.82，P<0.001）、0.62（95%CI=0.52~0.72，P=0.023），最佳截断值分别为1.89 mmol/L、19.15 μg/L；LDL-C联合25（OH）D₃水平[ln（p/1-p）=1.364X1-0.143X2-0.161，其中X1、X2分别为LDL-C、25（OH）D₃]预测青少年MDD患者NSSI行为的AUC为0.77（95%CI=0.69~0.85，P<0.001），灵敏度为77.92%、特异度为67.31%。结论伴有NSSI行为的青少年MDD患者存在一定水平的25（OH）D₃和血脂水平紊乱，且LDL-C联合25（OH）D₃水平对评估青少年MDD患者NSSI行为的发生有一定的参考价值，临床应定期检测其动态变化并对症处理。

关键词: 抑郁, 抑郁障碍, 青少年, 非自杀性自伤, 25羟维生素D₃, 血脂异常

CLC Number:

R 749.42

FAN Haojie,LIU Lewei,XIA Lei, et al. Correlation of Non-suicidal Self-injury with 25-Hydroxyvitamin D₃ and Blood Lipid Levels in Adolescents with Major Depressive Disorder[J]. Chinese General Practice, 2025, 28(05): 612-618. DOI: 10.12114/j.issn.1007-9572.2024.0127.
凡豪杰,刘乐伟,夏磊等. 青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D₃和血脂水平的相关性研究[J]. 中国全科医学, 2025, 28(05): 612-618. DOI: 10.12114/j.issn.1007-9572.2024.0127.

Figures/Tables 5

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组别	例数	性别[例（%）]		年龄（±s，岁）	BMI （±s，kg/m²）	病程[M（P₂₅，P₇₅），年]	文化程度[例（%）]
组别	例数	男	女	年龄（±s，岁）	BMI （±s，kg/m²）	病程[M（P₂₅，P₇₅），年]	初中	中专或高中	高中以上
非NSSI组	52	21（40.4）	31（59.6）	15.8±1.7	21.0±3.4	15.5（8.0，36.0）	15（28.8）	31（59.6）	6（11.6）
NSSI组	77	14（18.2）	63（81.8）	14.9±1.5	21.2±4.5	16.0（12.0，36.0）	44（57.1）	30（39.0）	3（3.9）
检验统计量值		7.739^a		3.180	-0.216	-0.535^b	10.833^a
P值		0.005		0.002	0.829	0.593	0.004
组别	父母婚姻状况[例（%）]		抗抑郁药物服用[例（%）]^c			PANSI总分（±s，分）	ISI总分（±s，分）	CES-D总分（±s，分）
组别	正常	不正常	未服药	SSRIs	其他	PANSI总分（±s，分）	ISI总分（±s，分）	CES-D总分（±s，分）
非NSSI组	38（73.1）	14（26.9）	21（40.4）	25（48.1）	6（11.5）	41.48±12.54	10.83±5.71	48.69±10.99
NSSI组	54（70.1）	23（29.9）	22（28.6）	46（59.7）	8（10.4）	53.94±12.01	13.70±5.54	52.94±8.50
检验统计量值	0.132^a		2.094^a			-5.678	-2.857	-2.349
P值	0.717		0.351			<0.001	0.005	0.021

组别	例数	性别[例（%）]		年龄（±s，岁）	BMI （±s，kg/m²）	病程[M（P₂₅，P₇₅），年]	文化程度[例（%）]
组别	例数	男	女	年龄（±s，岁）	BMI （±s，kg/m²）	病程[M（P₂₅，P₇₅），年]	初中	中专或高中	高中以上
非NSSI组	52	21（40.4）	31（59.6）	15.8±1.7	21.0±3.4	15.5（8.0，36.0）	15（28.8）	31（59.6）	6（11.6）
NSSI组	77	14（18.2）	63（81.8）	14.9±1.5	21.2±4.5	16.0（12.0，36.0）	44（57.1）	30（39.0）	3（3.9）
检验统计量值		7.739^a		3.180	-0.216	-0.535^b	10.833^a
P值		0.005		0.002	0.829	0.593	0.004
组别	父母婚姻状况[例（%）]		抗抑郁药物服用[例（%）]^c			PANSI总分（±s，分）	ISI总分（±s，分）	CES-D总分（±s，分）
组别	正常	不正常	未服药	SSRIs	其他	PANSI总分（±s，分）	ISI总分（±s，分）	CES-D总分（±s，分）
非NSSI组	38（73.1）	14（26.9）	21（40.4）	25（48.1）	6（11.5）	41.48±12.54	10.83±5.71	48.69±10.99
NSSI组	54（70.1）	23（29.9）	22（28.6）	46（59.7）	8（10.4）	53.94±12.01	13.70±5.54	52.94±8.50
检验统计量值	0.132^a		2.094^a			-5.678	-2.857	-2.349
P值	0.717		0.351			<0.001	0.005	0.021

组别	例数	TG [M（P₂₅，P₇₅），mmol/L]	TC （±s，mmol/L）	HDL-C （±s，mmol/L）	LDL-C （±s，mmol/L）	25（OH）D₃ （±s，μg/L）
非NSSI组	52	0.90（0.70，1.31）	3.28±0.85	1.05±0.31	1.64±0.59	15.44±5.23
NSSI组	77	1.01（0.73，1.57）	3.99±0.88	1.17±0.34	2.19±0.71	13.12±3.15
t（Z）值		-1.467^a	-4.555	-2.009	-4.666	2.874
P值		0.142	<0.001^b	0.047	<0.001^b	0.005^b

组别	例数	TG [M（P₂₅，P₇₅），mmol/L]	TC （±s，mmol/L）	HDL-C （±s，mmol/L）	LDL-C （±s，mmol/L）	25（OH）D₃ （±s，μg/L）
非NSSI组	52	0.90（0.70，1.31）	3.28±0.85	1.05±0.31	1.64±0.59	15.44±5.23
NSSI组	77	1.01（0.73，1.57）	3.99±0.88	1.17±0.34	2.19±0.71	13.12±3.15
t（Z）值		-1.467^a	-4.555	-2.009	-4.666	2.874
P值		0.142	<0.001^b	0.047	<0.001^b	0.005^b

变量	B	SE	Waldχ²值	P值	OR（95%CI）
模型1
LDL-C	1.364	0.345	15.910	<0.001	3.910（1.988~7.692）
25（OH）D₃	-0.143	0.052	7.540	0.006	0.867（0.783~0.960）
模型2
LDL-C	1.740	0.436	16.954	<0.001	5.695（2.422~13.388）
25（OH）D₃	-0.138	0.064	4.670	0.031	0.871（0.768~0.987）
年龄	-0.358	0.150	5.720	0.017	0.699（0.521~0.937）
PANSI总分	0.082	0.020	17.783	<0.001	1.086（1.045~1.128）

Correlation of Non-suicidal Self-injury with 25-Hydroxyvitamin D₃ and Blood Lipid Levels in Adolescents with Major Depressive Disorder

青少年抑郁障碍患者非自杀性自伤行为与25羟维生素D₃和血脂水平的相关性研究

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指标	AUC	95%CI	灵敏度（%）	特异度（%）	最佳截断值	约登指数	P值
LDL-C	0.73	0.65~0.82	68.83	69.23	1.89 mmol/L	0.38	<0.001
25（OH）D₃	0.62	0.52~0.72	100.00	25.00	19.15 μg/L	0.25	0.023
LDL-C联合25（OH）D₃	0.77	0.69~0.85	77.92	67.31	—	0.45	<0.001

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