抑郁对中老年冠心病患者血清白介素-1β水平的影响
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摘要
目的研究抑郁对中老年冠心病稳定性心绞痛患者白介素-1β(IL-1β)水平的影响。方法收集2007年7月至2007年12月期间住院治疗年龄≥50岁的中老年冠心病稳定性心绞痛患者86例。根据ZUNG抑郁自评量表(SDS)评定标准,冠心病伴抑郁患者62例(A组),冠心病不伴抑郁患者24例(B组),对两组患者的临床特征,血脂、血糖及IL-1β检测结果进行对比分析。结果两组研究对象在年龄、性别构成、吸烟、饮酒、受教育程度、合并高血压、合并糖尿病等之间的差异无统计学意义(P>0.05)。冠心病伴抑郁组IL-1β水平高于冠心病不伴抑郁组并且与不伴抑郁组比较有显著性差异,P<0.05。SDS问卷积分与IL-1β呈正相关,r为0.3013,P<0.01。同时按轻、中、重程度与IL-1β相关分析也呈正相关,r为0.3547,P<0.01。两组患者血脂水平无显著性差异,且与IL-1β之间没有相关性(P>0.05)。结论伴有抑郁的冠心病稳定性心绞痛患者血清IL-1β水平明显高于不伴有抑郁的冠心病患者,且与抑郁程度呈正比。研究表明抑郁与冠心病稳定性心绞痛之间通过免疫炎症因子这个中间因素影响冠心病的发生、发展、预后,是冠心病预后的预测因素之一。
Objective To investigate the influence of depression on serum interleukin-1βlevel of middle age and elderly patients with coronary hear disease of stable angina pectoris. Methods Eighty-six (age≥50) middle aged and elderly (aging ) patients with coronary hear disease of stable angina pectoris who were admitted to our department from Augest2007 to December2007 recruited to our study. According to ZHUG questionnaire (SDS) score whether accompanied with depression or not 86 patients divided into two groups. There were 62 patients in Group A (patients with depression) and 24 patients in group B (patients without depression) respectively. We analyzed clinical data, serum lipid, blood glucose and interleukin-1βlevel of two groups. Results There was no significant difference between two groups when compare age, sex, smoking, drinking, education, accompany with hypertension, accompany with diabetic (P>0.05). The level of interleukin-1βin coronary hear disease accompany with depression higher than coronary hear disease without depression and significant different with without depression group, P<0.05. Correlation analysis results showed that SDS score was positive related to interleukin-1β, r was 0.3547, P<0.01. No significant different between two groups on lipid level and no related to interleukin-1B (P>0.05). Conclusion The level of interleukin-1βin coronary heart disease accompany with depression higher than coronary hear disease without depression and positive related to depression degrees. The study showed that depression through immune inflammatory cytokines effect to cause, developing, prognosis of coronary hear disease, it is one of the predictor factor of poor prognosis in coronary hear disease.
Objective To investigate the influence of depression on serum interleukin-1βlevel of middle age and elderly patients with coronary hear disease of stable angina pectoris. Methods Eighty-six (age≥50) middle aged and elderly (aging ) patients with coronary hear disease of stable angina pectoris who were admitted to our department from Augest2007 to December2007 recruited to our study. According to ZHUG questionnaire (SDS) score whether accompanied with depression or not 86 patients divided into two groups. There were 62 patients in Group A (patients with depression) and 24 patients in group B (patients without depression) respectively. We analyzed clinical data, serum lipid, blood glucose and interleukin-1βlevel of two groups. Results There was no significant difference between two groups when compare age, sex, smoking, drinking, education, accompany with hypertension, accompany with diabetic (P>0.05). The level of interleukin-1βin coronary hear disease accompany with depression higher than coronary hear disease without depression and significant different with without depression group, P<0.05. Correlation analysis results showed that SDS score was positive related to interleukin-1β, r was 0.3547, P<0.01. No significant different between two groups on lipid level and no related to interleukin-1B (P>0.05). Conclusion The level of interleukin-1βin coronary heart disease accompany with depression higher than coronary hear disease without depression and positive related to depression degrees. The study showed that depression through immune inflammatory cytokines effect to cause, developing, prognosis of coronary hear disease, it is one of the predictor factor of poor prognosis in coronary hear disease.
引文
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[5] Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review [J]. Psychosom Med, 2003, 65: 201 210.
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[11] Musselman DL, EvansDL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, an treatment [J]. ArchGenPsychiatry, 1998, 55(7): 580-592.
[12]黄佐,樊民,吴宗贵.冠心病患者抑郁症状与冠状动脉病变的关系[J].中国临床康复, 2005, 9(4): 46 47.
[13] ]方润领,蒋玉卉,宋江山,程桂林.心肌梗死患者综合性心理干预对照研究[J].中国临床康复, 2003, 7(9): 1382-1383.
[14] Barefoot JC, Brummett BH, Clapp Channning NE, et al. Moderators of the effect of social support on depressive symptoms in cardiac patients[J].AmJCardiac, 2000, 86(4): 438-442.
[15]杨利群,李田昌,胡大一,等.胸痛患者伴随抑郁情况的研究[J].中华全科医师杂志, 2006, 5(6)354-357.
[16] Karen EJ, David JW, Christopher MO. Depression and Cardiovascular Disease: Mechanisms of Interaction [J]. Biol Psychiatry, 2003, 54: 248-261.
[17] Carney RM, Freedl and KE, Veith RC. Depression , the Autonomic Nervous System, and Coronary Heart Disease [J]. Psychosom Med, 2005,67Suppl1:29- 33.
[18] Glassman AH, Shapiro PA. Depression and the course of coronary artery disease [J].AmJPsychiatry, 1998, 155(1): 4-11.
[19] Stein PK, Carney RM, Freedland KE, et al. Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease [J]. JPsychosomRes, 2000, 48(4-5): 493-500.
[20] Sherwood A, Hinderliter AL, Watkings LL, et al. Impaired endothelial function in coronary heart disease patients with depressive symptomatology [J]. J Am Coll Cardiol.2005; 16; 46 (4): 656-659.
[21] Brydon L, Magid K, Steptoe A. Platelets, coronary heart disease, and stress[J]. Brain Behav Immun. 2006; 20(2): 113 119.
[22] Selley ML. Increased (E) 4hydroxy2nonenal and asymmetricdi methylarginine concentrations and decreased nitric oxide concentrations in the plasma of patients with major depression [J]. J Affect Disord.2004; 80(2-3): 249 256.
[23]国际心脏病学学会(ISFC)及世界卫生组织(WHO).临床命名及诊断人联合专题组制定缺血性心脏病命名及诊断[S]. 1979.
[24]卫生部卫生统计信息中心,北京协和医院世界卫生疾病分类合作中心国际疾病分类(ICD-10)指导手册.北京:中国协和医科大学出版社, 2001; 3～17.
[25]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志2001, 34(8): 184-188.
[26]祖蓓蓓.抑郁症与免疫抑制[J].国外医学精神病分册, 2004, 31(2): 97-99
[27] Maes M. Evidence for an immune response in major depression: a review and hypothesis [J]. Progress in Neuro-Psychopharmacology & Biological psychiatry, 1995,19: 11-38
[28] Kronfol Z. Immune dysregulation in major depression: a critical review of existingevidence [J]. Int. J.Nuropsychophamacol, 2002, 5: 333-343
[29] Suarez E C, Lewis J C, Krishnan R R, et al. Enhanced expression of cytokines and chemokines by blood monocytes to in vitro lipopolysaccharide stimulation are associated with hostility and severity of depressive symptoms in healthy women [J]. Psychoneuroendocrinology, 2004; 29(9): 1119-1128
[30] Levine J, Barak Y, Chengappa K N, et al. Cerebrospinal cytokine level in patients with acute depression [J]. Neuropsycholibiology, 1999, 40: 171-176
[31] Olga J.G, Marieke C. W, Maes M, et al. Cytokines and major depression [J]. Progress in Neuro-Psychopharmacology & Biological psychiatry, 2005, 29: 201-217.
[32]梁皓.重要炎症因子与冠心病的关系[J].实用诊断与治疗志, 2007, 21(5): 364-365.
[33] BLAKE GJ, RIDKER P M .Inflammatory bio-markers and cardiovascular risk prediction [J].J Intern Med, 2002,252:283-294.
[34] Cusack MR, Marber MS, Lambiase PD, et al. Systematic inflammation in unstable angina is the result of myocardial necrosis [J] .J Am Coll Cardial, 2002, 39(12): 1917-1923.
[35] Jenny NS, Tracy RP, Ogg MS, et al. In the elderly,interleukin-6plasma levels and the 174G>C polymorphism are associated with the development of cardiovascular disease [J]. Arterioscler Thromb Vasc Biol, 2002, 22(12):2066-2071.
[36]王战坤,蔡魏.细胞因子与冠状动脉狭窄程度的相关性研究[J].中华心血管病学杂志, 2003,3(31)588-590.
[37] Shen Chengxing, Chen Haozhu, Ge Junbo. The role of inflammatory stress in acut coronary syndrome[J].Chin Med J, 2004,117(1): 133-139.
[38]吕永良,吴爱勤,李鸣,刘建农.老年抑郁症病人免疫功能及其心理状况的对照研究[J].中国行为医学杂志, 2003, 12(6): 634-635.
[39]杨坤,张中兴,王长虹,等.抑郁症患者帕罗西汀治疗前后血清细胞因子C-反应蛋白和锌水平变化的研究[J].中国行为医学科学2005, 14(9): 792-794.
[40] Owen BM, Eccleston D, Ferrier IN, et al. Raised levels of plasma interleukin1 beta in major and post viral depression[J] ActaPsychiatrScand, 2001, 103(3): 226-228.
[41] Bearfoot JC, Helm S, Mark DB. Depression and long-term mortality risk in patients with coronary artery disease[J]. AmJCardiol, 1996, 78(6): 613-615.
[42]冯学泉,张作记,淑厚兴,等.不良心境与冠心病患者血清氧化低密度脂蛋白相关性[J].中国行为医学科学, 2006, 15(2): 112-114
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