抑郁症与冠心病

Depression and coronary heart disease

抑郁症可增加冠心病的患病危险及死亡率 ,但迄今为止还没有一种理论可明确阐述这种机制。本文综述抑郁症增加冠心病的发病率及死亡率的可能机制 :下丘脑 -垂体 -肾上腺系统对自主神经功能的改变 ,包括心率 ( HR)增快、心率变异性 ( HRV)降低、压力感受器敏感性 ( BRS)降低 ;中枢神经系统对自主神经功能的改变 ;血小板聚集作用增强 ;炎症反应 ;免疫反应 ;抗抑郁药的心肌毒性及药物间相互作用 ;不良的生活习惯 ;对治疗的依从性差。尽管目前对此机制的研究已有了一些进展 ,但还需要更多和更深入的研究来进一步阐明抑郁症对冠心病的影响。

Depression increases the risk of cardiac mortality and morbidity in the patients with coronary heart disease(CHD), but the mechanisms that underlie this association remain unclear. This review presents the evidence for several mechanisms that might explain how depression increases the risk for cardiac morbidity and mortality. The candidate mechanisms include: 1. The hypothalamic-pituitary-adrenal (HPA) axis alters cardiac autonomic tone: (1) elevated heart rate (HR); (2)reduced heart rate variability (HRV); (3)reduced baroreflex sensitivity (BRS). 2.The central nerve system alters cardiac autonomic tone ; 3. Increased platelet aggregation; 4. inflammatory and immunity processes;5. antidepressant cardiotoxicity and the interactions of drugs; 6. Bad living habits; 7. nonadherence to cardiac prevention and treatment regimens. Despite recent advances in our understanding of these potential mechanisms, further research is needed to determine how depression increases risk for cardiac morbidity and mortality.