【抑郁與冠心病的探究進(jìn)展綜述論文4200字】

綜述綜述南華大學(xué)碩士學(xué)位論文南華大學(xué)碩士學(xué)位論文抑郁與冠心病的研究進(jìn)展綜述論文目錄TOC\o"1-2"\h\u10885抑郁與CHD患者的預(yù)后： 15864CHD患者合并抑郁的可能發(fā)病機(jī)制 24276 210597 217477 27996-- 315433 32360 327732 3694CHD患者合并抑郁的早期篩查 426655CHD患者合并抑郁的治療 418219 48544 532036展望： 531070參考文獻(xiàn) 6摘要：后的影響、發(fā)病機(jī)制、早期篩查、治療方案等幾個(gè)方面進(jìn)行綜述。關(guān)鍵詞：冠心病、抑郁、機(jī)制、治療（Coronaryheartdisease，CHD）5名CHD1人患有抑郁癥，其3倍[1-2]“生物-心理-醫(yī)學(xué)”抑郁共病的現(xiàn)象越來越受到臨床醫(yī)師的關(guān)注。抑郁與CHD患者的預(yù)后：新診斷的CHD12內(nèi)會(huì)增加一倍[3]量-[4]名因AMI12個(gè)月的隨訪研究顯示，260名抑郁癥患者的直接醫(yī)療再入院時(shí)間延長(zhǎng)[5]654名疑似CHD33%21%。而總社會(huì)成本也可能在抑郁的CHD患者中增加，這可能是延遲返回工作導(dǎo)致的生產(chǎn)力損失而造成的[6]CHD定程度上造成了醫(yī)療資源的浪費(fèi)，成為嚴(yán)重的社會(huì)公共衛(wèi)生問題。CHD患者合并抑郁的可能發(fā)病機(jī)制研究表明，A型性格的人更容易患CHD。其性格特征主要體現(xiàn)在三個(gè)方面：AMI并與MACE的發(fā)生率增加相關(guān)。D型人格性格特征主要包括：負(fù)性情感和社會(huì)抑制性[8]。除了性格因素的影響外，CHD合并抑郁患者的不良行為改變也在疾病的進(jìn)過度疲勞也被證明是心源性猝死的前兆。ratevariability，HRV）的降低與該調(diào)節(jié)功能受損有關(guān)[10]。而心率增快與的降低均可誘發(fā)心源性猝死[11]。--抑郁與白細(xì)胞介素-1、白細(xì)胞介素-6、腫瘤壞死因子-α等參與非特異性免疫反應(yīng)的促炎性細(xì)胞因子的過度分泌有關(guān)omega-3和脂肪酸的血清濃度卻平行下降[13]激活，進(jìn)一步加重炎癥反應(yīng)和氧化應(yīng)激[9]。在軸的作用下，血清皮質(zhì)醇濃度增加，不僅誘導(dǎo)胰島素抵抗和脂質(zhì)代謝紊亂，還可破壞海馬神經(jīng)元，以致于對(duì)軸的負(fù)反饋?zhàn)饔脺p弱，形成惡性循環(huán)[14]。抑郁可通過介導(dǎo)內(nèi)皮功能障礙以及增強(qiáng)血小板反應(yīng)性來影響CHD患者的預(yù)后。研究表明，血小板反應(yīng)性增強(qiáng)是抑郁癥患者AS血栓形成易感性增加的潛在機(jī)制[15]5-5-5-羥色胺密度也可能增加血小板的反應(yīng)性[16]減弱[17]。切相關(guān)[18-19]。腸道微生物群代謝產(chǎn)物可產(chǎn)生神經(jīng)活性物質(zhì)來影響大腦發(fā)育和功交互作用可能導(dǎo)致抑郁的發(fā)生[20-21]可通過炎癥反應(yīng)影響中樞神經(jīng)系統(tǒng)的功能、神經(jīng)遞質(zhì)的信號(hào)傳導(dǎo)，導(dǎo)致抑郁癥[22-23]神經(jīng)系統(tǒng)的生理皮質(zhì)醇水平、炎癥因子和神經(jīng)遞質(zhì)調(diào)節(jié)來改善抑郁癥狀[24-25]。內(nèi)分泌因子通過旁分泌和自分泌途徑調(diào)節(jié)器官的生長(zhǎng)、代謝和功能。IGF-1生長(zhǎng)激素的調(diào)控。IGF-1是預(yù)防冠心病的有效保護(hù)因素[26]。血清IGF-1水平過高CHD的風(fēng)險(xiǎn)[26]IGF-1[27]。認(rèn)知能力較低的個(gè)體如果IGF-1水平較低，則更容易患抑郁癥[28-29]。FGF21善動(dòng)脈粥樣硬化和減輕心肌缺血再灌注損傷。Liu等證明FGF21水平與男性受試者貝克抑郁量表得分之間存在顯著的負(fù)相關(guān)，表明FGF21具有預(yù)防抑郁的功能[30]IGF-1FGF21可能參與了CHDCHD患者合并抑郁的早期篩查的CHD患者，因?yàn)榉蔷駥？漆t(yī)師對(duì)于抑郁的識(shí)別及診治往往是不甚了解的。所有CHD成年患者，包括急性起病或慢性進(jìn)展患者，都應(yīng)進(jìn)行抑郁篩查及風(fēng)險(xiǎn)評(píng)估[31]。美國(guó)心臟病協(xié)會(huì)建議首先使用PHQ-2量表進(jìn)行基線評(píng)估，若PHQ-2篩PHQ-9量表對(duì)于病情嚴(yán)重程度進(jìn)行評(píng)估[32]慮每年度或者更頻繁的進(jìn)行抑郁的篩查、評(píng)估。CHD患者合并抑郁的治療CHD患者合并抑郁的藥物治療可以有效緩解其抑郁情緒[33]，但無法減輕抑郁帶來的心臟損害以及死亡率的增加[34]。目前抗抑郁藥物主要包括三環(huán)類藥物、5-5-羥色胺和去甲腎上腺素再5-羥色胺再攝取抑制劑是治療CHD5-羥色胺和去甲腎上腺素再攝取抑制劑是一種新型抗[36]規(guī)律的生活作息以及適當(dāng)?shù)倪\(yùn)動(dòng)訓(xùn)練，提升生活質(zhì)量，加強(qiáng)CHD二級(jí)預(yù)防從而一定程度的改善，但并沒有較強(qiáng)的證據(jù)可以表明心里干預(yù)治療可以降低CHD患者的全因死亡率及相關(guān)并發(fā)癥風(fēng)險(xiǎn)[38]。展望：近期研究發(fā)現(xiàn)，腸道微生物群及一些內(nèi)分泌因子可能參與了CHD合并抑郁的發(fā)生、發(fā)展，但其相關(guān)機(jī)制仍需進(jìn)一步的基礎(chǔ)實(shí)驗(yàn)和臨床研究去探討及證實(shí)。目前中藥聯(lián)合抗抑郁藥物治療并未在臨床上較大范圍應(yīng)用，相關(guān)副作用尚未可參考文獻(xiàn)LaneD,CarrollD,RingC,etal.Theprevalenceandpersistenceofdepressionandanxietyfollowingmyocardialinfarction[J].Britishjournalofhealthpsychology,2002,7(Pt1):11-21.RuoB,RumsfeldJS,HlatkyMA,etal.Depressivesymptomsandhealth-relatedqualityoflife:theHeartandSoulStudy[J].Jama,2003,290(2):215-221.CarneyRM,RichFreedlandKE,etal.Majordepressivedisorderpredictscardiaceventsinpatientswithcoronaryarterydisease[J].Psychosomaticmedicine,1988,50(6):627-633.Frasure-SmithN,LespéranceReflectionsondepressionasacardiacriskfactor[J].Psychosomaticmedicine,2005,67(Suppl1):S19-25.Frasure-SmithN,LespéranceGravelG,etal.Depressionandhealth-carecostsduringthefirstyearfollowingmyocardialinfarction[J].Journalofpsychosomaticresearch,2000,48(4-5):471-478.RutledgeJohnsonBD,etal.Depressionandcardiovascularhealthcarecostsamongwomenwithsuspectedmyocardialischemia:prospectiveresultsfromtheWISEIschemiaSyndromeEvaluation)Study[J].JournaloftheAmericanCollegeofCardiology,2009,53(2):176-183.ConsoliSM,CordierS,DucimetierePJPM.ApsychologicalmodelaccountingfortheriskfordepressionintheFrenchGAZELcohort[J].PsychosomaticMedicine,1997,59.LinLiL,etal.Dpersonality,butnotAbehaviorpattern,isassociatedwithcoronaryplaquevulnerability[J].Psychology,health&medicine,2018,23(2):216-223.ZornSchürRR,Boksetal.Cortisolstressreactivityacrosspsychiatricdisorders:Asystematicreviewandmeta-analysis[J].Psychoneuroendocrinology,2017,77:25-36.李愛民. 冠心病患者心理抑郁的相關(guān)研究進(jìn)展[J].中國(guó)處方藥2018,16(06):13-15.MartensEJ,NyklícekI,SzabóBM,etal.Depressionandanxietyaspredictorsofheartratevariabilityaftermyocardialinfarction[J].Psychologicalmedicine,2008,38(3):375-383.MaesM,BockstaeleDR,GastelA,etal.Theeffectsofpsychologicalstressonleukocytesubsetdistributioninhumans:evidenceofimmuneactivation[J].Neuropsychobiology,1999,39(1):1-9.SeverusWE,LittmanAB,StollAL.Omega-3fattyacids,homocysteine,andtheincreasedriskofcardiovascularmortalityinmajordepressivedisorder[J].Harvardreviewofpsychiatry,2001,9(6):280-293.deAlmeidaKM,MoreiraCL,LaferB.Metabolicsyndromeandbipolardisorder:whatshouldpsychiatristsknow?[J].CNSneuroscience&therapeutics,2012,18(2):160-166.MusselmanDL,A,ManatungaAK,etal.Exaggeratedplateletreactivityinmajordepression[J].TheAmericanjournalofpsychiatry,1996,153(10):1313-1317.WilliamsMS.Plateletsanddepressionincardiovasculardisease:Abriefreviewofthecurrentliterature[J].journalofpsychiatry,2012,2(6):114-123.MusselmanDL,MarzecUM,ManatungaA,etal.Plateletreactivityindepressedpatientstreatedwithparoxetine:preliminaryfindings[J].Archivesofgeneralpsychiatry,2000,57(9):875-882.JieZ,XiaH,ZhongSL,etal.Thegutmicrobiomeinatheroscleroticcardiovasculardisease[J].Naturecommunications,2017,8(1):845.PAGEPAGE51PAGEPAGE50MohajeriMH,LaFataG,SteinertRE,etal.Relationshipbetweenthegutmicrobiomeandbrainfunction[J].Nutritionreviews,2018,76(7):481-496.DinanTG,CryanTheimpactofgutmicrobiotaonbrainandbehaviour:implicationsforpsychiatry[J].Currentopinioninclinicalnutritionandmetaboliccare,2015,18(6):552-558.PetraAI,PanagiotidouS,HatziagelakiE,etal.Gut-Microbiota-BrainAxisandItsEffectonNeuropsychiatricDisordersSuspectedImmuneDysregulation[J].Clinicaltherapeutics,2015,37(5):984-995.EvrenselA,CeylanME.TheGut-BrainAxis:TheMissingLinkinDepression[J].Clinicalpsychopharmacologyandneuroscience:theofficialscientificjournaloftheKoreanCollegeofNeuropsychopharmacology,2015,13(3):239-244.HayleyS,AudetMC,AnismanH.Inflammationandthemicrobiome:implicationsfordepressivedisorders[J].Currentopinioninpharmacology,2016,29:42-46.PirbaglouM,KatzJ,deSouzaRJ,etal.Probioticsupplementationcanpositivelyaffectanxietyanddepressivesymptoms:asystematicreviewofrandomizedcontrolledtrials[J].Nutritionresearch(NewNY),2016,36(9):889-898.CJK,MilevR.Erratumto:Theeffectsofprobioticsondepressivesymptomsinhumans:asystematicreview[J].Annalsofgeneralpsychiatry,2017,16:18.CarlzonD,SvenssonJ,PetzoldM,etal.BothlowandhighserumIGF-1levelsassociatewithincreasedriskofcardiovasculareventsinelderlymen[J].TheJournalofclinicalendocrinologyandmetabolism,2014,99(11):E2308-2316.BotM,MilaneschiPenninxetal.Plasmainsulin-likegrowthfactorIlevelsarehigherindepressiveandanxietydisorders,butlowerinantidepressantmedicationusers[J].Psychoneuroendocrinology,2016,68:148-155.FraterJ,LieD,Bartlettetal.Insulin-likeGrowthFactor1(IGF-1)asamarkerofcognitivedeclineinnormalageing:Areview[J].Ageingresearchreviews,2018,42:14-27.LinSuhrJ,DieboldS,etal.Associationsbetweendepressivesymptomsandmemorydeficitsvaryasafunctionofinsulin-likegrowthfactor(IGF-1)levelsinhealthyolderadults[J].Psychoneuroendocrinology,2014,42:118-123.LiuM,X,etal.NegativecorrelationbetweencerebrospinalfluidFGF21levelsandBDIscoresinmaleChinesesubjects[J].Psychiatryresearch,2017,252:111-113.SiuAL,Bibbins-DomingoK,GrossmanDC,etal.ScreeningforDepressioninAdults:USPreventiveServicesForceRecommendationStatement[J].Jama,2016,315(4):380-387.AAFPguidelineforthedetectionandmanagementofpost-myocardialinfarctiondepression[J].Annalsoffamilymedicine,2009,7(1):71-79.CoventryLovellK,DickensC,etal.Integratedprimarycareforpatientswithmentalandphysicalmultimorbidity:clusterrandomisedcontrolledtrialofcollaborativecareforpatientswithdepressioncomorbidwithdiabetesorcardiovasculardisease[J].BMJ(Clinicalresearc