Stein P K, Carney R M, Freedland K E, Skala J A, Jaffe A S, Kleiger R E, Rottman J N
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
J Psychosom Res. 2000 Apr-May;48(4-5):493-500. doi: 10.1016/s0022-3999(99)00085-9.
The purpose of this study was to investigate the relationship between depression and heart rate variability in cardiac patients.
Heart rate variability was measured during 24-hour ambulatory electrocardiographic (ECG) monitoring in 40 medically stable out-patients with documented coronary heart disease meeting current diagnostic criteria for major depression, and 32 nondepressed, but otherwise comparable, patients. Patients discontinued beta-blockers and antidepressant medications at the time of study. Depressed patients were classified as mildly (n = 21) or moderately-to-severely depressed (n = 19) on the basis of Beck Depression Inventory scores.
There were no significant differences among the groups in age, gender, blood pressure, history of myocardial infarction, diabetes, or smoking. Heart rates were higher and nearly all indices of heart rate variability were significantly reduced in the moderately-to-severely versus the nondepressed group. Heart rates were also higher and mean values for heart rate variability lower in the mildly depressed group compared with the nondepressed group, but these differences did not attain statistical significance.
The association of moderate to severe depression with reduced heart rate variability in patients with stable coronary heart disease may reflect altered cardiac autonomic modulation and may explain their increased risk for mortality.
本研究旨在调查心脏病患者中抑郁症与心率变异性之间的关系。
对40名符合当前重度抑郁症诊断标准且病情稳定的冠心病门诊患者以及32名无抑郁症但在其他方面具有可比性的患者进行24小时动态心电图（ECG）监测，测量其心率变异性。研究时患者停用β受体阻滞剂和抗抑郁药物。根据贝克抑郁量表评分，将抑郁症患者分为轻度抑郁（n = 21）或中度至重度抑郁（n = 19）。
各组在年龄、性别、血压、心肌梗死病史、糖尿病或吸烟方面无显著差异。与无抑郁症组相比，中度至重度抑郁症组的心率更高，几乎所有心率变异性指标均显著降低。与无抑郁症组相比，轻度抑郁症组的心率也更高，心率变异性平均值更低，但这些差异未达到统计学意义。
稳定型冠心病患者中，中度至重度抑郁症与心率变异性降低之间的关联可能反映了心脏自主神经调节的改变，并可能解释了他们死亡风险增加的原因。
