Rimar Liat, Rimar Doron
Department of Medicine E, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva.
Harefuah. 2004 Jan;143(1):73-8, 83.
Major depression is a risk factor, associated with a twofold increase in the incidence of ischemic heart disease (IHD). One of every 6 patients suffers from major depression following acute myocardial infarction (AMI). This connection is of major concern, considering that major depression is an independent risk factor for cardiac morbidity and mortality after AMI, increasing overall mortality fourfold. Activation of the immune system has a significant role in the pathogenesis of IHD and depression. Vast physiological responses, mediated mostly by activation of the immune system, accompany post MI depression and may account for increased prevalence of arrhythmias and high mortality. This includes activation of the hypothalamic-pituitary-adrenocortical axis, endothelial dysfunction, platelets activation and alterations of phospholipid composition in cell membranes. On the other hand, activation of the immune system after AMI includes elevated levels of interleukin-1 and interleukin-6. which induce "sickness behavior", characterized by symptoms similar to those observed in major depression. The key question raised by this data, whether inflammation is the common ground for both AMI and depression, or if it is accompanying one and sets the ground for the other, remains unanswered at this time. The significance of major depression as an independent risk factor for post MI mortality and morbidity raises the practical question, whether treatment of depression can reduce mortality after AMI. Several recent studies that evaluated this presumption, failed to prove it. In this review we present an overview of the cross interaction between depression, AMI and inflammation and its diagnostic and therapeutic implications.
重度抑郁症是一个风险因素，与缺血性心脏病（IHD）发病率增加两倍相关。每6名急性心肌梗死（AMI）患者中就有1人患有重度抑郁症。鉴于重度抑郁症是AMI后心脏发病和死亡的独立风险因素，会使总体死亡率增加四倍，这种关联备受关注。免疫系统激活在IHD和抑郁症的发病机制中起重要作用。AMI后抑郁症伴随着大量主要由免疫系统激活介导的生理反应，这可能是心律失常患病率增加和高死亡率的原因。这包括下丘脑 - 垂体 - 肾上腺皮质轴的激活、内皮功能障碍、血小板活化以及细胞膜中磷脂成分的改变。另一方面，AMI后免疫系统的激活包括白细胞介素 - 1和白细胞介素 - 6水平升高，它们会诱发“疾病行为”，其特征类似于在重度抑郁症中观察到的症状。这些数据提出的关键问题，即炎症是AMI和抑郁症的共同基础，还是它伴随着其中一个并为另一个奠定基础，目前仍未得到解答。重度抑郁症作为AMI后死亡率和发病率的独立风险因素的重要性，引发了一个实际问题，即抑郁症的治疗是否可以降低AMI后的死亡率。最近几项评估这一假设的研究未能证实这一点。在本综述中，我们概述了抑郁症、AMI和炎症之间的相互作用及其诊断和治疗意义。
