Douglas Kevin M, Taylor Allen J, O'Malley Patrick G
General Internal Medicine, Department of Medicine, Walter Reed Army Medical Center, Washington, DC, USA.
Psychosom Med. 2004 Sep-Oct;66(5):679-83. doi: 10.1097/01.psy.0000138132.66332.85.
Both depression and C-reactive protein (CRP) are markers of increased risk for cardiovascular events. This study examined the relationship between CRP and depression in a cohort of participants undergoing a periodic physical to assess potential for interaction as either mediation or confounding of effect on cardiovascular risk.
We conducted a cross-sectional study of a cohort of 696 consenting, active duty US Army personnel undergoing a periodic physical. We measured depression using the Patient Health Questionnaire-9, the depression module of the self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). We used a highly sensitive assay to measure CRP.
The mean age in the cohort was 44 years (SD +/- 3; 82% male). The mean CRP level was 1.7 mg/l (range, 0.3-9.9; SD +/- 1.6 mg/l). Depression scores ranged from 0 to 26 with a mean of 2 (SD +/- 3). Depression scores correlated with prevalences of major depressive disorder and of any depressive disorder of 3.3% and 15%, respectively. Depression scores correlated positively with CRP levels (r = 0.085; p =.028), as did other variables known to be associated with CRP: body mass index (BMI; r = 0.36), insulin levels (r = 0.22), mean arterial pressure (r = 0.21), triglycerides (r = 0.18), exercise (r = -0.12), female sex (r = 0.097), current smoking status (r = 0.08), and high density lipoprotein (r = -0.09). After controlling only for BMI, the relationship between depression and CRP lost statistical significance among women (adjusted r = 0.08; p =.37), among men (adjusted r = -0.11; p =.8), and overall (adjusted r = 0.047; p =.219).
Depressive symptoms are only weakly correlated with CRP. However, after adjusting for BMI, we found no significant relationship between CRP and depression. The relationship between depression and clinical coronary disease is unlikely to be explained through direct effects on CRP levels, but may be mediated by BMI.
抑郁症和C反应蛋白（CRP）都是心血管事件风险增加的标志物。本研究在一组接受定期体检的参与者中，考察了CRP与抑郁症之间的关系，以评估二者作为心血管疾病风险影响的中介或混杂因素时的潜在交互作用。
我们对696名同意参与的现役美国陆军人员进行了一项横断面研究，这些人员正在接受定期体检。我们使用患者健康问卷-9（Patient Health Questionnaire-9）来测量抑郁症，该问卷是精神障碍初级保健评估（PRIME-MD）自我管理版本中的抑郁症模块。我们使用高敏检测法来测量CRP。
该队列的平均年龄为44岁（标准差±3；82%为男性）。平均CRP水平为1.7mg/L（范围为0.3 - 9.9；标准差±1.6mg/L）。抑郁评分范围为0至26，平均分为2分（标准差±3）。抑郁评分与重度抑郁症患病率以及任何抑郁症患病率分别为3.3%和15%相关。抑郁评分与CRP水平呈正相关（r = 0.085；p = 0.028），其他已知与CRP相关的变量也是如此：体重指数（BMI；r = 0.36）、胰岛素水平（r = 0.22）、平均动脉压（r = 0.21）、甘油三酯（r = 0.18）、运动（r = -0.12）、女性性别（r = 0.097）、当前吸烟状况（r = 0.08）以及高密度脂蛋白（r = -0.09）。仅对BMI进行控制后，抑郁症与CRP之间的关系在女性中失去统计学意义（调整后r = 0.08；p = 0.37），在男性中也是如此（调整后r = -0.11；p = 0.8），总体上也是如此（调整后r = 0.047；p = 0.219）。
抑郁症状与CRP仅呈弱相关。然而，在对BMI进行调整后，我们发现CRP与抑郁症之间无显著关系。抑郁症与临床冠心病之间不太可能通过对CRP水平的直接影响来解释，而可能由BMI介导。
