Lahlou-Laforet Khadija, Alhenc-Gelas Martine, Pornin Maurice, Bydlowski Sarah, Seigneur Etienne, Benetos Athanase, Kierzin Jean-Michel, Scarabin Pierre-Yves, Ducimetiere Pierre, Aiach Martine, Guize Louis, Consoli Silla M
Department of C-L Psychiatry, Faculté de Médecine, Université Paris-Descartes, AP-HP, Hôpital Europeén Georges Pompidou, France.
Am J Cardiol. 2006 May 1;97(9):1287-91. doi: 10.1016/j.amjcard.2005.11.062. Epub 2006 Mar 20.
The increased risk of coronary heart disease (CHD) associated with depression is well documented. We hypothesized that impaired fibrinolysis is involved in this link. To explore the association of depressive mood and/or vital exhaustion with various measurements of fibrinolysis activity, 231 men (40 to 65 years old; 123 without CHD and taking no medication and 108 with documented CHD), completed the Center of Epidemiologic Studies Depression Scale and the Maastricht Questionnaire for vital exhaustion. Using classic cut-off points (Center of Epidemiologic Studies Depression Scale score >or=17, Maastricht Questionnaire score >or=8), 6.5% and 9.8% of subjects without CHD and 38% and 48.1% of those with CHD were classified as depressed and exhausted, respectively. Patients with CHD were older, had a higher body mass index, and higher levels of total cholesterol, glucose, plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA) antigen, and fibrinogen; 47% were treated for hypertension. Depressed subjects had higher levels of PAI-1 activity (p = 0.006) and exhausted patients had higher levels of PAI-1 activity (p = 0.011) and fibrinogen (p = 0.009). After adjusting for clinical condition (with or without CHD), smoking, hypertension, triglyceride concentration, and body mass index, PAI-1 activity remained higher in depressed subjects (p = 0.03). This association persisted after further adjustment for vital exhaustion or for t-PA antigen and fibrinogen levels. t-PA antigen and fibrinogen levels were not associated with depressive mood in multivariate analyses. No fibrinolytic variable was associated with vital exhaustion in multivariate analyses. In conclusion, depressive mood, but not vital exhaustion, is associated with higher levels of PAI-1 activity, suggesting a possible impairment of fibrinolysis and indicating a potential additional mechanism by which depressive mood may act as a cardiovascular risk factor.
抑郁症与冠心病（CHD）风险增加之间的关联已有充分记录。我们推测纤维蛋白溶解功能受损与这一联系有关。为了探究抑郁情绪和/或过度疲劳与纤维蛋白溶解活性的各种测量指标之间的关联，231名男性（年龄在40至65岁之间；123名无冠心病且未服用药物，108名有确诊冠心病）完成了流行病学研究中心抑郁量表和马斯特里赫特过度疲劳问卷。使用经典的临界值（流行病学研究中心抑郁量表得分≥17，马斯特里赫特问卷得分≥8），无冠心病的受试者中分别有6.5%和9.8%被归类为抑郁和过度疲劳，而有冠心病的受试者中这一比例分别为38%和48.1%。冠心病患者年龄更大，体重指数更高，总胆固醇、血糖、纤溶酶原激活物抑制剂1（PAI - 1）、组织纤溶酶原激活物（t - PA）抗原和纤维蛋白原水平更高；47%的患者接受过高血压治疗。抑郁受试者的PAI - 1活性水平更高（p = 0.006），过度疲劳患者的PAI - 1活性水平更高（p = 0.011）以及纤维蛋白原水平更高（p = 0.009）。在对临床状况（有无冠心病）、吸烟、高血压、甘油三酯浓度和体重指数进行调整后，抑郁受试者的PAI - 1活性仍然更高（p = 0.03）。在进一步对过度疲劳或t - PA抗原及纤维蛋白原水平进行调整后，这种关联依然存在。在多变量分析中，t - PA抗原和纤维蛋白原水平与抑郁情绪无关。在多变量分析中，没有纤维蛋白溶解变量与过度疲劳有关。总之，抑郁情绪而非过度疲劳与较高水平的PAI - 1活性相关，提示可能存在纤维蛋白溶解功能受损，并表明抑郁情绪可能作为心血管危险因素的一种潜在附加机制。
