Department of Psychiatry, University of California, San Diego, La Jolla, California 92161, USA.
J Am Coll Cardiol. 2010 Nov 16;56(21):1720-7. doi: 10.1016/j.jacc.2010.04.064.
the aim of this study was to determine whether depressive symptoms are related to alterations in the sensitivity of peripheral blood mononuclear cells to β-adrenergic agonists in patients with heart failure (HF) by measuring in vitro chemotaxis (CTX) to isoproterenol at rest and after acute exercise in patients with HF and controls.
clinical outcomes are worse for patients with HF presenting with symptoms of depression. Sympathetically modulated immune dysregulation associated with depression may be one mechanism leading to worse prognosis.
seventy-seven patients with HF and 44 controls (mean age 56.4 ± 1.3 years) completed the Beck Depression Inventory and a 15-min mild-graded exercise task on a stationary bicycle. Exercise intensity was kept relative to fitness levels for all participants by gradually increasing resistance to reach a Borg scale subjective rating of 12 to 13, "somewhat hard." Plasma norepinephrine and epinephrine levels were measured before and after exercise. Chemotaxis to isoproterenol was determined by measuring in vitro peripheral blood mononuclear cell migration through a modified Boyden chamber.
In patients with HF, depressive symptom severity was associated with greater CTX after exercise (p = 0.001). Higher resting norepinephrine in patients with HF was also associated with increased CTX to exercise (p = 0.03).
patients with HF with higher depressive symptoms and norepinephrine exhibited increased peripheral blood mononuclear cell CTX to isoproterenol to mild exercise, suggesting greater β-adrenergic sensitivity. Increased immune migration in patients with HF who have elevated depressive symptoms could be associated with cardiac remodeling and HF disease progression.
本研究旨在通过测量心力衰竭（HF）患者静息和急性运动后异丙肾上腺素诱导的体外趋化性（CTX），来确定抑郁症状是否与 HF 患者外周血单个核细胞对β-肾上腺素能激动剂的敏感性改变有关。
伴有抑郁症状的 HF 患者临床结局更差。与抑郁相关的交感神经调节免疫失调可能是导致预后更差的机制之一。
77 例 HF 患者和 44 例对照者（平均年龄 56.4±1.3 岁）完成贝克抑郁量表（BDI）和固定自行车上 15 分钟的轻度分级运动任务。通过逐渐增加阻力，使所有参与者的运动强度与体能水平保持一致，以达到 Borg 量表主观评分 12-13，即“有点难”。在运动前后测量血浆去甲肾上腺素和肾上腺素水平。通过改良 Boyden 室测量体外外周血单个核细胞迁移来确定异丙肾上腺素的趋化性。
HF 患者的抑郁症状严重程度与运动后 CTX 增加有关（p=0.001）。HF 患者静息时去甲肾上腺素水平较高也与运动后 CTX 增加相关（p=0.03）。
HF 患者中，抑郁症状严重且去甲肾上腺素水平较高的患者对异丙肾上腺素的外周血单个核细胞 CTX 增加，表明β-肾上腺素能敏感性增加。在抑郁症状升高的 HF 患者中，免疫细胞迁移增加可能与心脏重构和 HF 疾病进展有关。
