Heart Failure Unit, Second Cardiology Department, Attikon University Hospital, Athens, Greece.
J Card Fail. 2011 Sep;17(9):748-54. doi: 10.1016/j.cardfail.2011.05.004.
Depression is a common comorbid condition in patients with chronic heart failure (CHF). This pilot study investigated the plasma levels of oxidative stress markers in depressed CHF patients as well as the effects of antidepressant treatment with sertraline on these markers in the same patient population.
Patients with positive depression screening [Beck Depression Inventory (BDI) score >10 and/or Zung Self-Rating Depression Scale >40] underwent a psychiatric interview. Patients newly diagnosed as depressed received pharmacologic treatment with sertraline for 3 months (arm A) and were compared with those who did not comply with the antidepressant treatment (arm B). Markers of oxidative stress [malondialdehyde (MDA) and protein carbonyls (PC)], and nitrosative stress [nitrotyrosine (NT)] were assessed at baseline and 3 months later. Fifty-two out of 254 screened hospitalized CHF patients were diagnosed as depressed. Depressed patients had significantly higher levels of MDA compared with age- and gender-matched nondepressed patients (n = 40; 3.2 ± 2.0 vs 2.8 ± 3.8 μmol/L; P = .02). Twenty-eight patients received sertraline (arm A), and 24 refused to receive antidepressant treatment on the top of optimal heart failure treatment (arm B). Although baseline levels of MDA and PC in arm A and arm B did not differ significantly (P > .05), arm A patients demonstrated a significant reduction in MDA (F = 4.657; P = .037) and arm B patients demonstrated no change after 3 months. Regarding the examined scores, arm A patients had a decrease in BDI score (28 ± 11 vs 21 ± 13; P = .008), and arm B patients had no change in BDI score at follow-up (P > .05). Arm A had an increase in 6-minute walking distance (291 ± 110 vs 361 ± 87 m; P = .02), and arm B experienced no change (P > .05).
Increased oxidative stress may play a critical role in the pathophysiology of depression in CHF. Treatment with sertraline improves depressive symptoms and reduces plasma markers of oxidative stress in depressed CHF patients.
抑郁症是慢性心力衰竭（CHF）患者常见的合并症。这项初步研究调查了抑郁 CHF 患者的氧化应激标志物的血浆水平，以及同一患者群体中使用舍曲林进行抗抑郁治疗对这些标志物的影响。
经过阳性抑郁筛查的患者[贝克抑郁量表（BDI）评分> 10 分和/或zung 自评抑郁量表> 40 分]接受了精神病学访谈。新诊断为抑郁的患者接受了舍曲林的药物治疗 3 个月（A 组），并与不遵守抗抑郁治疗的患者（B 组）进行了比较。在基线和 3 个月后评估氧化应激标志物[丙二醛（MDA）和蛋白羰基（PC）]和硝化应激标志物[硝基酪氨酸（NT）]。在筛查出的 254 例住院 CHF 患者中，52 例被诊断为抑郁。与年龄和性别匹配的非抑郁患者相比，抑郁患者的 MDA 水平明显升高（n = 40；3.2 ± 2.0 比 2.8 ± 3.8 μmol/L；P =.02）。28 名患者接受了舍曲林治疗（A 组），24 名患者拒绝在最佳心力衰竭治疗的基础上接受抗抑郁治疗（B 组）。尽管 A 组和 B 组的 MDA 和 PC 基线水平无显著差异（P >.05），但 A 组患者的 MDA 显著降低（F = 4.657；P =.037），而 B 组患者在 3 个月后无变化。在检查的评分方面，A 组患者的 BDI 评分降低（28 ± 11 比 21 ± 13；P =.008），而 B 组患者的 BDI 评分在随访时没有变化（P >.05）。A 组患者的 6 分钟步行距离增加（291 ± 110 比 361 ± 87 m；P =.02），而 B 组患者无变化（P >.05）。
氧化应激增加可能在 CHF 患者的抑郁症病理生理学中起关键作用。舍曲林治疗可改善抑郁症状，并降低抑郁 CHF 患者的血浆氧化应激标志物。
