Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
Brain Behav Immun. 2013 Jul;31:183-8. doi: 10.1016/j.bbi.2012.09.002. Epub 2012 Sep 13.
Depression following an acute coronary syndrome (ACS, including myocardial infarction or unstable angina) is associated with recurrent cardiovascular events, but the depressive symptoms that are cardiotoxic appear to have particular characteristics: they are 'incident' rather than being a continuation of prior depression, and they are somatic rather than cognitive in nature. We tested the hypothesis that the magnitude of inflammatory responses during the ACS would predict somatic symptoms of depression 3 weeks and 6 months later, specifically in patients without a history of depressive illness. White cell count and C-reactive protein were measured on the day after admission in 216 ACS patients. ACS was associated with very high levels of inflammation, averaging 13.23×10(9)/l and 17.06 mg/l for white cell count and C-reactive protein respectively. White cell count during ACS predicted somatic symptom intensity on the Beck Depression Inventory 3 weeks later (β=0.122, 95% C.I. 0.015-0.230, p=0.025) independently of age, sex, ethnicity, socioeconomic status, marital status, smoking, cardiac arrest during admission and clinical cardiac risk, but only in patients without a history of depression. At 6 months, white cell count during ACS was associated with elevated anxiety on the Hospital Anxiety and Depression Scale independently of covariates including anxiety measured at 3 weeks (adjusted odds ratio 1.08, 95% C.I. 1.01-1.15, p=0.022). An unpredicted relationship between white cell count during ACS and cognitive symptoms of depression at 6 months was also observed. The study provides some support for the hypothesis that the marked inflammation during ACS contributes to later depression in a subset of patients, but the evidence is not conclusive.
急性冠状动脉综合征（ACS，包括心肌梗死或不稳定型心绞痛）后出现抑郁与心血管事件的复发相关，但具有心脏毒性的抑郁症状似乎具有特定的特征：它们是“新发”而不是先前抑郁的延续，并且是躯体性而非认知性的。我们检验了这样一个假设，即在 ACS 期间炎症反应的程度会预测 3 周和 6 个月后抑郁的躯体症状，特别是在没有抑郁病史的患者中。我们在 216 例 ACS 患者入院后的第二天测量了白细胞计数和 C 反应蛋白。ACS 与非常高的炎症水平相关，白细胞计数和 C 反应蛋白的平均值分别为 13.23×10(9)/l 和 17.06mg/l。ACS 期间的白细胞计数可预测 Beck 抑郁量表在 3 周后躯体症状的严重程度（β=0.122，95%置信区间 0.015-0.230，p=0.025），独立于年龄、性别、种族、社会经济地位、婚姻状况、吸烟、入院期间的心脏骤停和临床心脏风险，但仅在没有抑郁病史的患者中如此。6 个月时，ACS 期间的白细胞计数与 HADS 焦虑量表上的焦虑升高独立相关，包括在 3 周时测量的焦虑（调整后的比值比 1.08，95%置信区间 1.01-1.15，p=0.022）。ACS 期间白细胞计数与 6 个月时抑郁的认知症状之间也存在未预测到的关系。该研究为这样一个假设提供了一些支持，即在 ACS 期间明显的炎症会导致一部分患者随后出现抑郁，但证据并不确定。
