Department of Psychiatry & Behavioral Neuroscience, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA.
Curr Psychiatry Rep. 2013 Oct;15(10):400. doi: 10.1007/s11920-013-0400-5.
Morbidity and mortality of cardiovascular disease is exceedingly high worldwide. Depressive illness afflicts a significant portion of the population worldwide. Epidemiological studies have confirmed the high co-morbidity between these two entities and the co-morbidity is bidirectional. Systems that contribute to this co-morbidity include the central and autonomic nervous systems, the neuroendocrine, immune, vascular and hematologic systems. Specific pathophysiologic factors include imbalance between the sympathetic and the parasympathetic systems, sympathoadrenal activation, hypothalamic-pituitary-adrenal axis activation, immune system dysregulation with release of pro-inflammatory cytokines and chemokines, platelet activation and hypercoaguability. Inflammation occurs in cardiac and cardiovascular pathology independent of the presence or absence of depression and in depression. Inflammation is closely associated with endothelial dysfunction which is a preamble to atherosclerosis and atherothrombosis. A likely common instigator underlying this co-morbidity is mental stress leading to sustained sympathetic overdrive and diminished vagal tone. Diminished vagal tone contributes to a pro-inflammatory status which affects neurotransmitter regulation, specifically serotonergic transmission. Stress hormones and certain pro-inflammatory substances released by macrophages and microglia upregulate the rate-limiting enzymes in the metabolic pathway of tryptophan. This results in a shunt in tryprophan metabolism away from serotonin formation and down the kynurenine pathway with resulting formation of neurotoxic metabolites.
心血管疾病的发病率和死亡率在全球范围内都非常高。抑郁症在全球范围内严重影响着相当一部分人群。流行病学研究已经证实了这两种疾病之间存在高度的共病性，而且这种共病性是双向的。导致这种共病的系统包括中枢和自主神经系统、神经内分泌、免疫、血管和血液系统。具体的病理生理因素包括交感和副交感系统之间的失衡、交感肾上腺激活、下丘脑-垂体-肾上腺轴激活、免疫系统失调导致促炎细胞因子和趋化因子的释放、血小板激活和高凝状态。炎症发生在心脏和心血管病理学中，与抑郁的存在与否无关。在抑郁症中也存在炎症。炎症与内皮功能障碍密切相关，内皮功能障碍是动脉粥样硬化和动脉血栓形成的前奏。导致这种共病的一个可能的共同诱因是精神压力，导致持续的交感神经兴奋和迷走神经张力降低。迷走神经张力降低导致促炎状态，影响神经递质调节，特别是 5-羟色胺传递。应激激素和巨噬细胞和小胶质细胞释放的某些促炎物质上调色氨酸代谢途径中的限速酶。这导致色氨酸代谢向 5-羟色胺形成的旁路转移，并沿着犬尿氨酸途径形成神经毒性代谢物。
