Wright Lauren, Simpson William, Van Lieshout Ryan J, Steiner Meir
MiNDS Neuroscience Program, McMaster University, Canada and Women's Health Concerns Clinic, St Joseph's Healthcare, Hamilton, ON, Canada.
Ther Adv Cardiovasc Dis. 2014 Apr;8(2):56-69. doi: 10.1177/1753944714521671. Epub 2014 Feb 7.
Clinical studies have established an inherent comorbidity between depression and the development of cardiovascular disease (CVD). Furthermore, this comorbidity seems to be more amplified in women than in men. To further investigate this comorbidity, a thorough literature review was conducted on studies from 1992 to date. The PubMed database was accessed using the keywords: cardiovascular disease, inflammation, depression, and sex differences. Both human and animal studies were considered. This review takes the standpoint that depression and CVD are both inflammatory disorders, and that their co-occurrence may be related to how the hypothalamic-pituitary-adrenal axis, serotonergic transmission and circulation, and the renin-angiotensin-aldosterone system via angiotensin II are affected by the excess secretion of proinflammatory cytokines. More recently, preliminary research attributes this systemic inflammation to a global deficiency in CD4+CD25+FOXP3 regulatory T cells. 17-β estradiol and progesterone mediated modulation of cytokine secretion may partially explain the sex differences observed. These hormones and reproductive events associated with hormonal fluctuations are discussed in depth, including the analysis of perinatal models of depression and CVD, including preeclampsia. However, as evidenced by this review, there is a need for mechanistic research in humans to truly understand the nature and directionality of the relationship between depression and CVD.
临床研究已证实抑郁症与心血管疾病（CVD）的发生之间存在内在的共病关系。此外，这种共病关系在女性中似乎比在男性中更为明显。为了进一步研究这种共病关系，我们对1992年至今的相关研究进行了全面的文献综述。通过使用关键词“心血管疾病、炎症、抑郁症和性别差异”检索了PubMed数据库。纳入了人类和动物研究。本综述认为，抑郁症和心血管疾病都是炎症性疾病，它们的共同出现可能与促炎细胞因子的过度分泌如何影响下丘脑-垂体-肾上腺轴、血清素能传递和循环以及通过血管紧张素II的肾素-血管紧张素-醛固酮系统有关。最近，初步研究将这种全身炎症归因于CD4+CD25+FOXP3调节性T细胞的整体缺乏。17-β雌二醇和孕酮介导的细胞因子分泌调节可能部分解释了观察到的性别差异。本文深入讨论了这些激素以及与激素波动相关的生殖事件，包括对抑郁症和心血管疾病围产期模型（包括先兆子痫）的分析。然而，正如本综述所证明的，需要对人类进行机制研究，以真正了解抑郁症和心血管疾病之间关系的本质和方向性。
