Martinac Marko, Pehar Davor, Karlović Dalibor, Babić Dragan, Marcinko Darko, Jakovljević Miro
Acta Clin Croat. 2014 Mar;53(1):55-71.
Depression has been associated with various cardiovascular risk factors such as hypertension, obesity, atherogenic dyslipidemia and hyperglycemia. In depressive disorder, hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and changes in the immune system have been observed. On the other hand, somatic diseases such as obesity, hyperlipidemia, hypertension and diabetes mellitus type 2 are now perceived as important comorbid conditions in patients with depression. The pathogenesis of the metabolic syndrome and depression is complex and poorly researched; however, it is considered that the interaction of chronic stress, psychotrauma, hypercotisolism and disturbed immune functions contribute to the development of these disorders. The aim of the study was to investigate the relationship between depression and metabolic syndrome regarding the HPA axis dysfunction and altered inflammatory processes. Literature search in Medline and other databases included articles written in English published between 1985 and 2012. Analysis of the literature was conducted using a systematic approach with the search terms such as depression, metabolic syndrome, inflammation, cytokines, glucocorticoids, cortisol, and HPA axis. In conclusion, the relationship between depression and metabolic syndrome is still a subject of controversy. Further prospective studies are required to clarify the possible causal relationship between depression and metabolic syndrome and its components. Furthermore, it is important to explore the possibility of a common biologic mechanism in the pathogenesis of these two disorders, in which special attention should be paid to the immune system function, especially the possible specific mechanisms by which cytokines can induce and maintain depressive symptoms and metabolic disorders. The data presented here emphasize the importance of recognition and treatment of depressive disorders with consequent reduction in the incidence of metabolic syndrome, but also the need of regular search for metabolic disorders and their treatment to avoid all of these adverse effects and maybe reduce the incidence of depressive disorders.
抑郁症与多种心血管危险因素相关，如高血压、肥胖、致动脉粥样硬化性血脂异常和高血糖。在抑郁症患者中，已观察到下丘脑 - 垂体 - 肾上腺（HPA）轴功能亢进和免疫系统变化。另一方面，肥胖、高脂血症、高血压和2型糖尿病等躯体疾病现在被视为抑郁症患者重要的共病情况。代谢综合征和抑郁症的发病机制复杂且研究较少；然而，人们认为慢性应激、心理创伤、高皮质醇血症和免疫功能紊乱之间的相互作用促成了这些疾病的发展。本研究的目的是探讨抑郁症与代谢综合征之间关于HPA轴功能障碍和炎症过程改变的关系。在Medline和其他数据库中进行文献检索，纳入了1985年至2012年间发表的英文文章。使用系统方法对文献进行分析，检索词包括抑郁症、代谢综合征、炎症、细胞因子、糖皮质激素、皮质醇和HPA轴。总之，抑郁症与代谢综合征之间的关系仍然是一个有争议的话题。需要进一步的前瞻性研究来阐明抑郁症与代谢综合征及其组成部分之间可能的因果关系。此外，探索这两种疾病发病机制中共同生物学机制的可能性很重要，其中应特别关注免疫系统功能，尤其是细胞因子诱导和维持抑郁症状及代谢紊乱的可能具体机制。此处呈现的数据强调了识别和治疗抑郁症以降低代谢综合征发病率的重要性，同时也强调了定期筛查代谢紊乱及其治疗以避免所有这些不良影响并可能降低抑郁症发病率的必要性。
