van den Berg M P, Spijkerman T A, van Melle J P, van den Brink R H S, Winter J B, Veeger N J, Ormel J
Neth Heart J. 2005 May;13(5):165-169.
Depression is associated with an increased risk of cardiac morbidity and mortality in patients following myocardial infarction (MI). Our objective was to investigate the potential role of the autonomic nervous system in mediating this detrimental effect.
The study group consisted of 95 consecutive post-MI patients without depression and 53 post-MI patients with depression. Depressive symptoms were assessed by the Beck Depression Inventory (BDI). Activity of the autonomic nervous system was assessed by analysing heart rate variability (HRV) using 24-hour ambulatory electrocardiographic recordings as obtained three months post MI.
Higher age, female gender and left ventricular ejection fraction <0.40 were associated with lower HRV (SDANN, and very-low-frequency and low-frequency power, but not RMSSD and high-frequency power), as was depression. In the multivariate analysis, age and left ventricular ejection fraction but not gender emerged to be independently associated with HRV. After adjustment for these two covariates, depression remained significantly associated with low HRV.
Patients with depression in the present post-MI study are characterised by decreased longer-range HRV compared with the patients without depression, independent of other clinical variables. This observation supports the concept that one of the mechanisms underlying the detrimental effect of depression on post-MI prognosis may be that depression adds to the autonomic derangement post MI.
抑郁症与心肌梗死（MI）后患者心脏发病和死亡风险增加相关。我们的目的是研究自主神经系统在介导这种有害作用中的潜在作用。
研究组包括95例连续的无抑郁症的MI后患者和53例MI后患有抑郁症的患者。抑郁症状通过贝克抑郁量表（BDI）进行评估。自主神经系统的活动通过分析心率变异性（HRV）来评估，使用MI后三个月获得的24小时动态心电图记录。
年龄较大、女性以及左心室射血分数<0.40与较低的HRV（标准差平均NN间期、极低频和低频功率，但不是相邻RR间期差值的均方根和高频功率）相关，抑郁症也是如此。在多变量分析中，年龄和左心室射血分数而非性别与HRV独立相关。在对这两个协变量进行调整后，抑郁症仍与低HRV显著相关。
在本MI后研究中，与无抑郁症的患者相比，患有抑郁症的患者的特点是长程HRV降低，这与其他临床变量无关。这一观察结果支持了这样一种概念，即抑郁症对MI后预后产生有害影响的潜在机制之一可能是抑郁症加剧了MI后的自主神经紊乱。
