Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, von-Siebold-Str. 5, 37075 Göttingen, Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen.
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, von-Siebold-Str. 5, 37075 Göttingen, Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen; Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States.
Psychoneuroendocrinology. 2018 Oct;96:188-194. doi: 10.1016/j.psyneuen.2018.06.001. Epub 2018 Jun 4.
Natriuretic peptides (NP) are involved in the regulation of blood pressure and blood volume, and are elevated in patients with coronary artery disease (CAD). They are used as markers for illness severity, but their role in mental health is not well understood. Recently, A-type NP (ANP) has been associated with reduced anxiety in studies on cardiac patients; however, this study is the first to assess this effect for B-type NP (BNP) and for further dimensions of well-being and mental health. Depression, anxiety, and distress are more common in CAD patients than in the general population and are most likely not only influenced by psychological adaptation but also by neurobiological processes. We used baseline N-terminal proBNP (NT-proBNP) samples and psychometric assessments of 529 at least mildly depressed (Hospital Anxiety and Depression Scale, depression score ≥ 8) CAD patients from the multicenter Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) trial. Psychosocial status was assessed using standardized self-rating questionnaires on anxiety, depression, coping with illness, vital exhaustion, type D personality, and quality of life. Separate linear regression models for each psychometric scale revealed significant negative correlations of NT-proBNP with anxiety, depression, vital exhaustion, depressive coping, and negative affectivity. Moreover, patients with higher levels of NT-proBNP experienced less bodily pain and had a better self-rated mental health, despite worse physical functioning. Linear regression adjusted for age, sex, and physical functioning (Short Form Health Survey [SF-36]) revealed NT-proBNP to be a significant predictor for all tested measures of the patients' psychosocial status. These results indicate that NT-proBNP is not only positively associated with greater disease severity in mildly to moderately depressed CAD patients but also with better psychosocial status and mental well-being. Possible mechanisms of this effect are discussed.
利钠肽（NP）参与血压和血容量的调节，在冠状动脉疾病（CAD）患者中升高。它们被用作疾病严重程度的标志物，但它们在心理健康中的作用尚不清楚。最近，A型 NP（ANP）在心脏病人的研究中与焦虑减轻有关；然而，这项研究是首次评估 B 型 NP（BNP）和进一步的幸福感和心理健康维度的这种作用。抑郁、焦虑和痛苦在 CAD 患者中比在普通人群中更为常见，很可能不仅受到心理适应的影响，而且还受到神经生物学过程的影响。我们使用了基线 N 末端脑利钠肽前体（NT-proBNP）样本和来自多中心逐步心理治疗干预降低冠状动脉疾病风险（SPIRR-CAD）试验的 529 名至少轻度抑郁（医院焦虑和抑郁量表，抑郁评分≥8）CAD 患者的心理测量评估。使用焦虑、抑郁、应对疾病、生命耗竭、D 型人格和生活质量的标准化自我评定问卷评估社会心理状况。每个心理计量量表的单独线性回归模型显示，NT-proBNP 与焦虑、抑郁、生命耗竭、抑郁应对和负性情感呈显著负相关。此外，NT-proBNP 水平较高的患者尽管身体功能较差，但身体疼痛较少，自我报告的心理健康状况较好。调整年龄、性别和身体功能（健康调查简表 [SF-36]）的线性回归显示，NT-proBNP 是患者社会心理状况所有测试指标的显著预测因子。这些结果表明，NT-proBNP 不仅与轻度至中度抑郁 CAD 患者的疾病严重程度呈正相关，而且与更好的社会心理状态和心理健康相关。讨论了这种效应的可能机制。
