Center of Research on Psychology in Somatic diseases, Department of medical and clinical psychology, Tilburg University, Tilburg, the Netherlands.
Department of Neurology, Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands.
J Psychosom Res. 2019 Oct;125:109779. doi: 10.1016/j.jpsychores.2019.109779. Epub 2019 Jul 17.
The aim of this study was to examine gender differences of the associations between depressive symptoms and anxiety with inflammatory markers in patients with non-obstructive coronary artery disease (NOCAD).
Depressive symptoms and anxiety (Beck Depression Inventory BDI and Hospital Anxiety and Depression Scale HADS) were examined in 524 patients with NOCAD (52% women, mean age 64 ± 9 years) as part of the TweeSteden Mild Stenosis (TWIST) observational cohort study. Blood samples were analyzed for neutrophil gelatinase-associated lipocalin (NGAL) levels, high-sensitive C-reactive protein (hsCRP), and leukocyte differentiation. Multivariate analysis for the inflammatory markers with main effects of depressive symptoms or anxiety, gender, and their interactions were observed.
Women had elevated levels of hsCRP, and a lower monocyte and eosinophil count than men, with small to medium effect sizes (range η = 0.019-0.047). After Holm-Bonferroni correction depressive symptoms according to the BDI were associated with an overall elevated hsCRP level explaining 2.4% of the hsCRP variance. A significant positive association between BDI cognitive symptoms with elevated hsCRP level was observed in men (R = 0.045), but not in women (R < 0.001). Adjustment for age, body mass index, smoking, and physical activity attenuated this finding.
Small associations of inflammatory markers with depressive symptoms and anxiety were confounded by lifestyle factors, predominantly smoking. The interacting roles of gender, smoking, and psychological factors on inflammatory markers may point toward different behavioral and inflammatory pathways for women and men with NOCAD, which remains to be further explored.
ClinicalTrials.gov identifier: NCT01788241.
本研究旨在探讨非阻塞性冠状动脉疾病（NOCAD）患者抑郁症状和焦虑与炎症标志物之间的相关性是否存在性别差异。
作为 TweeSteden Mild Stenosis（TWIST）观察性队列研究的一部分，对 524 名 NOCAD 患者（52%为女性，平均年龄 64±9 岁）进行了抑郁症状和焦虑（贝克抑郁量表 BDI 和医院焦虑抑郁量表 HADS）的评估。分析了中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平、高敏 C 反应蛋白（hsCRP）和白细胞分化情况。观察了以抑郁症状或焦虑为主效应、性别及其相互作用为主要因素的炎症标志物的多变量分析。
女性的 hsCRP 水平升高，单核细胞和嗜酸性粒细胞计数较低，效应大小为小至中等（范围 η=0.019-0.047）。经过 Holm-Bonferroni 校正后，BDI 评估的抑郁症状与 hsCRP 水平整体升高相关，可解释 hsCRP 变异的 2.4%。BDI 认知症状与 hsCRP 水平升高呈显著正相关，仅在男性中观察到（R=0.045），而在女性中则未观察到（R<0.001）。调整年龄、体重指数、吸烟和体力活动后，该结果减弱。
炎症标志物与抑郁症状和焦虑的小关联受到生活方式因素的影响，主要是吸烟。性别、吸烟和心理因素对炎症标志物的相互作用可能表明 NOCAD 女性和男性存在不同的行为和炎症途径，这有待进一步探讨。
ClinicalTrials.gov 标识符：NCT01788241。
