Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America.
Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America.
J Psychosom Res. 2021 Jan;140:110291. doi: 10.1016/j.jpsychores.2020.110291. Epub 2020 Nov 11.
New-onset depressive symptoms commonly arise among persons without a history of major depressive disorder (MDD) in the setting of acute medical illness. Although depressive symptoms in general are associated with alterations in prognostic biomarkers following acute coronary syndrome (ACS), the nature of specifically new-onset depressive symptoms is less well-characterized. It is unclear whether such symptoms neurobiologically resemble recurrent symptoms of MDD or instead represent a distinct condition. In this exploratory analysis, we aimed to examine the effects of prior MDD history on the relationships between post-ACS depressive symptoms and cardiovascular biomarkers.
One-hundred sixty-four participants attended study visits 2 weeks and 6 months after ACS to complete self-report measures and provide biomarker samples. MDD history was identified by a psychiatrist through systematic electronic medical record review. Generalized estimating equations were performed to examine the moderating effects of MDD history on concurrent relationships between depressive symptoms and several biomarkers (endothelin-1, soluble intercellular adhesion molecule-1, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-alpha).
Twenty percent (n = 33) of participants had a history of MDD. Depressive symptoms were more strongly associated with levels of endothelin-1 in patients with prior MDD compared to those without (B = 0.024, 95% CI [0.005, 0.043], p = .012), adjusting for age, sex, medical factors, and anxiety. MDD history did not moderate relationships between depressive symptoms and other biomarkers.
Recurrent post-ACS depressive symptoms are more strongly associated with elevated endothelin-1 levels than new-onset symptoms. Further work is needed to clarify the mechanism and clinical implications of this relationship.
在急性疾病情况下，即使既往无重性抑郁障碍（MDD）病史，新发抑郁症状也常出现在无 MDD 病史的人群中。虽然一般来说，抑郁症状与急性冠状动脉综合征（ACS）后预后生物标志物的改变有关，但新发抑郁症状的性质尚未得到很好的描述。目前尚不清楚这些症状在神经生物学上是否类似于 MDD 的复发性症状，还是代表一种不同的情况。在这项探索性分析中，我们旨在检查既往 MDD 病史对 ACS 后抑郁症状与心血管生物标志物之间关系的影响。
164 名参与者在 ACS 后 2 周和 6 个月进行研究访问，以完成自我报告量表并提供生物标志物样本。通过精神病医生通过系统的电子病历审查确定 MDD 病史。使用广义估计方程检验 MDD 病史对抑郁症状与几种生物标志物（内皮素-1、可溶性细胞间黏附分子-1、高敏 C 反应蛋白、白细胞介素-6 和肿瘤坏死因子-α）之间的同期关系的调节作用。
20%（n=33）的参与者有 MDD 病史。与无 MDD 病史的患者相比，既往有 MDD 的患者抑郁症状与内皮素-1水平的相关性更强（B=0.024，95%CI[0.005，0.043]，p=0.012），调整了年龄、性别、医学因素和焦虑。MDD 病史并未调节抑郁症状与其他生物标志物之间的关系。
复发性 ACS 后抑郁症状与升高的内皮素-1水平的相关性强于新发症状。需要进一步的工作来阐明这种关系的机制和临床意义。
