Cai Liqiang, Wei Lili, Yao Jiashu, Qin Yanhua, You Yafeng, Xu Luoyi, Tang Jinsong, Chen Wei
Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Gen Psychiatr. 2022 Dec 27;35(6):e100918. doi: 10.1136/gpsych-2022-100918. eCollection 2022.
The risk of major depressive disorder (MDD) and insomnia is higher in patients with coronary heart disease (CHD) than in the general population. In addition, immune inflammation may be a shared aetiological factor for mental disorders and CHD. However, it is unclear whether MDD is associated with poor sleep quality and cell-mediated immune function in patients with CHD.
This study investigated the impact of depression on sleep quality and cell-mediated immune functions in patients with CHD and examined discriminative factors in patients with CHD with and without MDD.
This cross-sectional retrospective study was conducted at the Zhejiang University School of Medicine affiliated with Sir Run Run Shaw Hospital. The study population consisted of 84 patients with CHD assigned to two groups based on their Hamilton Depression Rating Scale (HAMD) score (CHD with MDD (HAMD score of ≥10) vs without MDD). Subjective sleep quality, systemic inflammatory response and cell-mediated immune functions were assessed in patients with CHD with (n=50) and without (n=34) MDD using the Pittsburgh Sleep Quality Index (PSQI), routine blood tests and flow cytometry. The relationships between variables were ascertained using Pearson's product-moment, and linear discriminant analysis was used to explore the discriminative factors between groups.
Patients with CHD with MDD had significantly poorer sleep quality than those without MDD (Z=-6.864, p<0.001). The Systemic Inflammation Index (SII) and CD4/CD8 T-cell ratios were higher in patients with CHD with MDD than in those without MDD (Z=-3.249, p=0.001). Patients with CHD with MDD had fewer CD3CD8 and CD3 T cells (Z=3.422, p=0.001) than those without MDD (t=2.032, p=0.045). Furthermore, patients with CHD with MDD may be differentiated from those without MDD using the PSQI, SII and T-cell levels, as these variables correctly classified the depressed and non-depressed groups with an accuracy of 96.4%.
MDD may be responsible for poor sleep quality, increased cell-mediated immunity and SII in patients with CHD, which are discriminative factors for CHD in the depressive state. Clinicians should be aware of these interactions, as treatment for depressive symptoms may also improve CHD prognosis.
冠心病（CHD）患者患重度抑郁症（MDD）和失眠的风险高于普通人群。此外，免疫炎症可能是精神障碍和冠心病的共同病因。然而，尚不清楚MDD是否与冠心病患者的睡眠质量差和细胞介导的免疫功能有关。
本研究调查了抑郁症对冠心病患者睡眠质量和细胞介导免疫功能的影响，并检查了患有和未患有MDD的冠心病患者的判别因素。
这项横断面回顾性研究在浙江大学医学院附属邵逸夫医院进行。研究人群包括84名冠心病患者，根据汉密尔顿抑郁量表（HAMD）评分分为两组（患有MDD的冠心病患者（HAMD评分≥10）与未患有MDD的患者）。使用匹兹堡睡眠质量指数（PSQI）、常规血液检查和流式细胞术评估了患有MDD（n = 50）和未患有MDD（n = 34）的冠心病患者的主观睡眠质量、全身炎症反应和细胞介导的免疫功能。使用Pearson积矩相关分析确定变量之间的关系，并使用线性判别分析探索组间的判别因素。
患有MDD的冠心病患者的睡眠质量明显比未患有MDD的患者差（Z = -6.864，p < 0.001）。患有MDD的冠心病患者的全身炎症指数（SII）和CD4/CD8 T细胞比值高于未患有MDD的患者（Z = -3.249，p = 0.001）。患有MDD的冠心病患者的CD3CD8和CD3 T细胞比未患有MDD的患者少（Z = 3.422，p = 0.001）（t = 2.032，p = 0.045）。此外，使用PSQI、SII和T细胞水平可以区分患有MDD和未患有MDD的冠心病患者，因为这些变量对抑郁组和非抑郁组的正确分类准确率为96.4%。
MDD可能是导致冠心病患者睡眠质量差、细胞介导免疫增加和SII升高的原因，这些是抑郁状态下冠心病的判别因素。临床医生应意识到这些相互作用，因为治疗抑郁症状也可能改善冠心病的预后。
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