【抑郁与冠心病的探究进展综述论文4200字】

综述综述南华大学硕士学位论文南华大学硕士学位论文抑郁与冠心病的研究进展综述论文目录TOC\o"1-2"\h\u10885抑郁与CHD患者的预后： 15864CHD患者合并抑郁的可能发病机制 24276 210597 217477 27996-- 315433 32360 327732 3694CHD患者合并抑郁的早期筛查 426655CHD患者合并抑郁的治疗 418219 48544 532036展望： 531070参考文献 6摘要：后的影响、发病机制、早期筛查、治疗方案等几个方面进行综述。关键词：冠心病、抑郁、机制、治疗（Coronaryheartdisease，CHD）5名CHD1人患有抑郁症，其3倍[1-2]“生物-心理-医学”抑郁共病的现象越来越受到临床医师的关注。抑郁与CHD患者的预后：新诊断的CHD12内会增加一倍[3]量-[4]名因AMI12个月的随访研究显示，260名抑郁症患者的直接医疗再入院时间延长[5]654名疑似CHD33%21%。而总社会成本也可能在抑郁的CHD患者中增加，这可能是延迟返回工作导致的生产力损失而造成的[6]CHD定程度上造成了医疗资源的浪费，成为严重的社会公共卫生问题。CHD患者合并抑郁的可能发病机制研究表明，A型性格的人更容易患CHD。其性格特征主要体现在三个方面：AMI并与MACE的发生率增加相关。D型人格性格特征主要包括：负性情感和社会抑制性[8]。除了性格因素的影响外，CHD合并抑郁患者的不良行为改变也在疾病的进过度疲劳也被证明是心源性猝死的前兆。ratevariability，HRV）的降低与该调节功能受损有关[10]。而心率增快与的降低均可诱发心源性猝死[11]。--抑郁与白细胞介素-1、白细胞介素-6、肿瘤坏死因子-α等参与非特异性免疫反应的促炎性细胞因子的过度分泌有关omega-3和脂肪酸的血清浓度却平行下降[13]激活，进一步加重炎症反应和氧化应激[9]。在轴的作用下，血清皮质醇浓度增加，不仅诱导胰岛素抵抗和脂质代谢紊乱，还可破坏海马神经元，以致于对轴的负反馈作用减弱，形成恶性循环[14]。抑郁可通过介导内皮功能障碍以及增强血小板反应性来影响CHD患者的预后。研究表明，血小板反应性增强是抑郁症患者AS血栓形成易感性增加的潜在机制[15]5-5-5-羟色胺密度也可能增加血小板的反应性[16]减弱[17]。切相关[18-19]。肠道微生物群代谢产物可产生神经活性物质来影响大脑发育和功交互作用可能导致抑郁的发生[20-21]可通过炎症反应影响中枢神经系统的功能、神经递质的信号传导，导致抑郁症[22-23]神经系统的生理皮质醇水平、炎症因子和神经递质调节来改善抑郁症状[24-25]。内分泌因子通过旁分泌和自分泌途径调节器官的生长、代谢和功能。IGF-1生长激素的调控。IGF-1是预防冠心病的有效保护因素[26]。血清IGF-1水平过高CHD的风险[26]IGF-1[27]。认知能力较低的个体如果IGF-1水平较低，则更容易患抑郁症[28-29]。FGF21善动脉粥样硬化和减轻心肌缺血再灌注损伤。Liu等证明FGF21水平与男性受试者贝克抑郁量表得分之间存在显著的负相关，表明FGF21具有预防抑郁的功能[30]IGF-1FGF21可能参与了CHDCHD患者合并抑郁的早期筛查的CHD患者，因为非精神专科医师对于抑郁的识别及诊治往往是不甚了解的。所有CHD成年患者，包括急性起病或慢性进展患者，都应进行抑郁筛查及风险评估[31]。美国心脏病协会建议首先使用PHQ-2量表进行基线评估，若PHQ-2筛PHQ-9量表对于病情严重程度进行评估[32]虑每年度或者更频繁的进行抑郁的筛查、评估。CHD患者合并抑郁的治疗CHD患者合并抑郁的药物治疗可以有效缓解其抑郁情绪[33]，但无法减轻抑郁带来的心脏损害以及死亡率的增加[34]。目前抗抑郁药物主要包括三环类药物、5-5-羟色胺和去甲肾上腺素再5-羟色胺再摄取抑制剂是治疗CHD5-羟色胺和去甲肾上腺素再摄取抑制剂是一种新型抗[36]规律的生活作息以及适当的运动训练，提升生活质量，加强CHD二级预防从而一定程度的改善，但并没有较强的证据可以表明心里干预治疗可以降低CHD患者的全因死亡率及相关并发症风险[38]。展望：近期研究发现，肠道微生物群及一些内分泌因子可能参与了CHD合并抑郁的发生、发展，但其相关机制仍需进一步的基础实验和临床研究去探讨及证实。目前中药联合抗抑郁药物治疗并未在临床上较大范围应用，相关副作用尚未可参考文献LaneD,CarrollD,RingC,etal.Theprevalenceandpersistenceofdepressionandanxietyfollowingmyocardialinfarction[J].Britishjournalofhealthpsychology,2002,7(Pt1):11-21.RuoB,RumsfeldJS,HlatkyMA,etal.Depressivesymptomsandhealth-relatedqualityoflife:theHeartandSoulStudy[J].Jama,2003,290(2):215-221.CarneyRM,RichFreedlandKE,etal.Majordepressivedisorderpredictscardiaceventsinpatientswithcoronaryarterydisease[J].Psychosomaticmedicine,1988,50(6):627-633.Frasure-SmithN,LespéranceReflectionsondepressionasacardiacriskfactor[J].Psychosomaticmedicine,2005,67(Suppl1):S19-25.Frasure-SmithN,LespéranceGravelG,etal.Depressionandhealth-carecostsduringthefirstyearfollowingmyocardialinfarction[J].Journalofpsychosomaticresearch,2000,48(4-5):471-478.RutledgeJohnsonBD,etal.Depressionandcardiovascularhealthcarecostsamongwomenwithsuspectedmyocardialischemia:prospectiveresultsfromtheWISEIschemiaSyndromeEvaluation)Study[J].JournaloftheAmericanCollegeofCardiology,2009,53(2):176-183.ConsoliSM,CordierS,DucimetierePJPM.ApsychologicalmodelaccountingfortheriskfordepressionintheFrenchGAZELcohort[J].PsychosomaticMedicine,1997,59.LinLiL,etal.Dpersonality,butnotAbehaviorpattern,isassociatedwithcoronaryplaquevulnerability[J].Psychology,health&medicine,2018,23(2):216-223.ZornSchürRR,Boksetal.Cortisolstressreactivityacrosspsychiatricdisorders:Asystematicreviewandmeta-analysis[J].Psychoneuroendocrinology,2017,77:25-36.李爱民. 冠心病患者心理抑郁的相关研究进展[J].中国处方药2018,16(06):13-15.MartensEJ,NyklícekI,SzabóBM,etal.Depressionandanxietyaspredictorsofheartratevariabilityaftermyocardialinfarction[J].Psychologicalmedicine,2008,38(3):375-383.MaesM,BockstaeleDR,GastelA,etal.Theeffectsofpsychologicalstressonleukocytesubsetdistributioninhumans:evidenceofimmuneactivation[J].Neuropsychobiology,1999,39(1):1-9.SeverusWE,LittmanAB,StollAL.Omega-3fattyacids,homocysteine,andtheincreasedriskofcardiovascularmortalityinmajordepressivedisorder[J].Harvardreviewofpsychiatry,2001,9(6):280-293.deAlmeidaKM,MoreiraCL,LaferB.Metabolicsyndromeandbipolardisorder:whatshouldpsychiatristsknow?[J].CNSneuroscience&therapeutics,2012,18(2):160-166.MusselmanDL,A,ManatungaAK,etal.Exaggeratedplateletreactivityinmajordepression[J].TheAmericanjournalofpsychiatry,1996,153(10):1313-1317.WilliamsMS.Plateletsanddepressionincardiovasculardisease:Abriefreviewofthecurrentliterature[J].journalofpsychiatry,2012,2(6):114-123.MusselmanDL,MarzecUM,ManatungaA,etal.Plateletreactivityindepressedpatientstreatedwithparoxetine:preliminaryfindings[J].Archivesofgeneralpsychiatry,2000,57(9):875-882.JieZ,XiaH,ZhongSL,etal.Thegutmicrobiomeinatheroscleroticcardiovasculardisease[J].Naturecommunications,2017,8(1):845.PAGEPAGE51PAGEPAGE50MohajeriMH,LaFataG,SteinertRE,etal.Relationshipbetweenthegutmicrobiomeandbrainfunction[J].Nutritionreviews,2018,76(7):481-496.DinanTG,CryanTheimpactofgutmicrobiotaonbrainandbehaviour:implicationsforpsychiatry[J].Currentopinioninclinicalnutritionandmetaboliccare,2015,18(6):552-558.PetraAI,PanagiotidouS,HatziagelakiE,etal.Gut-Microbiota-BrainAxisandItsEffectonNeuropsychiatricDisordersSuspectedImmuneDysregulation[J].Clinicaltherapeutics,2015,37(5):984-995.EvrenselA,CeylanME.TheGut-BrainAxis:TheMissingLinkinDepression[J].Clinicalpsychopharmacologyandneuroscience:theofficialscientificjournaloftheKoreanCollegeofNeuropsychopharmacology,2015,13(3):239-244.HayleyS,AudetMC,AnismanH.Inflammationandthemicrobiome:implicationsfordepressivedisorders[J].Currentopinioninpharmacology,2016,29:42-46.PirbaglouM,KatzJ,deSouzaRJ,etal.Probioticsupplementationcanpositivelyaffectanxietyanddepressivesymptoms:asystematicreviewofrandomizedcontrolledtrials[J].Nutritionresearch(NewNY),2016,36(9):889-898.CJK,MilevR.Erratumto:Theeffectsofprobioticsondepressivesymptomsinhumans:asystematicreview[J].Annalsofgeneralpsychiatry,2017,16:18.CarlzonD,SvenssonJ,PetzoldM,etal.BothlowandhighserumIGF-1levelsassociatewithincreasedriskofcardiovasculareventsinelderlymen[J].TheJournalofclinicalendocrinologyandmetabolism,2014,99(11):E2308-2316.BotM,MilaneschiPenninxetal.Plasmainsulin-likegrowthfactorIlevelsarehigherindepressiveandanxietydisorders,butlowerinantidepressantmedicationusers[J].Psychoneuroendocrinology,2016,68:148-155.FraterJ,LieD,Bartlettetal.Insulin-likeGrowthFactor1(IGF-1)asamarkerofcognitivedeclineinnormalageing:Areview[J].Ageingresearchreviews,2018,42:14-27.LinSuhrJ,DieboldS,etal.Associationsbetweendepressivesymptomsandmemorydeficitsvaryasafunctionofinsulin-likegrowthfactor(IGF-1)levelsinhealthyolderadults[J].Psychoneuroendocrinology,2014,42:118-123.LiuM,X,etal.NegativecorrelationbetweencerebrospinalfluidFGF21levelsandBDIscoresinmaleChinesesubjects[J].Psychiatryresearch,2017,252:111-113.SiuAL,Bibbins-DomingoK,GrossmanDC,etal.ScreeningforDepressioninAdults:USPreventiveServicesForceRecommendationStatement[J].Jama,2016,315(4):380-387.AAFPguidelineforthedetectionandmanagementofpost-myocardialinfarctiondepression[J].Annalsoffamilymedicine,2009,7(1):71-79.CoventryLovellK,DickensC,etal.Integratedprimarycareforpatientswithmentalandphysicalmultimorbidity:clusterrandomisedcontrolledtrialofcollaborativecareforpatientswithdepressioncomorbidwithdiabetesorcardiovasculardisease[J].BMJ(Clinicalresearc