抑郁情绪障碍对围术期老年冠心病患者外周血单核细胞CD40表达及血浆白细胞介素-8的影响

目的 观察合并抑郁情绪障碍的老年冠心病(CHD)患者围术期外周血单核细胞表面CD40表达及血浆白细胞介素8(IL-8)浓度的变化,探讨抑郁情绪障碍和冠心病间的相关免疫学机制。方法 选择2009年12月至2010年12月河北医科大学第三医院高龄冠心病患者100例,冠状动脉粥样硬化性心脏病诊断明确,无认知障碍。所有患者均行单节段腰后路全椎板减压植骨融合内固定术。术前1d采用汉密尔顿抑郁和焦虑量表评定患者的抑郁和焦虑评分,并据此将患者分为3组：无抑郁组（A组,n =30）：抑郁评分≤20分,且焦虑评分≤6分;抑郁干预组（B组,n=35）：为抑郁评分≥30分,且焦虑评分≤6分,白术前1d至术后第7天进行心理辅助治疗;抑郁非干预组（C组,n=35）：抑郁评分≥30分,且焦虑评分≤6分。术前1d及术后第7天抽取外周静脉血测定单核细胞表面CD40表达及血浆IL-8浓度。并于术后第7天再次测定抑郁评分。结果 术后B组的抑郁评分(25.1±2.9)低于术前(33.2±1.4)和C组(34.2±0.8,P＜0.05);术前A组的CD40荧光强度(123±18)低于B、C组（197±23,204±26）,(P＜0.05),术后A组(132 ±20)低于B组(147±19),但B组低于C组(212±18,P＜0.05),且CD40荧光强度和抑郁总分呈显著性正相关(r=0.597,P＜0.01);术前A组的IL-8浓度(85 ng/L±16 ng/L)低于B、C组(151 ng/L±18 ng/L,164 ng/L±22 ng/L),(P＜0.01),B和C组差异无统计学意义,但术后B组( 158 ng/L±19 ng/L)低于C组(197 ng/L±24 ng/L,P＜0.05),且血浆IL-8浓度与抑郁总分呈显著性止相关(r=0.751,P＜0.01)。结论 抑郁情绪障碍可能会造成围术期老年冠心病患者血浆IL-8分泌增多及单核细胞CD40表达上调。

Effects of depressive disorder on monocytic expression of CD(40) and plasma IL-8 concentration in senile coronary heart disease patients

Objective To observe the monocytic expression of CD40 and plasma IL-8 concentration in senile CHD (coronary heart disease ) patients with depressive disorder and examine the effects of immunological factors in depressive disorder and CHD. Methods A total of 100 senile CHD patients ( ＞60yr old) were divided into 3 group: control group (A, n =30), depression score ≤20 & anxiety score ≤6;therapy group ( B, n =35 ) , depression score ≥ 30 & anxiety score ≤ 6, psychological evaluations with HAMD( Hamilton depression rating scale)from Day 1 pre-operation to Day 7 post-operation; non-therapy group ( C, n =35 ), depression score ≥30 & anxiety score ≤6. They underwent the same operation : lumbar decompression & fusion, stripping of great saphenous vein and repair of indirect hernia. At Day 1 preoperation and Day 7 post-operation, 2 ml venous blood was drawn for the detection of monocytic expression of CD40 and plasma concentration of IL-8 ( interleukin-8 ). Results Depressive value of Group B at postoperation was lower than that at pre-operation and Group C ( (25.1 ± 2.9) vs ( 33.2 ± 1.4) & (34.2 ±0.8), P ＜ 0.05 ) ; the pre-operative expression of CD40 of Group A was lower than the other groups ((123 ±18) vs (197 ±23) & (204 ±26) , P ＜0.05). And Group B at post-operation was lower than Group C (( 147 ± 19) vs (212 ± 18 ), P ＜ 0.05 ); the pre-operative concentration of IL-8 was lowest in Group A ( (85 ± 16 ) ng/L vs ( 151 ± 18 ) ng/L & ( 164 ± 22 ) ng/L, P ＜ 0.05 ). And Group B at postoperation was lower than Group C ( ( 158 ± 19 ) ng/L vs ( 197 ± 24 ) ng/L, P ＜ 0.05 ) . There were significantly positive correlations between depression scores, the expression of CD40 and the plasma concentration of IL-8. Conclusion Depressive disorders elevate the monocytic expression of CD40 and raise the plasma concentration of IL-8 in senile CHD patients. Some immunological factors may play a important role in depressive disorder and CHD.