血管性认知功能损害研究值得重视的问题

血管性认知功能损害(VCI)是指由血管因素导致或与之伴随的认知功能损害,除卒中外,血管性脑的损害及高血压、糖尿病、冠心病等血管性危险因素也是重要原因。VCI是异质性的临床状态,涵盖了从轻微认知损害到血管性痴呆的各种表现,皮质下缺血性小血管病是其中最常见的类型,以执行功能受损和伴发淡漠、抑郁障碍为特征。对VCI的诊断主要依据临床表现并参考各自不同的表现类型。应按照临床证据和指南要求规范进行治疗干预。     

短程小剂量奥氮平联合氟西汀治疗血管性抑郁症99例疗效观察

血管性抑郁症是指由脑血管病或血管危险因素引起的老年期抑郁综合征。目前常用的抗抑郁药物普遍起效慢，患者依从性低，导致治疗失败。2005年8月-2007年12月，我们观察了短程小剂量奥氮平联合氟西汀治疗血管性抑郁症的临床疗效及安全性。     

血管性抑郁

血管性抑郁作为抑郁的一种亚型,在临床表现、影像学特征和治疗转归等方面均有特殊性。文章就血管性抑郁的定义、分类、发病机制、临床表现、诊断、治疗和转归进行了综述,着重介绍了近年来支持血管性抑郁假说的临床证据,并对血管性抑郁与血管危险因素、脑血管病和痴呆的关系进行了讨论。     

血管性抑郁

血管性抑郁作为抑郁的一种亚型，在临床表现、影像学特征和治疗转归等方面均有特殊性。文章就血管性抑郁的定义、分类、发病机制、临床表现、诊断、治疗和转归进行了综述，着重介绍了近年来支持血管性抑郁假说的临床证据，并对血管性抑郁与血管危险因素、脑血管病和痴呆的关系进行了讨论。     

血管性抑郁

血管性抑郁为抑郁症的一种亚型,在临床特征、影像学表现和治疗转归等方面均有其特殊性.文章综述了对血管性抑郁的危险因素、发病机制、诊断、临床特征、治疗和转归等方面的研究进展,特别是血管性抑郁的血管危险因素、神经血管单元稳态变化、免疫细胞因子激活、脑白质损害的影像学特征、重复经颅磁刺激治疗及其与痴呆和心脑血管病的相互关系.     

心理因素对冠心病发病及严重程度的影响

目的探讨心理因素对冠心病患者发病及严重程度的影响。方法收集我院冠心病患者96例及100例正常对照组,应用贝克抑郁量表(BDI)、焦虑自评量表(SAS)、生活事件量表(LES)、A型行为量表(TABPSQ)、多伦多述情障碍量表(TAS)、应付方式问卷(CSQ)、社会支持问卷(SSS),测定抑郁焦虑程度、生活事件、人格特征、应付方式、社会支持、患病后的心身健康状况及其影响因素。并将96例冠心病患者根据BDI和SAS分为伴有焦虑抑郁症(A组)36例,不伴有焦虑抑郁症(B组)60例,对两组患者的冠状动脉造影结果进行对照研究。结果冠心病组负性生活事件总数、精神紧张值、TAS总分、TH+CH、伴有焦虑和或抑郁的发生率明显高于对照组(P0.05)。并进行多元回归分析,冠心病患者的心理障碍程度与冠状动脉病变程度相关(P0.01)。结论心理因素是冠心病的独立危险因素,其严重程度与冠状动脉病变程度相关。     

抑郁与冠心病发病机制最新研究进展

近年来,抑郁是冠心病独立的危险因素这一观点已越来越受到人们的重视与认可。Frasure-Smith等[1]提供了最新的相关资料。早期的研究提出了若干个抑郁对冠心病可能存在的影响机制,包括行为因素如病人对治疗的依从性差等和生理因素如心律失常等。近期又提出了一些新的生理机制,如心脏自主神经功能改变、炎症过程、血栓形成、内皮功能障碍、遗传因素等。1抑郁是主要的心血管疾病危险因素抑郁常常与其他心血管疾病危险因素同时存在,如吸烟、静息生活方式、肥胖、糖尿病、高血压等。但许多研究已显示,对其他危险因素进行校正后,抑郁对冠心病具有…     

无心房颤动的缺血性卒中患者抑郁状态与血管危险因素的关系

目的:探讨无心房颤动的缺血性卒中患者抑郁状态与血管危险因素之间的关系。方法:对59例无心房颤动的缺血性卒中患者随访12-18个月(平均13个月),采用24项Hamilton抑郁量表(HAMD)对患者进行评分,得分<8分为无抑郁症状,8-17分为抑郁状态,>17分为抑郁。收集患者单项血管危险因素、血管危险因素总数以及三项血管危险因素数目之和(高血压、心脏病及糖尿病),分析卒中后抑郁与血管危险因素的关系。结果:抑郁的发生与心脏病家族史、既往卒中史以及三项血管危险因素数目之和有关(P<0.05)。结论:无心房颤动的缺血性卒中患者卒中后抑郁的发生与血管危险因素有关,但相关性不强。     

抑郁症与冠心病

近年来研究表明 ,冠心病患者抑郁症的患病率很高 ,并直接影响了冠心病的发生、发展和预后。1　抑郁症是冠心病发生、发展的危险因素很多研究表明 ,抑郁能增加冠心病的患病危险 ,抑郁可能是其首次发作后几十年内冠心病发生的一个独立的危险因素 ,从出现抑郁到首次发现冠心病的周期大约是 10年 ;患者的抑郁症状可持续存在或频繁发作 ,并与冠心病病情进展和急性发作相伴。Cam ey发现抑郁症患者的心率明显低于非抑郁患者 ,在心肌缺血程度相同情况下 ,有抑郁情绪者更易体验到心绞痛 ,其机制可能是由于 β-内啡肽调节的变化或压力感受器刺激的差…     

冠心病再血管化治疗后发生抑郁患者的危险因素分析

目的探析冠心病再血管化治疗后发生抑郁患者的危险因素。方法选取2012年3月~2014年4月我院收治的再血管化治疗后冠心病患者50例作为研究对象,根据其术后心理状况分为观察组(抑郁患者)和对照组(非抑郁患者),各25例。结果两组患者的介入治疗时间、麻醉时间、气管插管时间和住院时间对比,对照组患者均明显短于观察组,差异有统计学意义(P0.05)。结论冠心病患者再血管化治疗后,若出现抑郁症状,将延长患者的介入治疗时间、麻醉时间、气管插管时间和住院时间,增加患者治疗期间的危险。     

Patients with Depression are at Increased Risk for Secondary Cardiovascular Events after Lower Extremity Revascularization

Background For patients with peripheral arterial disease (PAD), depression is associated with worse patency and recurrent symptoms in the treated leg, but its association with death or cardiovascular events in other vascular beds is unknown. Objective To assess the association between depression and mortality or cardiovascular events outside the affected leg after PAD revascularization. Design Retrospective cohort study. Subjects Two hundred fifty-seven consecutive patients undergoing lower extremity revascularization for symptomatic PAD at a single institution between January 2000 and May 2005 were included in this study. By protocol, patients were previously screened for depression and diagnosed by the primary care provider. Measurements The outcomes evaluated included a composite of death or major adverse cardiovascular events (MACE; coronary heart disease, contralateral PAD, or cerebrovascular event) as well as major outcome categories of death, coronary heart disease, contralateral PAD, or cerebrovascular events. Results At revascularization, 35.0% patients had been diagnosed with depression. Those with depression were significantly younger and more likely to use tobacco. By life-table analysis, patients with depression had significantly increased risk for death/MACE, coronary heart disease, and contralateral PAD events, but not cerebrovascular events or death. By multivariate analysis, patients with depression were at significantly increased risk for death/MACE (hazard ratio [HR] = 2.05; p < .0001), contralateral PAD (HR = 2.20; p = .009), and coronary heart disease events (HR = 2.31; p = .005) but not cerebrovascular events or death. Conclusions Depression is common among patients undergoing revascularization for symptomatic PAD. After intervention, patients with depression are at significantly increased risk for coronary heart disease events and progression of contralateral PAD. Prospective analysis is required to confirm these results.     

Retinal vascular signs: a window to the heart?

There is increasing recognition that coronary microvascular dysfunction also plays an important role in coronary heart disease. Little is known about this aspect of coronary heart disease due to difficulties in studying the coronary microcirculation directly. The retina is a unique site where the microcirculation can be imaged directly, providing an opportunity to study in vivo the structure and pathology of the human circulation and the possibility of detecting changes in microvasculature relating to the development of cardiovascular disease. This review covers the recent progress in research linking retinal vascular signs to coronary heart disease, and finds accumulating evidence that retinal vascular signs may provide a window into the health of the coronary microvasculature. The most widely studied signs, arteriolar narrowing, and more recently, venular dilation, are likely associated with increased risk of coronary heart disease in women, independent of traditional risk factors. Attempts to improve coronary heart disease risk prediction by incorporating retinal vessel calibre size into risk prediction scores complementing traditional algorithms such as the Framingham risk scores have so far been disappointing. Research is ongoing into the predictive utility of other retinal vascular signs. Retinal photography provides long-lasting records that enable monitoring of longitudinal changes in these retinal signs and vascular health.Full English text available fromwww.revespcardiol.org     

冠心病合并抑郁焦虑障碍常用量表评价

随着医学模式向社会-心理-生物综合医学模式转变,心理、社会因素在心血管疾病的发生、发展、预后和治疗中的作用越来越受到人们的关注。抑郁焦虑可能是冠心病的危险因素之一,可加速其进程,并且是患者预后不良的危险因素。然而,非精神科医务人员对冠心病合并抑郁焦虑的识别率很低,此类患者往往未能得到及时的诊断和治疗,甚至由于过度的检查和治疗,进一步加重了患者的心理障碍和经济负担。及早正确识别冠心病合并抑郁焦虑并对其进行干预是有待解决的问题。文章就如何识别冠心病患者合并抑郁焦虑障碍以及目前常用抑郁焦虑量表的应用及评价方面的研究现状做一综述。     

抑郁的躯体化与冠心病发生的关系

目的探讨抑郁的躯体化与冠状动脉(冠脉)粥样硬化性心脏病(冠心病)的关系。方法根据冠脉造影Gensini评分将349例冠心病患者分为<30分组和≥30分组,两组均采用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)进行评估。结果与冠脉病变Gensini评分<30分组比较,≥30分组年龄更大、吸烟者更多、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)浓度更低及HAMD评分更高(P<0.05);回归分析显示焦虑/躯体化(OR=1.99,95%CI:1.71~2.31,P<0.001)是冠心病发病的高危因素。结论抑郁症状越重,冠脉病变越严重,抑郁的躯体化是冠心病发病的高危因素。     

Treatment of depression in patients with coronary heart disease

Depression and coronary heart disease are common conditions that often occur together. Evidence shows that the co-occurrence of these illnesses is not random but driven by depression as a risk factor for the occurrence and progression of coronary heart disease. This link is due, in part, to the impact that depression has on neuroendocrine pathways leading to increased platelet activation, cortisol and catecholamine excess, and altered autonomic nervous system function that influence the pathogenesis and progression of coronary atherosclerosis and subsequent heart disease. We know that treating depression in patients with coronary heart disease improves the symptoms and signs of depression. Evidence is less compelling that treating depression improves the morbidity and mortality of coronary heart disease. However, early findings suggest that some antidepressants may improve the course of coronary heart disease and improve patient compliance with various cardiac interventions. We outline a practical approach to the treatment of depression in patients with coronary heart disease. This approach includes education, counseling, antidepressant drugs, and referral when appropriate.     

Coronariographic significance of heart rate variation related to ischemic episodes in patients undergoing peripheral vascular surgery.

OBJECTIVES: To evaluate the characteristics of myocardial ischemia during daily life and their coronariographic significance in a group of patients with proven coronary artery disease undergoing peripheral vascular surgery. SETTING: Department of Cardiology--Central Hospital--Lisbon. METHODS: In 14 patients undergoing peripheral vascular surgery and in whom coronariography revealed coronary significative lesions, Holter monitoring was performed during a 24-hour period. Two groups of ischemic episodes were considered: Group A constituted by 44 episodes detected in patients with left main or three vessel disease and group B by 12 episodes detected in patients with one ot two vessel disease. In each group the ischemic parameters were studied. RESULT: The incidence of myocardial ischemia was 64%. Statistically significant differences were observed between group A and B concerning the mean heart rate variation from two minutes before the onset of ST-segment depression to its onset (2.39 bpm vs 8.75 bpm; p < 0.05), from the onset of ST-segment depression to its maximal depression (4.43 bpm vs 16.67 bpm; p < 0.001) and from two minutes before St-segment depression to its maximal depression (6.82 bpm vs 25.4 bpm; p < 0.00001). No differences were found in duration and maximal ST-segment depression. CONCLUSION: Particular characteristics of heart rate variation related to the ischemic episodes seem to have a relation with the severity of coronary artery disease in patients undergoing peripheral vascular surgery.     

老年冠心病患者与抑郁障碍的相关性研究

目的 探讨抑郁障碍是否为老年冠心病的危险因素并观察冠心病伴抑郁障碍患者炎性标记物水平变化.方法 对188例入选者进行临床情况调查、汉密顿抑郁量表评分和血清炎性标记物水平测定,分析冠心病伴抑郁障碍患病率及影响冠心病发病的危险因素.结果 冠心病患者87例,其抑郁障碍患病率为29.9%(26例),非冠心病入选者101例,患病率为11.9%(12例),抑郁障碍在两组间差异有统计学意义(P＜0.01).年龄、高血压、糖尿病、脂代谢异常和抑郁障碍是冠心病的危险因素之一.冠心病伴抑郁障碍组和冠心病不伴抑郁障碍组入选者在突发生活事件、心功能分级差异有统计学意义(均P＜0.05).两组入选者在冠状动脉病变、冠状动脉病变治疗差异无统计学意义(P＞0.05).冠心病伴抑郁障碍组和冠心病不伴抑郁组外周血炎性标记物水平比较显示,伴抑郁障碍组血清单核细胞趋化因子-1水平增高,高敏C反应蛋白和肿瘤坏死因子α差异无统计学意义.结论 老年冠心病患者伴抑郁障碍患病率高于老年非冠心患者群.抑郁障碍是影响冠心病发病的危险因素之一.老年冠心病患者抑郁障碍与炎性标记物之间可能存在一定关系.

Abstract：

Objective To explore whether depressive disorder is one of risk factors for coronary artery disease (CAD) in enrolled patients and observe the level of inflammation markers in coronary artery disease patients with depression. Methods In all patients, we recoded clinical information and data from Hamilton Depression Rating Scale for Depression( HRSD)and measured concentration of monocyte chemoattractant protein-1 (MCP-1), tumour necrosis factor α (TNFα) and hypersensitive C-reaction protein (hsCRP). Results Among 87 patients with coronary artery disease, depressive disorder was diagnosed in 26 patients, the prevalence of depressive disorder was 29. 9%. Among 101 patients without coronary artery disease, 12 patients were suffering from depressive disorder, the prevalence of depressive disorder was 11.90%. The prevalence of depressive disorder in coronary artery disease group was statistically higher than that in non-coronary heart disease group (29.8% vs.11.9%, P<0. 01). The incidence of coronary artery disease was associated with age, hypertension,diabetes mellitus, hypercholesterolemia and depression. Life events and stage of heart function occurred differently between CAD patients with and without depression (P<0. 05). There were no differences in the degree of coronary artery stenosis and the type of treatment (P>0. 05) between the two groups. There were higher concentration of MCP-1 in coronary artery disease patients with depression, but no remarkable difference in hsCRP and TNFa. Conclusions There is high prevalence of depressive disorder, which is one of risk factor for coronary artery disease. The depressive disorder may be associated with inflammation biomarker in patients with coronary artery disease.     

老年冠心病患者经皮冠状动脉介入治疗术后焦虑抑郁对不良心血管事件发生率的影响

目的探讨焦虑抑郁情绪对老年冠心病患者行经皮冠状动脉介入治疗(PCI)术后并发主要不良心血管事件(MACE)的影响。方法选取2012年3月至2015年9月在南充市身心医院实施PCI手术治疗的冠心病患者400例进行研究,根据PCI术后7~14 d患者是否并发焦虑和抑郁分组:焦虑抑郁组(n=88)和正常对照组(n=279)。对比两组患者PCI术后1年MACE的发生率,多因素logistic回归分析焦虑抑郁与患者PCI术后MACE的关系。结果焦虑抑郁组患者的MACE事件发生率为25.00%,高于正常组13.98%,差异具有统计学意义(x~2=5.864,P=0.015);逐步向前logistic回归分析结果表明高密度脂蛋白胆固醇(HDL-C)降低(OR=0.692)、冠脉病变支数增加(OR=2.987)、并发焦虑抑郁(OR=2.164)是老年冠心病患者PCI术后发生MACE事件的独立危险因素(P0.05)。结论老年冠心病患者PCI术后并发焦虑抑郁可增加MACE事件的发生率。     

Stressful life events and depressive disorders as risk factors for acute coronary heart disease]

BACKGROUND: Several studies outlined the role of stressful life events in the pathogenesis of coronary heart disease. It has recently been emphasized the role of depression, both clinical and subclinical, in the course of myocardial infarction. The relationship between recent life events, major depression, depressive symptomatology and onset of acute coronary heart disease has been less considered. METHODS: Ninety-seven consecutive patients with first episode of coronary heart disease and 97 healthy subjects matched for sociodemographic variables were included. All patients were interviewed by Paykel's interview for recent life events, a semistructured interview for determining the psychiatric diagnosis of mood disorders, a semistructured interview for demoralization. Patients were assessed while on remission from the acute phase. The time period considered was the year preceding the first episode of coronary heart disease, and the year before interview for controls. RESULTS: Patients with acute coronary heart disease reported significantly more life events than control subjects (p < 0.001). All categories of events (except entrance events) were significantly more frequent. Thirty percent of patients were identified as suffering from a major depressive disorder; 9% of patients were suffering from minor depression, and 20% from demoralization. Even though there was an overlap between major depression and demoralization (12%), 17% of patients with major depression were not classified as demoralized and 7 % of patients with demoralization did not satisfy the criteria for major depression. Independently of mood disorders, patients have a higher (p < 0.001) mean number of life events than controls. With regard to life events, the same significant difference (p < 0.001) compared to controls applied to patients with and without mood disorders. CONCLUSIONS: Our findings emphasize the relationship between life events and acute coronary heart disease. These data, together with those regarding traditional cardiac risk factors, may have clinical and prognostic implications to be verified in longitudinal studies.