更年期女性抑郁症与冠心病

冠心病是人类主要死亡原因之一.抑郁症与冠心痛之间存在密切联系.抑郁症被认为是冠心病的一种重要危险因素,而冠心病患者又是抑郁症的高危人群.现从合并有更年期女性抑郁症的冠心病患者的概况、临床表现、可能机制、治疗等方面,探讨更年期女性抑郁症与冠心病的关系以及更年期女性抑郁症对冠心痛预后的影响,说明在合并有更年期抑郁症的女性冠心病患者中,抗抑郁治疗和冠心病二级治疗同等重要.     

抑郁症与神经症合并躯体慢性疼痛比较研究

目的 研究抑郁症与神经症合并躯体慢性疼痛的临床比较,与抑郁焦虑的关系及对社会功能的影响.方法 对400例抑郁症与神经症患者,用自编的躯体化症状的特点问卷、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、社会功能缺陷筛选量表(SDS)、慢性疼痛等级评价量表进行调查,比较慢性疼痛共病情况、疼痛分布的特点、抑郁焦虑的严重程度、社会功能缺陷状况.结果 抑郁症与慢性疼痛共病患者出现率为15.24%,显著低于神经症合并慢性疼痛者(31.08%).抑郁症患者头部疼痛的发生率显著高于神经症患者.抑郁症组无论是共病组还是非共病组HAMD、SDS总分均高于神经症组(P＜0.01);抑郁症组与神经症组HAMA总分无明显差异;抑郁症共病组的HAMD总分明显高于抑郁症非共病组和神经症组(P＜0.01).结论 抑郁症与神经症均可合并慢性疼痛,且2种疾病患者的疼痛分布情况不一致.抑郁症共病组的HAMD总分明显高于非共病组,提示抑郁症状与慢性疼痛的关系密切.抑郁症与神经症社会功能的受损与是否合并疼痛无显著相关,主要与疾病性质有关.     

抑郁症与冠心病

抑郁症与冠心病之间存在密切联系,并被认为是心血管系统尤其是缺血性心脏病的另一种重要危险因素.产生抑郁的主要原因多涉及认知扭曲、生活中缺少令人愉快的事、人际间关系等问题,它从多方面影响冠心病发生、发展.抗抑郁药物治疗、心理社会干预以及运动疗法是冠心病合并抑郁症的主要治疗方法.SADHART和ENRICHD试验是目前针对冠心病合并抑郁患者进行药物及非药物治疗的最客观、权威的研究.     

冠心病合并抑郁障碍的研究进展

目前冠心病和抑郁症是两种严重威胁人类健康的主要疾病,冠心病与抑郁症关系十分密切,两者互相影响,共同使患者病情恶化。现从冠心病合并抑郁症的发病特点、共同的发病机制、治疗这几个方面的进展进行综述。     

冠心病合并抑郁症的治疗研究

目的总结冠心病合并抑郁症的治疗经验。方法收集2005年5月—2010年7月在我院住院治疗的56例冠心病合并抑郁症患者,除给予常规的冠心病治疗外,先给予心理治疗,对于心理治疗无效或疗效差者加用药物治疗。结果 46例患者症状好转出院,出院后继续接受冠心病及抗抑郁治疗,通过出院后定期随访,病情稳定,冠心病病情无加重,抑郁症亦逐渐好转,疗效较好。8例患者依从性差,拒绝服用抗抑郁药物,冠心病症状好转后转外院继续治疗,2例患者因冠心病病情危重死亡。结论心理治疗和药物治疗是提治疗高心病合并抑郁症疗效的有效措施。     

对于心血管病合并抑郁症的认识和处理对策

近年来,国内外冠心病合并抑郁症的发生率均很高,引起学者们越来越多的关注。本文总结了相关流行病学调查结果,抑郁症对冠心病的不利影响,及其共同的发病机制,以及当前国内外对冠心病合并抑郁症的诊断程序与处理策略。     

老年抑郁症对轻度认知功能损害转归产生的影响

目前认为轻度认知功能损害(MCI)是正常老年和老年痴呆之间的转变阶段,但并不是所有的MCI患者都发展成痴呆,老年抑郁症患者常伴有MCI,且与痴呆的转化率关系密切.近年研究提示,老年抑郁症对MCI的病程、转归及预后都会产生重大的影响[1],因此研究和探讨MCI和老年抑郁症共病的特征,及早识别共病患者中的抑郁症状.本文就老年抑郁症和MCI共病的相互关系、流行病学、病理生理及临床特征方面的研究进展情况综述如下.     

冠心病合并抑郁症研究的进展

冠心病和抑郁症严重影响患者健康，给家庭和社会带来沉重负担，且两种疾病之间具有密切的联系。抑郁可以预测冠心病的发生，冠心病可以引起抑郁的发生。本文就冠心病合并抑郁症的发病机制和治疗研究的进展作一综述。     

冠心病合并抑郁症患者的临床特点分析

目的分析冠心病合并抑郁症患者的临床特点。方法选择2010年8月—2012年9月在我院干部病房门诊就诊的冠心病患者100例,将患者分为冠心病合并抑郁症组(试验组)及冠心病未合并抑郁症组(对照组),各50例。回顾性分析患者临床资料,包括患者合并症(包括糖尿病、高血压、高脂血症、肥胖)、临床表现(包括心率增快、心绞痛发作1次/周、心律失常及ST-T改变)、不良生活习惯(包括吸烟、久坐、饮酒)及规律服药情况。结果试验组患者高血压、高脂血症发生率高于对照组,心率增快、心绞痛发作1次/周、心律失常发生率高于对照组,吸烟率、久坐率及饮酒率均高于对照组,规律服药率低于对照组(P0.05);两组患者糖尿病、肥胖发生率及ST-T改变发生率比较,差异均无统计学意义(P0.05)。结论冠心病合并抑郁症患者高血压和高脂血症发生率高、不良生活习惯多、临床表现严重、服药依从性差。     

欣舒颗粒对冠心病合并抑郁症病人心率变异性及超敏C-反应蛋白的影响

目的 观察欣舒颗粒对冠心病合并抑郁症病人心率变异性（HRV）及其对超敏C反应蛋白（hs—CRP）的影响，并探讨其作用机制。方法 40例冠心病合并抑郁症病人随机分成两组，研究组20例，在常规西医冠心病二级预防治疗的基础上，加用欣舒颗粒冲服，对照组仅予以西医冠心病二级预防治疗。分别于治疗前和治疗2周后观察两组病人24hHRV、hs—CRP等指标的变化。结果 两组治疗后HRV、hs—CRP水平较治疗前明显改善（P〈0．05），且研究组优于对照组（P〈0.05）。结论 欣舒颗粒可显著改善冠心病合并抑郁症病人的HRV，抑制炎症反应，提高冠心病疗效。     

Comparison of efficacy and safety of complementary and alternative therapies for coronary heart disease complicated with anxiety or depression disorder: A protocol for Bayesian network meta-analysis

Background:With the acceleration of the pace of life, the phenomenon of anxiety and depression in patients with coronary heart disease (CHD) is more and more common, and “psycho-cardiology” arises spontaneously. At present, the drug treatments of psycho-cardiology are difficult to achieve satisfactory results, and the side effects are obvious. Complementary and replacement therapies of CHD complicated with anxiety or depression disorder play an increasingly positive role, but there is a lack of comparison among different complementary and alternative therapies. In this study, Bayesian network meta-analysis (NMA) analysis method will be used for the first time to synthesize all the evidences of direct and indirect comparison among a variety of interventions, and rank their effectiveness and safety.Methods:Two independent researchers will search from the beginning to January 2021 mainly including randomized controlled trials (RCTs) and closely related ongoing RCTs of complementary and alternative therapies for CHD complicated with anxiety or depression disorder. And then identify, select and extract the data. The primary outcome measures are frequency of acute attack angina, severity of angina pectoris; the changed score in the validated scales, which can assess severity of anxiety or depression. Secondary outcomes include total efficacy rate, electrocardiogram improvement, traditional Chinese medicine symptoms score, changes of dosage of nitroglycerin and adverse effects. Using softwares WinBUGS 1.4.3 and STATA 16.0 for pairwise meta-analysis and NMA to comprehensively evaluate various interventions. The quality of evidences will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation.Results:This NMA will comprehensively compare and rank the efficacy and safety of a series of complementary and alternative therapies in the treatment of CHD complicated with anxiety or depression disorder.Conclusion:Supplementary and replacement therapies play an essential role in improving CHD complicated with anxiety or depression disorder. We expect that the NMA will provide reliable evidences of evidence-based medicine for treatment of CHD complicated with anxiety or depression disorder.Protocol registration number:INPLASY202120046.Ethical approval:This review does not require ethical approval.     

纤维支气管镜在小儿非青紫型先天性心脏病呼吸道病变诊疗中的应用

目的探讨纤维支气管镜（FB）在小儿非青紫型先天性心脏病（CHD）呼吸道病变诊疗中的应用价值。方法对30例非青紫型CHD患儿进行FB检查,对其中6例合并肺不张患儿进行了支气管肺泡灌洗（BAL）治疗。结果镜下发现非青紫型CHD患儿呼吸道病变以炎症及气道阻塞性改变多见,分别占86.7％、76.7％,其中气管或支气管外压性狭窄20例,气管或支气管软化4例,喉软化3例,右侧气管源性支气管2例,气管下段先天性狭窄、左侧声带麻痹各1例。对6例肺不张患儿进行了BAL治疗,治愈3例。术中1例（36.7％）出现一过性低氧血症,无严重并发症发生。结论炎症反应、气管或支气管狭窄、软化是非青紫型CHD患儿常见的气道病变,FB在小儿非青紫型CHD气道病变评估中不仅能发挥诊断作用,而且发挥治疗作用,目相对安全。     

老年冠心病和抑郁对血小板活性的影响

目的:观察老年冠心病和抑郁对血小板活性的影响。方法:根据WHO对缺血性心脏病的命名及诊断标准确定冠心病组及非冠心病组。根据抑郁自评量表(SDS)评分分为抑郁组及非抑郁组。将受试对象最终分为非冠心病非抑郁组(n=87例)、冠心病非抑郁组(n=94例)、非冠心病抑郁组(n=85例)、冠心病抑郁组(n=97例),分别测定血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)。结果:各组与非冠心病非抑郁组相比,PLT、MPV、PDW值均升高,差异均有统计学意义(均P0.01)。冠心病非抑郁组和非冠心病抑郁组相比,PLT、MPV、PDW值升高或降低不明显,两组间PLT、MPV、PDW差异无统计学意义。冠心病非抑郁组与冠心病抑郁组相比PLT值升高或降低不明显,差异无统计学意义,MPV、PDW值均升高,差异有统计学意义。非冠心病抑郁组与冠心病抑郁组相比,PLT值升高或降低不明显差异无统计学意义,MPV、PDW值均升高差异有统计学意义。结论:冠心病与抑郁均可使血小板活性增高,当两病共患时血小板活性增高更显著。     

黛力新对冠心病伴焦虑抑郁患者治疗效果和生活质量的影响

目的：探讨氟哌噻吨美利曲辛片（黛力新）与抗心肌缺血治疗对冠心病伴焦虑抑郁患者的疗效和对生活质量的影响。方法：冠心病伴焦虑抑郁患者128例,随机被均分为黛力新组（给予抗心肌缺血药物联合黛力新治疗）和常规治疗组（单纯抗心肌缺血治疗）。疗程4周时观察临床症状、心电图及焦虑自评量表和抑郁自评量表评分的变化;半年后采用中国心血管病人生活质量评定问卷进行生活质量评估。结果：黛力新组心绞痛和心电图总有效率分别为92．2％和84．4％,明显高于常规治疗组的79．7％和68．8％（P均〈0．05）,黛力新组焦虑自评量表和抑郁自评量表评分在治疗后显著下降（P均〈0．01）,且显著优于常规治疗组[焦虑评分量表（39．65±7．22）分比（53．30±8．50）分,抑郁评分量表（42．23±8．92）分比（57．47±9．50）分,P均〈0．01],常规治疗组治疗前后无显著变化（P均〉0．05）;黛力新组中国心血管病人生活质量评定问卷的各项得分均明显高于常规治疗组（P均〈0．01）。结论：黛力新治疗冠心病伴焦虑、抑郁患者效果好,能够改善患者的生活质量。     

Depression and Coronary Heart Disease

Depression and coronary heart disease (CHD) are significant contributors to the burden of disease in both developed and developing countries. Although depression seems to be a marker of increased risk after the diagnosis of CHD, it is currently unclear whether depression can be considered as an independent risk factor and whether its treatment lowers the risk. We review the data from prominent trials and recent analyses in regard to the association of depression with CHD. We also review some of the mechanisms that might contribute to this association.     

Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

There is a growing population of adults with congenital heart disease (CHD) due to improved survival beyond childhood. It has been suggested that adults with CHD may be at increased risk for mental health problems, particularly depression. The reported incidence of depression in CHD varies from 9% to 30%. This review examines the evidence for a higher depression rate in CHD vs general population. Possible explanations are offered from a variety of disease models, ranging from brain injury to the psychoanalytical approach. Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy, separation from the parents during hospitalizations and brain organic syndromes. Later in life, patients often have to cope with physical limitations. Recent improvements in care may be protective. Current patients may benefit from an earlier age at first surgical intervention, fewer reoperations and inclusion to the mainstream schooling, among other factors. At this point, there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD. Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.     

冠心病患者的情感问题及临床意义

目的:探讨冠心病患者的情感变化及有针对性的心理治疗和护理。方法:采用焦虑、忧郁量表对102例冠心病患者进行测试和分析。结果:102例病人中有焦虑症者63例,占61.4%,平均焦虑分值为48.65,与正常人均数44分比较有极显著性差异(t=3.56,P<0.01);有忧郁症者65例,占63.7%,平均抑郁分为49.81,与正常人平均分45分比较差异有极显著性(t=4.75,P<0.01)。结论:住院冠心病人半数以上有焦虑和抑郁,应加强冠心病人的心理调整和护理。     

Right atrium vegetation in prosthetic aortic endocarditis

Depression is the third leading cause of disease burden worldwide and is predicted to be the leading cause by 2030. Importantly, depression has been identified as an independent risk factor for coronary heart disease (CHD) and both share significant physiological overlap. Identification of depression is complex. Consequently, accurate diagnosis of comorbid depression and CHD is challenging and requires a move toward an interdisciplinary engagement of knowledge transfer. A concerted effort is required utilising translational research to better identify depression in the CHD population. This approach is not meant to categorise patients, rather it is aimed at progressing toward an improved prognosis. Further, this approach should provide health professionals with the confidence to apply the term depression and define its meaning in a more precise and consistent manner.     

Depression and CHD risk: How should we intervene?

Opinion statement Depression is common in the community and is a risk factor for the development of coronary heart disease (CHD). In patients with CHD, the prevalence of major depression is nearly 20% and the prevalence of minor depressive disorder is approximately 27%. When present in patients with existing CHD, depression is independently associated with worse outcome, including higher morbidity and mortality, and worse health status. Observational studies suggest that use of antidepressant medications in patients with CHD is associated with decreased risk of cardiovascular events. However, only one randomized controlled trial, the ENRICHD (Enhancing Recovery in Coronary Heart Disease) study, was designed to evaluate whether treatment of depression in patients with CHD can improve cardiac prognosis. Although the study showed that cognitive behavior therapy was better than usual care in improving depression, there was no improvement in all-cause mortality or recurrent cardiac events. There have been no clinical trials specifically designed to evaluate whether pharmacologic treatment of depression improves cardiovascular outcomes in patients with CHD. Thus, there is a clear need for additional trials testing interventions to improve cardiac prognosis based on treatment of depression. In the meantime, depression remains an important illness in its own right and deserves treatment. Safe and effective treatments of depression in patients with CHD include cognitive behavior therapy and selective serotonin reuptake inhibitors.     

Depression, stress, and heart disease in earthquakes and Takotsubo cardiomyopathy

The preponderance of evidence links depressive disorder and coronary heart disease (CHD). Despite this evidence, multiple clinical trials have failed to show that effective treatment of depression favorably modifies the development, clinical course, or outcome of comorbid CHD. Possible reasons for these failures include the heterogeneity of depression, limitations of assessment instruments, limited understanding of the biology of depressive disorders, lack of biological markers, and the observation that depression may be more a product of CHD than a true risk factor for it. In this commentary, to better address the effects of externally provoked stress on physical health, we examine evidence about 2 specific examples of stress and subsequent heart disease: earthquake-induced adverse cardiac events among individuals with coronary artery disease, and stress-induced Takotsubo cardiomyopathy. In the former case, existing studies suggest that the stress and distress of earthquakes accelerate the development of poor cardiac outcomes for individuals with established coronary artery disease. In the latter example, existing case studies indicate that the profound left ventricular dysfunction of Takotsubo cardiomyopathy tends to quickly normalize once the acute stress is relieved. Together, these examples indicate that the presence or absence of prestress medical illness and its severity may better determine the outcome of the medical illness than the nature and severity of the stress, including depression. That is, any effort to look at depression among individuals with medical illness must look carefully at the medical illness itself and consider depression a possible nonspecific stress. In patients with comorbid depression and CHD, we propose using the more firmly established CHD outcome measurements to better understand how depression or other stressors and their associated treatments influence the prognosis and outcome of this medical illness.