Research Progress on the Relationship between Depression and Coronary Microvascular Disease

doi:10.12114/j.issn.1007-9572.2019.00.188

Abstract

Abstract: The coronary microvascular system refers to arteries with an inner diameter of less than 0.5 mm，and its number of vessels accounts for 95% of the entire coronary artery tree.The viewpoint that coronary microvascular disease（CMVD）causes angina pectoris in patients has attracted more and more attention.With the continuous development of the bio-psycho-social medical model and the proposal of psycho-cardiology，the adverse effects of psychological disorders on cardiovascular diseases are gradually recognized.This article introduces the definition，epidemiology，pathogenesis and risk factors of CMVD and depression，and summarizes their common pathogenesis and risk factors.It is found that there is a correlation between depression and CMVD，and it is believed that the effective and reasonable treatment of depression can improve the condition of CMVD，and then improve patients' quality of life and prognosis.Therefore，the study of depression and CMVD should be paid more attention by clinicians.

Key words: Depression, Coronary artery disease, Thrombotic microangiopathies, Review, Psychology-cardiology medicine

摘要： 冠状动脉微血管系统指血管内径<0.5 mm的动脉，其血管数量占整个冠状动脉树的95%，冠状动脉微血管疾病（CMVD）引起患者心绞痛症状的观点受到越来越多的关注。随着生物-心理-社会医学模式的不断发展及双心医学的提出，精神心理障碍对心血管疾病的不利影响逐渐得到认可。本文介绍了CMVD和抑郁的定义、流行病学、发病机制及危险因素，总结了CMVD和抑郁共同的发病机制、危险因素。分析发现抑郁与CMVD之间存在相关性，并且认为通过有效、合理地治疗抑郁可以改善CMVD患者病情，进而改善患者生活质量及预后。所以抑郁与CMVD的相关性研究需引起临床医师更多的重视。

关键词: 抑郁, 冠状动脉疾病, 血栓性微血管病, 综述, 双心医学

ZHAO Bo,QIN Gang. Research Progress on the Relationship between Depression and Coronary Microvascular Disease　[J]. Chinese General Practice, 2019, 22(18): 2156-2160. DOI: 10.12114/j.issn.1007-9572.2019.00.188.
赵波,秦纲. 抑郁与冠状动脉微血管疾病相关性研究进展[J]. 中国全科医学, 2019, 22(18): 2156-2160. DOI: 10.12114/j.issn.1007-9572.2019.00.188.

References

［1］CHEN C，WEI J，ALBADRI A，et al．Coronary microvascular dysfunction-epidemiology，pathogenesis，prognosis，diagnosis，risk factors and therapy［J］．Circ J，2016，81（1）：3-11．DOI：10.1253/circj.CJ-16-1002.
［2］PHAN A，SHUFELT C，MERZ C N.Persistent chest pain and no obstructive coronary artery disease［J］．JAMA，2009，301（14）：1468-1474．DOI：10.1001/jama.2009.425.
［3］MURTHY V L，NAYA M，TAQUETI V R，et al．Effects of sex on coronary microvascular dysfunction and cardiac outcomes［J］．Circulation，2014，129（24）：2518-2527．DOI：10.1161/CIRCULATIONAHA.113.008507.
［4］TAQUETI V R，HACHAMOVITCH R，MURTHY V L，et al．Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization［J］．Circulation，2015，131（1）：19-27．DOI：10.1161/CIRCULATIONAHA.114.011939.
［5］王信淳，洪牮，许迪.抑郁合并冠心病的研究现状［J］．实用老年医学，2018，32（6）：591-593.
［6］CAMICI P G，CREA F.Coronary microvascular dysfunction［J］．N Engl J Med，2007，356（8）：830-840．DOI：10.1056/NEJMra061889.
［7］L?FFLER A I，BOURQUE J M.Coronary microvascular dysfunction，microvascular angina，and management［J］．Curr Cardiol Rep，2016，18（1）：1．DOI：10.1007/s11886-015-0682-9.
［8］中华医学会心血管病学分会基础研究学组，中华医学会心血管病学分会介入心脏病学组，中华医学会心血管病学分会女性心脏健康学组，等．冠状动脉微血管疾病诊断和治疗的中国专家共识［J］．中国循环杂志，2017，32（5）：421-430．DOI：10.3969/j.issn.1000-3614.2017.05.003.
［9］JESPERSEN L，HVELPLUND A，ABILDSTR?M S Z，et al．Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events［J］．Eur Heart J，2012，33（6）：734-744．DOI：10.1093/eurheartj/ehr331.
［10］PATEL B，FISHER M.Therapeutic advances in myocardial microvascular resistance：unravelling the enigma［J］．Pharmacol Ther，2010，127（2）：131-147．DOI：10.1016/j.pharmthera.2010.04.014.
［11］KUO L，DAVIS M J，CHILIAN W M.Longitudinal gradients for endothelium-dependent and -independent vascular responses in the coronary microcirculation［J］．Circulation，1995，92（3）：518-525.
［12］CAMICI P G，OLIVOTTO I，RIMOLDI O E.The coronary circulation and blood flow in left ventricular hypertrophy［J］．J Mol Cell Cardiol，2012，52（4）：857-864．DOI：10.1016/j.yjmcc.2011.08.028.
［13］CHAUHAN A，MULLINS P A，TAYLOR G，et al．Both endothelium-dependent and endothelium-independent function is impaired in patients with angina pectoris and normal coronary angiograms［J］．Eur Heart J，1997，18（1）：60-68.
［14］LANZA G A，CREA F.Primary coronary microvascular dysfunction：clinical presentation，pathophysiology，and management［J］．Circulation，2010，121（21）：2317-2325．DOI：10.1161/CIRCULATIONAHA.109.900191.
［15］KAUFMANN P A，GNECCHI-RUSCONE T，DI TERLIZZI M，et al．Coronary heart disease in smokers：vitamin C restores coronary microcirculatory function［J］．Circulation，2000，102（11）：1233-1238.
［16］TONA F，SERRA R，DI ASCENZO L，et al．Systemic inflammation is related to coronary microvascular dysfunction in obese patients without obstructive coronary disease［J］．Nutr Metab Cardiovasc Dis，2014，24（4）：447-453．DOI：10.1016/j.numecd.2013.09.021.
［17］SARA J D，WIDMER R J，MATSUZAWA Y，et al．Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease［J］．JACC Cardiovasc Interv，2015，8（11）：1445-1453．DOI：10.1016/j.jcin.2015.06.017.
［18］PEPINE C J，ANDERSON R D，SHARAF B L，et al．Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart，Lung and Blood Institute WISE（Women's Ischemia Syndrome Evaluation）study［J］．J Am Coll Cardiol，2010，55（25）：2825-2832．DOI：10.1016/j.jacc.2010.01.054.
［19］SICARI R，RIGO F，CORTIGIANI L，et al．Additive prognostic value of coronary flow reserve in patients with chest pain syndrome and normal or near-normal coronary arteries［J］．Am J Cardiol，2009，103（5）：626-631．DOI：10.1016/j.amjcard.2008.10.033.
［20］RIZZONI D，PALOMBO C，PORTERI E，et al．Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients［J］．J Hypertens，2003，21（3）：625-631．DOI：10.1097/01.hjh.0000052467.40108.a7.
［21］WESSEL T R，ARANT C B，MCGORRAY S P，et al．Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia：results from the NHLBI Women's Ischemia Syndrome Evaluation（WISE）［J］．Clin Cardiol，2007，30（2）：69-74．DOI：10.1002/clc.19.
［22］TAMAI O，MATSUOKA H，ITABE H，et al．Single LDL apheresis improves endothelium-dependent vasodilatation in hypercholesterolemic humans［J］．Circulation，1997，95（1）：76-82.
［23］ISHIMORI M L，MARTIN R，BERMAN D S，et al．Myocardial ischemia in the absence of obstructive coronary artery disease in systemic lupus erythematosus［J］．JACC Cardiovasc Imaging，2011，4（1）：27-33．DOI：10.1016/j.jcmg.2010.09.019.
［24］CALISKAN Z，KELES N，GOKTURK H S，et al．Is activation in inflammatory bowel diseases associated with further impairment of coronary microcirculation?［J］．Int J Cardiol，2016，223：176-181．DOI：10.1016/j.ijcard.2016.08.141.
［25］RATTAZZI M，PUATO M，FAGGIN E，et al．C-reactive protein and interleukin-6 in vascular disease：culprits or passive bystanders?［J］．J Hypertens，2003，21（10）：1787-1803．DOI：10.1097/01.hjh.0000084735.53355.44.
［26］苏文君，曹志永，蒋春雷.抑郁症的炎症机制及诊疗新策略［J］．生理学报，2017，69（5）：715-722.
［27］WIUM-ANDERSEN M K，?RSTED D D，NIELSEN S F，et al．Elevated C-reactive protein levels，psychological distress，and depression in 73，131 individuals［J］．JAMA Psychiatry，2013，70（2）：176-184．DOI：10.1001/2013.jamapsychiatry.102.
［28］LIU Y，HO R C，MAK A.Interleukin（IL）-6，tumour necrosis factor alpha（TNF-α）and soluble interleukin-2 receptors（sIL-2R）are elevated in patients with major depressive disorder：a meta-analysis and meta-regression［J］．J Affect Disord，2012，139（3）：230-239．DOI：10.1016/j.jad.2011.08.003.
［29］CHRAPKO W，JURASZ P，RADOMSKI M W，et al．Alteration of decreased plasma NO metabolites and platelet NO synthase activity by paroxetine in depressed patients［J］．Neuropsychopharmacology，2006，31（6）：1286-1293．DOI：10.1038/sj.npp.1300961.
［30］VALKANOVA V，EBMEIER K P，ALLAN C L.CRP，IL-6 and depression：a systematic review and meta-analysis of longitudinal studies［J］．J Affect Disord，2013，150（3）：736-744．DOI：10.1016/j.jad.2013.06.004.
［31］朱立静，孙冰婷，宗阳，等．抑郁症组学生物标志物的研究进展［J］．中国医院药学杂志，2016，36（23）：2131-2134．DOI：10.13286/j.cnki.chinhosppharmacyj.2016.23.24.
ZHU L J，SUN B T，ZONG Y，et al．Research progress on omics biomarkers of depression［J］．Chinese Journal of Hospital Pharmacy，2016，36（23）：2131-2134．DOI：10.13286/j.cnki.chinhosppharmacyj.2016.23.24.
［32］RADLEY J J，SISTI H M，HAO J，et al．Chronic behavioral stress induces apical dendritic reorganization in pyramidal neurons of the medial prefrontal cortex［J］．Neuroscience，2004，125（1）：1-6．DOI：10.1016/j.neuroscience.2004.01.006.
［33］王优，欣怡，赵久波，等．抑郁症心率变异性研究进展［J］．中国神经精神疾病杂志，2017，43（10）：634-637．DOI：10.3969/j.issn.1002-0152.2017.10.015.
［34］SHIMBO D，CHILD J，DAVIDSON K，et al．Exaggerated serotonin-mediated platelet reactivity as a possible Link in depression and acute coronary syndromes［J］．Am J Cardiol，2002，89（3）：331-333.
［35］HANTSOO L，CZARKOWSKI K A，CHILD J，et al．Selective serotonin reuptake inhibitors and endothelial function in women［J］．J Womens Health（Larchmt），2014，23（7）：613-618．DOI：10.1089/jwh.2013.4623.
［36］陈晓丽，宋玉萍，孙宏伟，等．冠心病共患抑郁症的现状和影响因素及治疗方法研究进展［J］．中国全科医学，2016，19（23）：2747-2751．DOI：10.3969/J.issn.1007-9572.2016.23.001.
CHEN X L，SONG Y P，SUN H W，et al．Research progress of coronary heart disease combined with depression：current situation，influence factors and treatment［J］．Chinese General Practice，2016，19（23）：2747-2751．DOI：10.3969/J.issn.1007-9572.2016.23.001.
［37］WHYBROW P C，PRANGE A J Jr.A hypothesis of thyroid-catecholamine-receptor interaction.Its relevance to affective illness［J］．Arch Gen Psychiatry，1981，38（1）：106-113.
［38］DUNTAS L H，MAILLIS A.Hypothyroidism and depression：salient aspects of pathogenesis and management［J］．Minerva Endocrinol，2013，38（4）：365-377.
［39］汤月霞，吴宗贵.抑郁与心血管疾病［J］．中华心血管病杂志，2017，45（9）：814-817．DOI：10.3760/cma.j.issn.0253-3758.2017.09.017.

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