Study Of Relationship Between Depressive Status And Psychosocial Factors And Chang Of Interleukin-17 In Aging Patients With Coronary Heart Disease

Objectives:①To explore the risk factors and morbility of depression in aging patients with coronary heart disease.②To evalute changes of the level of IL-17 and CRP in plasma of aging coronary heart disease with depression and expression of IL-17 in monocytes of these patients.③To know the role of comprehensive intervention to aging coronary heart disease with depression in depressive systom,quality of life and ischemia of myocardium.Methods:①A cross-sectional study was conducted in three communities of Wangyuehu,Chengjiahu,Guangjiqiao.322 aging CHD patients were selected.Face to face interview was used in data collection together with the HAMD,social support rating scales and self-made scales.The data were analysis in spss 15.0.②We analyzed the levels of IL-17 and CRP in plasma using enzyme-linked immunosorbent assay and expression of IL-17 in monocytes using RT-PCR in 68 patients divided into two groups. Depression group(n＝38)and un-depression group(n＝30).③The 96 depressive aging patients with coronary heart disease were alloted into comprehensive intervention group(n＝50),Drug therapy group(n＝46).We observed the effect of comprehensive intervention on depressive system,quality of life and ischemia of myocardium.Results:①The prevalence of depression in aging coronary heart disease was 45.8%in 332 patients.The prevalence of female patients is higher than that of male patients(48.9%vs 43.2%).Female,aging,lower degree culture and non-ambulatory patients had higher risk of depression with OR at 1.48,1.69,2.154,8.92.(all P＜0.05).Subjective support scores and utilized degree to support scores of depression groups were all higher than that of the control group(all P＜0.05).②Concentrations of IL-17 and CRP and expression of IL-17 in monocytes of aging coronary heart disease with depressive status were significantly higher than that of the control group(all P＜0.01).Concentrations of IL-17 and CRP were positively related to scores of HAMD(P＜0.05).Concentrations of IL-17 were positively related to CRP in plasma in aging coronary heart disease patients with depressive status(P＜0.05).Leves of CRP and IL-17 and expression of IL-17 in monocytes in acute coronary syndrom acccompanied depressive status were higher than those of stable angina acompanied depression(all P＜0.01).③Comprehensive intervention and drug therapy could improve scores of HAMD,scores of SAQ,frequency of ST depression and time of ST depression compared to treatment before(all P＜0.05).the effect of comprehensive intervention was the same as drug therapy.Conclusions:①we investigated conditions of aging coronary artery disease patients with depression in changsha for the first time.The results indicated that the prevalence of depression in aging patients with coronary heart disease was high.The prevalence of female patients was higherthan that of male patients.Female,aging,lower degree of culture, non-ambulatory and lower social support were correlation with depressive status.②For the first time we found that interleukin-17 and C-reactive protein may play an important role in the mechanism of aging coronary heart diseasewith depression.③Comprehensive intervention can lighten depressive systoms, elevate quality of life and improve symptoms of angina Chapter 1 Analysis of relationship between depressivestatus and psychosocial factors in aging coronary heartdiseaseObjective:To explore the risk factors and morbility of depression in aging patients with coronary heart disease(CHD)。Methods:A cross-sectional study was conducted in communities of wang yuehu,Chenjiahu and Guangjiqiao in changsha from June in 2006 to Feburary in 2008.332 CHD patients were selected randomly.Face to face interview was used in data collection together with the HAMD,social support rating scales and investigate scales self-made.Multinomial Logistic Model was adopted in date analysis.Results:①Among 332 patients,152 patients suffered from depression (45.8%).115 patients(34.6%) were minor to middle depressive disorders and 37 patients(11.2%) were major depression.②The prevalence,of depressive status in 70-year group was higher than that of 60-year group(55.8%VS 36.9%,P＜0.05).③The prevalence of depressive status in female aging patients was higher than that of male aging patients(48.9%VS 43.2%,P＜0.05). ④Female,age,lower culture degree and non-ambulatory patients had a statistically higher risk of depression with the OR at 1.48,1.69, 2.154,8.92,(all P＜0.05)⑤Subjective support scores and utilized degree to support scores of depressive stares groups were all higher than that of non-depressive status groups(15.0±3.9 VS 22.6±4.0,6.4±2.0 VS 8.0±2.0,respectively,all P＜0.05).⑥Objective support scores,subjective support scores and utilized degree to support scores were not correlation with HAMD scores.Conclusion:It was noticeable that the prevalence of depressive status in patients of aging coronary heart disease was high.With aging increasing,the prevalence increased,The prevalence of depressive status in female patients were higher than that of men patients.Low culture level, non-ambulatory patients and low social support were associated with depressive status. Chapter 2 Changes of interleukin-17 and C-reactive proteinin aging coronary heart disease patients with depressivestatusObjective:The aim was to evaluate levels of IL-17 and CRP in plasma of aging coronary heart disease patients with depressive status and expression of IL-17 in monocytes of these patients.Methods:We analyzed the concentrations of IL-17 and CRP in plasma using enzym-linked immunosorbent assay and expression of IL-17 in monocytes using RT-PCR in 68 selected patient randomly divided into two groups,depressive status group(n＝38)and un-depressive status group(n＝30).Results:①Concentrations of IL-17 and CRP were significantly higher in aging depressive status patient with coronary heart disease than those of the control group(323.96±97.15 pg/ml VS 214.30±58.08 pg/ml,4.86±1.32 ng/ml VS 2.16±0.69ng/ml,all P＜0.01).Expression of IL-17 in monocytes of aging depressive status with coronary heart disease were higher than that of the control group(0.55±0.14,0.26±0.08,P＜0.01).②In aging coronary heart disease patients with depressive status group,levels of IL-17 and CRP and expressions of IL-17 in monocytes in acute coronary syndrome accompanied depressive status group were higher than those of stable angina accompanied depressive status group. (372.67±91.39 pg/ml VS 284.57±84.45 pg/ml,5.51±1.36ng/ml VS 4.28±1.01 ng/ml,0.62±0.19 VS 0.49±0.13,all P＜0.01)③In aging coronary heart disease patients depressive status group concentrations of IL-17 major depressive status patients were significantly higher than those of minor to moderate depressive status patients(395.42±128.75pg/ml,310.27±96.35pg/ml p＜0.01).The plasma levels of CRP in aging coronary heart disease patients with major depression status were increased as compared,with minor to moderate depressive status patients(4.90±1.38ng/ml,4.10±1.25ng/ml,P＜0.01). Expression of IL-17 in monocyte of aging coronary heart disease with major depressive status were elevated as compared with minor to moderate depressive status patients(0.61±0.22,0.48±0.13, P＜0.01).Expression of IL-17 in the major depression patients were higher than that of the minor to moderate depression patients,(P＜0.05).④The prevalence of major depressive status in acute coronary syndrome was higher than that in stable angina in aging coronary heart disease patients with depressive status(P＜0.05).⑤The levels of CRP were positively related with IL-17 in aging coronary heart disease patients with depressive status (r＝0.802,P＜0.05).The concentration of IL-17 and CRP were positively associated with the scores of HAMD(r＝0.672,P＜0.05,r＝0.421,P＜0.05).Conclusion:Interleukin-17 and C-reactive protein are play an important role in the mechanism of aging coronary heart disease with depressive status. Chapter 3 The effect of comprehensive intervention onquality of life of aging coronary heart disease patientswith depressive statusObjective:To study whether comprehensive intervention for depression in aging patients with coronary heart disease(CHD) can or not lead to some improvement in depressive symptoms,quality of life and ischemia of myocardium.Methods:96 depressive status aging patients with coronary heart disease were alloted into comprehensive intervention group(n＝50),drug treatment group(n＝46)randomly.Patients received comprehensive intervention and anti-depressant serotonin HCIz(zoloft,Pfizer50mg qd) on the basis of conventional cardiac medicine therapy for 12 weeks in the comprehensive intervention group and drug therapy,respectively.Results:①After treatment scores of HAMD and SAQ and change of ST were improvement in comprehensive intervention group and drug treatment group.Scores of HAMD were lower than treatment before(17.85±5.38 VS 28.72±7.54,18.72±6.17 VS 27.85±8.27,respectively,all P＜0.01)in the two groups.Scores of activate restriction were higher than treatment before(32.32±8.67 VS 26.58±5.30,33.28±7.95 VS 27.32±5.47,all P＜0.01)in the two groups,Scores of contest degree were higher than treatment before(16.39±4.83 VS 14.20±2.64,16.31±5.07 VS 13.98±4.02,all P＜0.01)in the two groups.Total scores of SAQ were higher than treatment before(80.25±25.32 VS 62.19±12.35,83.27±27.12 VS 63.07±13.54,all P＜0.01),Score of angina attack were higher than treatment before(8.19±2.45 VS 7.05±2.35,8.06±2.63 VS 6.97±2.18,all P＜0.05).Frequency of ST depression were lower than treatment before(32.5±12.7 VS 84.3±13.8, 31.9±13.9 VS 82.2±15.7,all P＜0.05).Times of ST depression were lower than treatment before(88.4±28.7 VS 172.5±32.8,89.5±32.7 VS 176.3±36.4,all P＜0.01).There were no difference in the scores of angina stability between treatment before and.after treatment in two. group(3.52±0.87 VS 3.02±1.27,3.47±0.95 VS 2.95±1.15,all P＞0.05).②There were no difference in scores difference of HAMD among the two groups after treatment(9.03±3.15,9.35±3.01,P＞0.05).There were no difference in scores difference of degree to recognizing disease,activate restriction,angina attack,content degree,angina stability and total SAQ among the two groups(2.32±0.67 VS 2.28±0.65,6.32±1.81 VS 6.10±2.05,1.17±0.38 VS 1.08±0.29,2.13±0.68 VS 2.09±0.63,0.52±0.17 VS 0.49±0.16,19.98±6.56 VS 19.75±6.72 respectively,all P＞0.05).There were no difference in difference of frequency and times of ST depression among the two groups(50.08±16.75 VS 50.75±17.36, 92.75±31.26 VS 88.75±30.92,respectively,all P＞0.05).Conclusion:Comprehensive intervention can relieve depressive symptoms,improve quality of life and improve anginal symptoms.