The Relationship And Mechanism Between Depression And Unidentified Thoracodynia

IntroductionThoracodynia is one of the chief complaints, which is always met in clinic. There are many patients with unidentified thoracodynia,which takes clinical workers attention to. Nowadays we have discovered that there are more than 70% patients with unidentified thoracodynia have chest pain for a long time after being confirmed that there is no problem for the coronary artery,even the symptoms may be more serious than before. We have a lot of evidences showed that the patients with unidentified thoracodynia are concerned with depression. The doctors always ignore that these symptoms may be relatived with depression,which makes the effect of treatment bad and money wasted. At the same time,the patients will have more burden. There are many investigations showed that IL-6,CRP,CD4+/CD8+ and 5-HT are concerned with depression. But up to now,there is no a comprehensive investigation for the relationship between depression and unidentified thoracodynia all over the world.PurposeTo explore the relationship and possible mechanism of action between depressive disorder and unidentified thoracodynia, which offer a more suitable treatment for the patients with unidentified thoracodynia.MethodsAll of the 70 cases are divided to four groups:the patients with unidentified thoracodynia, the patients with acute myocardial infarction(AMI), the patients with depressive disorder and the health controls. Scoring all the patients with HAMD. Use the following equipments to detect all the indicators.1. ELISAUse ELISA to detect CRP and IL-6 from peripheral blood.2. HPLC Use the high performance liquid chromatography (HPLC) to detect the Serotonin (5-hydroxytryptamine; 5-HT) in platelet pellet.3. Flow cytometryUse the flow cytometer to detect the percentage between the immunocyte CD4+ and CD8+ in the peripheral blood.Results1. There are 18 patients with unidentified thoracodynia,fourteen of them are males, the others are females, the average age is 59.22±14.40; and there are 25 patients with acute myocardial infarction(AMI), nineteen of them are males, the others are females, the average age is 63.32±11.82; the patients with depressive disorder are 9 persons, five of them are males ,four of them are females,the average age is 46.78±17.06; and the health controls are 18 persons, half of them are males, the others are females, the average is 51.17±9.38. The average age of the patients with unidentified thoracodynia is higher than the patients with depressive disorder, they are significant difference (P<0.05). However, there is no significant difference (P>0.05) between them and the healthy controls. At the same time, the healthy controls and the patients with depression have lower average age than the patients with AMI, there is significant difference (P<0.05) between them and the patients with AMI, and there is no significant difference (P>0.05) between the patients with unidentified thoracodynia and the patients with AMI.2. The scores of HAMD for the patients with unidentified thoracodynia, the patients with depressive disorder , healthy controls and the patients with AMI is 16.63±4.88,25.63±2.67,8.56±2.45,10.20±3.15 respectively. there is significant difference (P<0.05) between the healthy controls and the patients with AMI in the scores of HAMD, and both of them have lower scores of HAMD than the patients with unidentified thoracodynia, there is significant difference(P<0.05) between them and the patients with unidentified thoracodynia, At the same time, the patients with depression have much higher scores of HAMD than the other groups, they are significant difference(P<0.05).3. The level of CRP in peripheral blood for the patients with unidentified thoracodynia, the patients with depressive disorder , healthy controls and the patients with AMI is 3.32(2.21~439)ug/ml,2.85(1.94~4.97)ug/ml,3.94(2.44~5.89)ug/ml,11.50(5.80~29.45)ug/ml respectively. there is no significant difference(P > 0. 05)among the patients with depressive disorder, the patients with unidentified thoracodynia and the healthy controls about the detective of CRP, however, the patients with AMI have higher level of CRP than the other groups, there is significant difference (P< 0. 05)between the patients with AMI and the other three groups.4. The level of IL-6 in peripheral blood for the patients with unidentified thoracodynia, the patients with depressive disorder , healthy controls and the patients with AMI is 6.72(4.45~7.99) pg/ml,5.99(3.60~16.67) pg/ml,2.28(1.30~4.24) and 14.83(10.41~22.34) pg/ml respectively. there is no significant difference(P>0.05) between the patients with depression and the patients with unidentified thoracodynia in the level of IL-6,however, both of them have higher level of IL-6 than the healthy controls, there is significant difference(P<0.05)among them about the IL-6.At the same time, the patients with AMI have higher level of IL-6 than the other three groups, they are significant difference(P<0.05).5. The level of CD4+/CD8+ in peripheral blood for the patients with unidentified thoracodynia, the patients with depressive disorder , healthy controls and the patients with AMI is 1.64±0.85,1.62±0.48,1.73±0.69 and 2.50±1.54 respectively. there is no significant difference(P>0.05) among the patients with depression ,the patients with unidentified thoracodynia and the healthy controls in the level of CD4+/CD8+.However, the patients with AMI have higher level of CD4+/CD8+ than the other three groups, they are significant difference(P<0.05).6. The level of 5-HT in platelet pellet. for the patients with unidentified thoracodynia, the patients with depressive disorder , healthy controls and the patients with AMI is 670.59(227.58~1212.69)nmol/L,287.49(87.04~566.90)nmol/L,851.83(582.09~1817.07)nmol/L,1338.87(737.53~1794.43)nmol/L respectively. there is no significant difference(P>0.05) between the patients with depression and the patients with unidentified thoracodynia in the level of 5-HT.At the same time, both of them have lower level of 5-HT than the other two groups, there is significant difference (P<0.05)between them and the other two groups. Also, there is no significant difference (P>0.05) between the patients with AMI and the healthy controls in the level of 5-HT. Conclusion1. The patients with unidentified thoracodynia are going to have depressive disorder possibly. The reason of thoracodynia for the patients may come from depressive disorder. Maybe we can detect the level of CPR,IL-6,CD4+/CD8+ and 5-HT in peripheral blood to estimate the patients with unidentified thoracodynia who are going to have depression or not.2. The patients with acute myocardial infarction (AMI) have stronger inflammatory reaction and immunological response than the healthy adults.