Enhancing Recovery After Cardiac Surgery

描述(申请人提供)：每年约有1880万成年人患有抑郁症。在冠状动脉旁路移植术(CABG)术后康复的患者中，抑郁症的发生率很高，而且抑郁症与发病率和死亡率的增加有关。最近的发现表明，抑郁症涉及促炎细胞因子和炎症标志物的变化，这些变化也与进行性冠状动脉疾病(CAD)及其并发症有关。本研究假设促炎细胞因子网络是介导CABG患者抑郁的一个生理系统，对CABG患者可能具有临床意义。它建立在一个概念模型的基础上，该模型将抑郁、促炎细胞因子、炎症标记物和关于认知行为疗法(CBT)在CABG患者中的疗效的初步工作联系起来。CBT是一种基于识别和重组负面想法的结构化干预措施，在初步研究中显著降低了严重抑郁症的发生率。本研究将通过检测CBT对促炎细胞因子(IL-6及其可溶性受体[SLL-6R])和炎症标志物(C-反应蛋白[CRP]和可溶性细胞间黏附分子a[slCAM-1])的影响来探讨CBT的生物学机制。CABG患者是研究CBT生物学机制的理想人群，因为1)CBT操作如此普遍，2)术后抑郁发生率高，3)抑郁与较差的临床结果相关，4)进展性CAD是这些患者的主要发病率和死亡率。本研究的目的是评估CBT对所指示的生物标志物的影响，评估接受CBT的患者抑郁症状与生物标志物之间的时间相关性，并描述抑郁症状的变化与生物标志物变化和治疗的关系。采用两组随机实验前测-后测设计。筛查后，114名重度抑郁症患者将随机接受常规护理和医疗护理，或接受8周的护士指导的CBT加常规护理。出院后1个月和3个月采血。数据将使用分层线性模型和逐步线性回归进行分析，控制人口统计学和临床变量的影响，包括年龄、性别、抗抑郁药物的使用、他汀类药物的使用和体外循环时间。

DESCRIPTION (provided by applicant): Depression affects approximately 18.8 million adults annually. In patients recovering from coronary artery bypass graft (CABG) surgery, high rates of depression have been reported and depression is associated with increased morbidity and mortality. Recent discoveries show that depression involves changes in proinflammatory cytokines and inflammatory markers that are also implicated in progressive coronary artery disease (CAD) and its complications. This proposed research is based on the hypothesis that the proinflammatory cytokine network is one physiological system that mediates depression with possible clinical significance for CABG patients. It builds upon a conceptual model linking depression, Proinflammatory cytokines, inflammatory markers, and upon initial work regarding the efficacy of cognitive behavioral therapy (CBT) in CABG patients. CBT is a structured intervention based on identification and reframing of negative thoughts that has substantially reduced the incidence of major depression in pilot studies. In this study, the biological mechanisms of CBT will be evaluated by testing its effects on proinflammatory cytokines (interleukin [IL]-6 and its soluble receptor [slL-6r]) and inflammation markers (C-reactive protein [CRP] and soluble intercellular adhesion molecule a [slCAM-1]). CABG patients are an ideal population in which to examine the biological mechanisms of CBT because 1) the procedure is so pervasive, 2) rates of postoperative depression are high, 3) depression is associated with poorer clinical outcomes, and 4) progressive CAD is the major cause of morbidity and mortality in these patients. The aims of the study are to evaluate the effects of CBT on the indicated biological markers, evaluate the temporal correlations between depressive symptoms and biological markers in patients receiving CBT, and describe the relationship of changes in depressive symptoms to changes in biological markers and treatment. A 2-group randomized experimental pretest-posttest design is proposed. After screening, 114 patients with major depression will be randomized to usual nursing and medical care or 8 weeks of nurse-led CBT plus usual care. Blood sampling will occur 1 month and 3 months after hospital discharge. Data will be analyzed using hierarchical linear models and stepwise linear regression, controlling for the effects of demographic and clinical variables including age, gender antidepressant use, statin use, and cardiopulmonary bypass time.