Influence Of Depression Disorder On In-stent Restenosis And Activator Protein-1 In Patients After PCI

ObjectiveTo explore the influence of depression disorder on incidence rate of in-stent restenosis(ISR),inflammatory marker activated protein-1 and its downstream pathway-matrix metalloproteinase-2(MMP-2)and tissue inhibitors of metaloproteinases-2(TIMP-2)in patients after percutaneous coronary intervention(PCI).Thus it aim to provide a possible theoretical basis for the influence of depressive disorder on the prognosis of coronary heart disease and in-stent restenosis,and provide new ideas for the diagnosis and treatment of patients with coronary heart disease and depression.MethodsThe study included 200 patients who underwent PCI in Tianjin First Central Hospital during December 2016 to January 2018.According to the Diagnostic and Statistical Manual of Mental Disorders(4th Edition,Revised Edition)and Self-rating Depression Scale(SDS)and Hamilton Depression Scale(HAMD-24)score,patients were divided into 60 patients with depression and 140 patients without depression.General clinical datas of two groups of patients,including name,gender,age,smoking,drinking history,hypertension,diabetes history,fasting blood glucose,insulin levels,and blood lipid were collected.The amount of phosphorylated c-Jun in leukocyte lysate,MMP-2 and TIMP-2 were measured by enzyme-linked immunosorbent assay(ELISA).The incidence of ISR and amount of phosphorylated c-Jun,MMP-2 and TIMP-2 levels were compared between the two groups.Multivariate stepwise regression analysis was used to investigate the influencing factors of AP-1 and its downstream pathways.Logistic regression analysis was used to investigate the in-fluencing factors of ISR.Results1.Coronary angiography was performed 1 year after PCI.A total of 27 patients developed ISR,15 patients in the depression group,and 12 patients in the control group.The incidence rate of ISR in the depression group was significantly higher than that of the control group(P=0.002).2.The levels of serum phosphorylated c-Jun,MMP-2,TIMP-2 and MMP-2/TI MP-2 in the depression group were higher than those in the control group(phosphorylated c-Jun:1.45±0.44vs1.15±0.40,t=4.713,P=0.000;MMP-2:481.15±62.70 v s433.63±62.67,t=4.936,P=0.000;TIMP-2:408.58±64.62vs386.27±57.07,t=2.434,P=0.016;MMP-2/TIM-P-2:1.19±0.09vs1.13±0.07,t=4.934,P=0.000).3.Pearson correlation analysis showed that SDS score was positively correlated with serum phosphorylated c-Jun,MMP-2 and TIMP-2(r=0.809,P=0.000;r=0.673,P=0.000;r=0.722,P=0.000),and HAMD-24 score was positively correlated with serum phosphorylated c-Jun,MMP-2 and TIMP-2(r=0.819,P=0.000;r=0.701,P=0.000;r=0.720,P=0.000).4.Multiple stepwise regression analysis showed that depression was independently and positively correlated with phosphorylated c-Jun,MMP-2 and TIMP-2(t=5.295,P=0.000,t=5.571,P=0.000,t=2.811,P=0.000).5.Logistic regression analysis indicated that depression were independently a-nd positively correlated with ISR(OR=4.108,P=0.001).Conclusion1.The incidence of ISR was significantly increased in patients with CHD complicated with depressive disorder,and the inflammatory mechanism plays an important role in ISR in patients with CHD.2.The inflammatory response was abnormally active in patients with depressive disorder,and the release of inflammatory mediators was increased..3.Depressive disorder may affect the activation of activated protein-1,promote the secretion of MMP-2 while TIMP-2 cannot counteract the role of MMP-2,which affects the occurrence of ISR.