| Background:Psychosomatic diseases are a sort of physical diseases which are closely related to the social psychological factors.Coronary heart disease(CHD)comorbid depression and anxiety disorders(CDA)is one kind of psychosomatic diseases,which can be named as psycho-cardiology diseases.Since neuroendocrinology is the bridge between the mind and the heart,it is crucial to explore the changes of autonomic nerve function in patients with CDA disease under mental stress to explore the pathogenesis of CDA disease.Objective:The aim of this study was to explore the changes of heart rate variability,salivary cortisol and salivary ?-amylase in CDA disease group during mental stress comparing with healthy control group and CHD group.Methods : The Patient Health Questionnaire-9(PHQ-9)and Generalized Anxiety Disorder-7(GAD-7)were used to evaluate anxiety and depression disorders in patients with CHD(N=81)and healthy individuals(N=10).According to the scale score,the subjects were divided into 3 groups: the healthy control group,the CHD group and the CDA group(CHD comorbid mild and above anxiety and/or depression),and all subjects were evaluated for changes in hemodynamics,heart rate variability,salivary cortisol and salivary ?-amylase during the mental stress test,followed by subjective psychological evaluation.Statistical comparison analysis was performed between different time points and between groups.correlation factor analysis was performed.Correlation analysis was carried out on the factors that may affect the mental stress responses.Results : Sleep and stress problems were more common in CDA patients,and stress perceived levels were positively correlated with depression and anxiety severity(r=0.365,p=0.009;r=0.283,p=0.046).Different from the healthy,the change of the heart-blood pressure product in the CDA patients was mainly dominated by the change of blood pressure,especially systolic blood pressure,rather than heart rate.The autonomic nerve response to mental stress in CDA patients was characterized by low reactivity and slow recovery,with no significant changes in r MSSD and HF during mental stress,less increase in LFnu than that of the healthy and CHD groups(31.5% vs.68.5% vs.33.9%)and with delayed recovery tobaseline.The responses of hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal medulla system under mental stress have similar trends to those in healthy individuals and CHD groups,showing a peak at 10 minutes after mental stress and a return to baseline 30 minutes after.After adjusting for other factors,the correlation between high levels of GAD-7in CDA patients and low response in sympathetic nerve activity was still significant(F =6.528,p = 0.014),showing a progressive low response to stressful events.Besides,the subjective stress score was found to be significantly positively correlated with changes of most indicators in the response to mental stress.Conclusions:The physiological flexibility of patients with CDA is diminished under mental stress,which is manifested by a significant reduction in the amplitude of autonomic nerve responses,which is also closely related to the degree of anxiety and subjective stress feeling. |
PDF Full Text Request