抑郁对不同类型缺血性心力衰竭患者的预后影响

摘要

目的 分析抑郁对不同类型缺血性心力衰竭患者的预后影响.方法 纳入缺血性心力衰竭患者535例,其中射血分数保留的心力衰竭(HFpEF) 241例、射血分数中间值的心力衰竭(HFmrEF) 142例和射血分数减低的心力衰竭(HFrEF) 122例.用患者健康问卷量表进行抑郁测评,分为抑郁组218例和正常组317例,抑郁包括轻度、中度、中重度和重度.随访36个月,失访30例.采用Kaplan-Meier曲线分析累积生存率.结果 抑郁组总病死率高于正常组(39.00％ vs 30.16％,P=0.040),Kaplan-Meier曲线分析显示,随抑郁程度加重累积生存率减低(P=0.000).HFpEF和HFmrEF患者随抑郁程度加重总病死率无统计学差异(P=0.524,P=0.189);HFrEF患者随抑郁程度加重总病死率逐渐上升,不同抑郁程度总病死率有统计学差异(38.89％ vs 52.94％ vs 66.67％ vs 83.88％,P=0.014);HFpEF、HFmrEF、HFrEF累积生存率均随着抑郁程度加重而减低(P=0.000).结论 抑郁对不同类型缺血性心力衰竭患者预后影响存在差异,抑郁增加HFrEF患者总病死率.%Objective To analyze the effect of depression on the outcome in different ischemic heart failure (IHF) patients.Methods Five hundreds and thirty-five IHF patients (241 HFpEF patients,142 HFmrEF patients,122 HFrEF patients) were included in this study.Their depression was scored according to the PHQ-9.The patients were divided into depression group (n=218) and depression-free group (n=317).The severity of depression was divided into mild,moderate,moderate-severe and severe.The patients were followed up for 36 months and their accumulative survival rate was analyzed by Kaplan-Meier survival curve analysis.Results The total mortality was higher in depression group than in depression free group (39.00％ vs 30.16％,P=0.040).The accumulative survival rate decreased with the increasing PHQ-9 score (P=0.000).No significant difference was found in the total mortality of HFpEF and HFrEF patients (P=0.524,P=0.189).The mortality increased gradually with the severity of depression in HFrEF patients.However,the total mortality was significantly lower in HFrEF patients than in HFpEF and HFmrEF patients (38.89％ vs 52.94％,66.67％ vs 83.88％,P=0.014).The accumulative survival rate of HFpEF,HFmrEF and HFrEF patients decreased with the increasing severity of depression (P=0.000).Conclusion The effect of depression is diffrernt on the outcome in different IHF patients.Depresssion increases the mortality of HFrEF patients.