冠心病患者心理抑郁状态及其对预后的影响

摘要

目的：分析冠心病（ CAD）患者心理抑郁状态，评价心理抑郁对P选择素（ P-selectin）、超敏C反应蛋白（ hs-CRP）等指标的影响，观察心理抑郁与主要不良心血管事件（ mACE）及再住院率的关系。方法选取2012-01-01至2013-12-31在华北理工大学附属医院由于胸闷、胸痛症状就诊，以CAD收住院的患者538例，其中排除CAD者69例作为对照组，诊断为CAD者469例作为CAD组。CAD组患者又进一步分为稳定型心绞痛亚组47例、不稳定型心绞痛亚组222例、心肌梗死亚组200例。应用汉密尔顿抑郁量表（ HAmD）评价受试者心理抑郁状态；并检测生化指标、血脂指标、hs-CRP、P-selectin水平。对CAD患者随访1年，记录其mACE发生及再住院情况。结果对照组抑郁发生率为18.8%（13/69），CAD组为35.4%（166/469），CAD组抑郁发生率高于对照组（χ2=7.424， P=0.006）。对照组、稳定型心绞痛亚组、不稳定型心绞痛亚组、心肌梗死亚组抑郁发生率比较，差异有统计学意义（χ2=7.424，P=0.006）。将CAD组心理抑郁患者作为抑郁亚组（166例），不存在抑郁的患者作为非抑郁亚组（303例）。两亚组性别、年龄比较，差异均有统计学意义（ P<0.05）；抑郁亚组P-selectin、hs-CRP、收缩压、心率、低密度脂蛋白胆固醇（ LDL-C）、病变数（冠状动脉狭窄程度≥50%）、严重病变数（冠状动脉狭窄程度≥75%）均高于非抑郁亚组（ P<0.05）。非抑郁亚组 mACE 发生率为23.8%（72/303），再住院率为14.2%（43/303）；抑郁亚组mACE发生率为33.7%（56/166），再住院率为22.9%（38/166）。两亚组mACE发生率、再住院率比较，差异均有统计学意义（χ2=5.375，P=0.020；χ2=5.681，P=0.017）。结论抑郁不仅与CAD相关，而且与CAD的严重程度密切相关。老年、女性CAD患者心理抑郁的患病率明显升高。CAD心理抑郁患者不仅血小板活化水平高、炎性反应明显，而且聚集常见的心血管疾病危险因素，影响患者转归和预后。%Objective To investigate the depressive state of patients with coronary artery disease( CAD),evaluate the influence of depressive state on indexes such as P-selectin and hypersensitive C-reactive protein( hs-CRP),and explore the relation between depression and major cardiovascular events( mACE) and readmission rate. Methods We enrolled 538 patients who visited a doctor due to chest distress and chest pain and were hospitalized with a diagnosis of CAD in the Affiliated Hospital of North China University of Science and Technology from January 1,2012 to December 31,2013. The patients with CAD excluded were assigned into control group,and the patients who were definitely diagnosed as CAD were assigned into CAD group. The CAD group was further divided into stable angina pectoris subgroup(n=47),unstable angina pectoris subgroup(n=222)and myocardial infarction subgroup(n =200). HAmD was employed to evaluate the depressive state of subjects. Biochemical indexes,serum lipid index,serum hs-CRP and P-selectin level were examined. We undertook one-year follow-up,during which mACE incidence and readmission rate were recorded. Results The depression rates of control group and CAD group were 18. 8%(13/69)and 35. 4%(166/469),with CAD group higher than control group(χ2 =7. 424,P=0. 006). Control group, stable angina pectoris subgroup, unstable angina pectoris subgroup and myocardial infarction subgroup were significantly different in depression rate(χ2 =7. 424,P=0. 006). CAD patients with depression were assigned into depression subgroup(n=166),and CAD patients without depression were assigned into non-depression subgroup(n=303). The two subgroups were significantly different in gender and age(P<0. 05);depression subgroup was higher(P<0. 05)than non-depression subgroup in P-selectin,hs-CRP,systolic blood pressure,heart rate,LDL-C,number of lesion( coronary artery stenosis degree≥50%) and number of serious lesion ( coronary artery stenosis degree≥75%). The incidence rate of mACE and readmission rate were 23. 8%( 72/303 ) and 14. 2%( 43/303 ) for non -depression subgroup and were 33. 7%( 56/166) and 22. 9%(38/166) for depression subgroup. The two subgroups were significantly different in the incidence of mACE and admission rate(χ2 =5. 375,P =0. 020;χ2 =5. 681,P =0. 017). Conclusion Depression is not only related with CAD,but also closely related with the severity of CAD. Elderly CAD patients and female CAD patients have higher prevalence of depression. CAD patients with depression not only have high platelet activation level and obvious inflammatory reaction,but also have risk factors for common cardiovascular diseases,which may influence the lapse and prognosis of CAD patients.